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You can only respond to these questions with information from the text below. Answer with 1 bullet point.	How many individuals were threatened by Mcdonald's in relation to the pamphlet produced?	Helen Steel and Dave Morris joined “London Greenpeace” in 1980. The organization was not connected to international Greenpeace; rather it was an independent activist group that campaigned for social change on a broad range of issues. One of the group’s projects was the distribution of a pamphlet that was published in 1986, entitled “What’s Wrong with McDonald’s". McDonald’s hired private detectives to infiltrate the organization, and ultimately threatened to sue the individuals who were distributing the pamphlets.2 In order to avoid being sued for libel, three of the five apologized, and in 1990 promised to stop distributing the pamphlets. But Ms. Steel and Mr. Morris, who have been dubbed the “McLibel 2,” refused.3 No doubt this obstinacy was not expected, as McDonald’s had apparently been successful in the past in stopping criticism and forcing apologies from much more affluent foes, including the BBC.4 McDonald’s U.S. and its U.K. affiliate (“First Plaintiffs” and “Second Plaintiffs” respectively) filed suit against Morris and Steel. The more than two and a half-year trial, the longest in English history, began in June of 1994, after twenty-eight pre-trial hearings.5 In June of 1997, in a 750 page judgment, Justice Rodger Justice Bell found that McDonald’s had been defamed and assessed damages equivalent to $96,000 against the two defendants.6 the company.8 It is not very likely that McDonald’s will ever recover its $96,000, as Mr. Morris is an unemployed former postal worker and Ms. Steel is a part time bartender.7 But the president of McDonald’s U.K. testified that this was not about money—it was about preventing lies being used to try to “‘smash’” the company. The recovery would not come close to compensating McDonald’s for its costs in the law suit, which have been estimated to be about $10 million, including over £ 6,500 per day of trial for their team of top English libel lawyers.9 satisfied,”10 Although a McDonald’s official commented that they were “broadly some have suggested that it was at best a Pyrrhic victory.11 The case became a public relations disaster around the world, thanks in large part to the Internet, which now has a very active anti-McDonald’s website. The site displays the offending pamphlet as well as even more derogatory comments about McDonald’s, including some allegations from other sources that McDonald’s had previously successfully suppressed by threats of law suits. ce.17 When Justice Bell finally released his judgment, it included some rather detrimental conclusions about McDonald’s business practices. Although Justice Bell found in favor of McDonald’s on nearly all of their claims, he did reject a few. He concluded that McDonald’s had contributed to cruelty to animals, used advertising to manipulate children, and paid employees so little as to depress wages in the catering industry in England. These findings were prominently reported in numerous articles describing the judgement. The statements found to be defamatory included assertions in the pamphlet that McDonald’s was destroying rain forests; causing starvation in the Third World; producing litter in cities; causing heart disease, cancer and food poisoning; subjecting employees to “bad” working conditions; exploiting women and minority workers; and covering up the low quality of their food with advertising gimmicks aimed at children.19 Morris and Steel faced formidable obstacles under English law due to a combination of restrictive substantive libel laws, denial of a jury trial, the potential for very high damage awards and legal costs,43 and a lack of legal aid. The exclusion of defamation actions from the otherwise rather generous legal aid system in England44 is based on the fear of frivolous petty suits.45 Reformers have convincingly disputed this rationale;46 but in any event, the McDonald’s case aptly demonstrates the severe disadvantage the rule imposes on defendants of modest means being sued by affluent plaintiffs. England’s strict liability libel law contributes to its reputation as a haven for libel plaintiffs. The $96,000 award given by Justice Bell in McDonald’s was, by these standards, quite modest. But a company with annual earnings of $32 billion does not sue defendants like Morris and Steel for the money. They were suing to stop the criticism and deter future critics, and their track record in squelching criticism by threatened civil suits in England had been quite good until they faced the “McDonald’s 2.	system instruction: [You can only respond to these questions with information from the text below. Answer with 1 bullet point.] question: [How many individuals were threatened by Mcdonald's in relation to the pamphlet produced?] context block: [Helen Steel and Dave Morris joined “London Greenpeace” in 1980. The organization was not connected to international Greenpeace; rather it was an independent activist group that campaigned for social change on a broad range of issues. One of the group’s projects was the distribution of a pamphlet that was published in 1986, entitled “What’s Wrong with McDonald’s". McDonald’s hired private detectives to infiltrate the organization, and ultimately threatened to sue the individuals who were distributing the pamphlets.2 In order to avoid being sued for libel, three of the five apologized, and in 1990 promised to stop distributing the pamphlets. But Ms. Steel and Mr. Morris, who have been dubbed the “McLibel 2,” refused.3 No doubt this obstinacy was not expected, as McDonald’s had apparently been successful in the past in stopping criticism and forcing apologies from much more affluent foes, including the BBC.4 McDonald’s U.S. and its U.K. affiliate (“First Plaintiffs” and “Second Plaintiffs” respectively) filed suit against Morris and Steel. The more than two and a half-year trial, the longest in English history, began in June of 1994, after twenty-eight pre-trial hearings.5 In June of 1997, in a 750 page judgment, Justice Rodger Justice Bell found that McDonald’s had been defamed and assessed damages equivalent to $96,000 against the two defendants.6 the company.8 It is not very likely that McDonald’s will ever recover its $96,000, as Mr. Morris is an unemployed former postal worker and Ms. Steel is a part time bartender.7 But the president of McDonald’s U.K. testified that this was not about money—it was about preventing lies being used to try to “‘smash’” the company. The recovery would not come close to compensating McDonald’s for its costs in the law suit, which have been estimated to be about $10 million, including over £ 6,500 per day of trial for their team of top English libel lawyers.9 satisfied,”10 Although a McDonald’s official commented that they were “broadly some have suggested that it was at best a Pyrrhic victory.11 The case became a public relations disaster around the world, thanks in large part to the Internet, which now has a very active anti-McDonald’s website. The site displays the offending pamphlet as well as even more derogatory comments about McDonald’s, including some allegations from other sources that McDonald’s had previously successfully suppressed by threats of law suits. ce.17 When Justice Bell finally released his judgment, it included some rather detrimental conclusions about McDonald’s business practices. Although Justice Bell found in favor of McDonald’s on nearly all of their claims, he did reject a few. He concluded that McDonald’s had contributed to cruelty to animals, used advertising to manipulate children, and paid employees so little as to depress wages in the catering industry in England. These findings were prominently reported in numerous articles describing the judgement. The statements found to be defamatory included assertions in the pamphlet that McDonald’s was destroying rain forests; causing starvation in the Third World; producing litter in cities; causing heart disease, cancer and food poisoning; subjecting employees to “bad” working conditions; exploiting women and minority workers; and covering up the low quality of their food with advertising gimmicks aimed at children.19 Morris and Steel faced formidable obstacles under English law due to a combination of restrictive substantive libel laws, denial of a jury trial, the potential for very high damage awards and legal costs,43 and a lack of legal aid. The exclusion of defamation actions from the otherwise rather generous legal aid system in England44 is based on the fear of frivolous petty suits.45 Reformers have convincingly disputed this rationale;46 but in any event, the McDonald’s case aptly demonstrates the severe disadvantage the rule imposes on defendants of modest means being sued by affluent plaintiffs. England’s strict liability libel law contributes to its reputation as a haven for libel plaintiffs. The $96,000 award given by Justice Bell in McDonald’s was, by these standards, quite modest. But a company with annual earnings of $32 billion does not sue defendants like Morris and Steel for the money. They were suing to stop the criticism and deter future critics, and their track record in squelching criticism by threatened civil suits in England had been quite good until they faced the “McDonald’s 2.]	You can only respond to these questions with information from the text below. Answer with 1 bullet point. EVIDENCE: Helen Steel and Dave Morris joined “London Greenpeace” in 1980. The organization was not connected to international Greenpeace; rather it was an independent activist group that campaigned for social change on a broad range of issues. One of the group’s projects was the distribution of a pamphlet that was published in 1986, entitled “What’s Wrong with McDonald’s". McDonald’s hired private detectives to infiltrate the organization, and ultimately threatened to sue the individuals who were distributing the pamphlets.2 In order to avoid being sued for libel, three of the five apologized, and in 1990 promised to stop distributing the pamphlets. But Ms. Steel and Mr. Morris, who have been dubbed the “McLibel 2,” refused.3 No doubt this obstinacy was not expected, as McDonald’s had apparently been successful in the past in stopping criticism and forcing apologies from much more affluent foes, including the BBC.4 McDonald’s U.S. and its U.K. affiliate (“First Plaintiffs” and “Second Plaintiffs” respectively) filed suit against Morris and Steel. The more than two and a half-year trial, the longest in English history, began in June of 1994, after twenty-eight pre-trial hearings.5 In June of 1997, in a 750 page judgment, Justice Rodger Justice Bell found that McDonald’s had been defamed and assessed damages equivalent to $96,000 against the two defendants.6 the company.8 It is not very likely that McDonald’s will ever recover its $96,000, as Mr. Morris is an unemployed former postal worker and Ms. Steel is a part time bartender.7 But the president of McDonald’s U.K. testified that this was not about money—it was about preventing lies being used to try to “‘smash’” the company. The recovery would not come close to compensating McDonald’s for its costs in the law suit, which have been estimated to be about $10 million, including over £ 6,500 per day of trial for their team of top English libel lawyers.9 satisfied,”10 Although a McDonald’s official commented that they were “broadly some have suggested that it was at best a Pyrrhic victory.11 The case became a public relations disaster around the world, thanks in large part to the Internet, which now has a very active anti-McDonald’s website. The site displays the offending pamphlet as well as even more derogatory comments about McDonald’s, including some allegations from other sources that McDonald’s had previously successfully suppressed by threats of law suits. ce.17 When Justice Bell finally released his judgment, it included some rather detrimental conclusions about McDonald’s business practices. Although Justice Bell found in favor of McDonald’s on nearly all of their claims, he did reject a few. He concluded that McDonald’s had contributed to cruelty to animals, used advertising to manipulate children, and paid employees so little as to depress wages in the catering industry in England. These findings were prominently reported in numerous articles describing the judgement. The statements found to be defamatory included assertions in the pamphlet that McDonald’s was destroying rain forests; causing starvation in the Third World; producing litter in cities; causing heart disease, cancer and food poisoning; subjecting employees to “bad” working conditions; exploiting women and minority workers; and covering up the low quality of their food with advertising gimmicks aimed at children.19 Morris and Steel faced formidable obstacles under English law due to a combination of restrictive substantive libel laws, denial of a jury trial, the potential for very high damage awards and legal costs,43 and a lack of legal aid. The exclusion of defamation actions from the otherwise rather generous legal aid system in England44 is based on the fear of frivolous petty suits.45 Reformers have convincingly disputed this rationale;46 but in any event, the McDonald’s case aptly demonstrates the severe disadvantage the rule imposes on defendants of modest means being sued by affluent plaintiffs. England’s strict liability libel law contributes to its reputation as a haven for libel plaintiffs. The $96,000 award given by Justice Bell in McDonald’s was, by these standards, quite modest. But a company with annual earnings of $32 billion does not sue defendants like Morris and Steel for the money. They were suing to stop the criticism and deter future critics, and their track record in squelching criticism by threatened civil suits in England had been quite good until they faced the “McDonald’s 2. USER: How many individuals were threatened by Mcdonald's in relation to the pamphlet produced? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	18	13	703	null	292
When responding, restrict yourself to only information found within the given article - no other information is valid or necessary.	How should we as a labor hire provider respond if a labor hire worker refuses to carry out work due to safety concerns?	GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 1 of 7 Labour hire: duties of persons conducting a business or undertaking This Guide provides information for persons conducting a business or undertaking (PCBUs) involving the supply of workers (labour hire PCBUs) to work for another business or undertaking (host PCBUs) on complying with their health and safety duties under the model Work Health and Safety (WHS) laws. Model Work Health and Safety Act and labour hire arrangements Labour hire arrangements are covered by the model WHS Act. The primary duty of care under the model WHS Act is owed by a PCBU to a ‘worker’, which includes a labour hire worker. All labour hire PCBUs and host PCBUs have a primary duty of care to ensure, so far as is reasonably practicable, the health and safety of labour hire workers engaged by, or caused to be engaged by them, or whose activities are influenced or directed by the PCBU. The model WHS Act provides that more than one duty holder may have the same duty, in this instance a labour hire PCBU and a host PCBU. Labour hire arrangements can be complex. In some circumstances, there may be more than one labour hire or host PCBU. If more than one person has a duty for the same matter, each person must meet their duty to the extent to which they have the capacity to influence and control the matter. A labour hire PCBU or host PCBU may exercise influence and control over a relevant matter through, for example, the terms of a contract or directing workers in a practical sense. However, duty holders cannot contract out of or transfer their WHS obligations to another person. Consultation between PCBUs All duty holders in a labour hire arrangement must consult, cooperate and coordinate with each other so far as is reasonably practicable. Each duty holder should share information to find out who is doing what and work together in a cooperative and coordinated way to ensure compliance with WHS laws. For example, host and labour hire PCBUs must discuss consultation arrangements, the hazards and risks associated with the work, what precautions will be taken to ensure the health and safety of the labour hire worker and the respective roles the organisations in responding to an incident. Some labour hire PCBUs may have substantial knowledge of WHS issues and risk management practices in their industry that may assist in assessing the practices of a host PCBU and ensuring compliance with WHS laws. Duty holders should not assume that someone else is taking care of a health and GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 2 of 7 safety matter. Find out who is doing what and work together with other duty holders so risks are eliminated or minimised as far as is reasonably practicable. What is reasonable practicable will depend on the circumstances. Relevant issues for duty holders to discuss will depend on the circumstances. These may include: • hazards and risks that may arise, taking into account things like the physical environment where work will occur • control measures to eliminate or minimise risks and the suitability of those measures • compliance with minimum requirements set by legislation, such as the WHS laws • how work will be carried out (including safe work methods and processes that are already in place or need to be in place) • the people involved in the work (including supervision arrangements) • competency and training requirements, including arrangements for the provision of additional training required for the particular work • arrangements for facilitating assessments of the individual worker’s needs and/or competencies, as appropriate • arrangements for health monitoring and relevant vaccinations • the respective roles of the organisations in responding to an incident, as well as relevant policies and procedures, and • any other factors which may impact the work environment and how work is carried out. Like all PCBUs, labour hire and host PCBUs are required to be proactive in managing hazards and risks. The duties in the model WHS Act are ongoing and must be complied with throughout the labour hire arrangement. Be aware that circumstances can change over time and this may result in a change in the hazards and risks or in the ways they may be eliminated or minimised. Changes that may necessitate a review of hazards, risks and control measures may include: • change in a work process • change in the physical environment • different people undertaking the work, with different skills or means of co-ordinating activities • new hazards are identified, and • new ways to eliminate or minimise risks are identified or invented. If a labour hire worker has a reasonable concern that to carry out the work would expose them to a serious health or safety risk, they may cease, or refuse to carry out work. A labour hire and host PCBU must not discriminate against a worker for exercising this or any other right under the model WHS Act. Duties of a host PCBU As a host PCBU under the model WHS Act, you have the same health and safety duties to labour hire workers as you do to other types of workers. It is your duty to ensure, so far as is reasonably practicable, the health and safety of all workers while at work. This duty requires you to eliminate or, if that is not reasonably practicable, to minimise risks to their health and safety. To identify what is reasonably practicable to do, you must take into account all the relevant matters and work with the labour hire PCBU/s to provide the highest level of protection that is both possible and reasonable in the circumstances. GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 3 of 7 As a host PCBU, you must also consult, cooperate and coordinate activities with the labour hire PCBU/s to ensure you meet your obligations. The model WHS Act specifically provides that you cannot contract out of or transfer your WHS obligations to another party, including labour hire or other host PCBUs. Before engaging labour hire workers Before you engage labour hire workers to carry out work, you should consider: • providing the labour hire PCBU/s with detailed information about the nature of work to be carried out including details of, and where possible supporting material, relating to: o the work environment/s o tasks to be performed o accommodation arrangements o any known hazards or risks o any plant or equipment to be used o organisational and WHS arrangements, including supervision arrangements and any other organisations responsible for the worker during the arrangement o health and safety risks associated with the work, and o any skills, knowledge, licenses and qualifications required to safely undertake the work. • verifying, in consultation with the labour hire PCBU, that the selected worker/s have any necessary qualifications, licences, skills and training to carry out the work safely. In limited circumstances, you may be required to verify the worker/s are medically fit to carry out the work (see regulations 168 and 417(3)(b) of the model WHS Regulations) • discussing with the labour hire PCBU arrangements for health monitoring and vaccinations • consulting with the labour hire PCBU/s on WHS matters including in relation to who will provide any necessary equipment such as personal protective equipment (PPE), and relevant points of contact for health and safety between the organisations • ensuring that general health and safety information about the work, workplace and work environment has been provided to the worker/s. Check that you have provided this information in a way that is suitable, adequate and readily understandable for the worker/s • eliminating or, if that is not reasonably practicable, minimising risks in the workplace • establishing, in consultation with the labour hire PCBU/s, a review process for ensuring the ongoing WHS of workers, and • any more you can do to ensure the health and safety of all your workers. During a labour hire worker’s placement While labour hire workers are carrying out work, you should consider: • providing the worker/s with a site specific safety induction outlining WHS duties, policies, procedures and practices in the workplace including consultation methods • where WHS advice or workplace assessments are required, ensuring the persons engaged to conduct GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 4 of 7 those assessments are suitably qualified • treating labour hire workers as you would employees and other workers with respect to health and safety and the provision of a safe working environment and PPE (if PPE is not provided by the labour hire PCBU/s) • providing adequate supervision of the worker/s at all times to ensure that work is being performed safely • consulting with the labour hire PCBU/s and worker/s regarding any changes which may affect WHS. Ensure you do not transfer workers to new tasks or change the nature of their work tasks, work environment or work location until you have consulted with the worker/s and obtained the approval of the labour hire PCBU/s • encouraging labour hire workers to participate in the identification of hazards and risks specific to their work • supporting and encouraging labour hire workers to participate in workplace safety consultative arrangements • working with the labour hire PCBU/s to facilitate appropriate WHS arrangements. For example, allow the labour hire PCBU/s access to workers, the workplace and relevant documents for the purpose of workplace safety assessments and to fulfil their WHS duties as a PCBU • facilitating any assessments conducted by the labour hire PCBU/s, for example, WHS management assessments or work site assessments • providing any further training, instruction or information prior to transferring a labour hire worker to new tasks, in a way that is suitable, adequate and readily understandable to the worker. • encouraging labour hire workers to maintain contact with the labour hire PCBU/s throughout their placement, and • in the event of an incident, notifying the labour hire PCBU/s as soon as practicable and working with them to implement agreed arrangements. For example, allowing the labour hire PCBU/s access to the workplace and to relevant documents to fulfil their WHS duties as a PCBU. Duties of a labour hire PCBU As a labour hire PCBU under the model WHS laws, it is your duty to ensure, so far as is reasonably practicable, the health and safety of workers during their placement with the host PCBU/s. It is your duty to eliminate or, if that is not reasonably practicable, minimise risks to health and safety a labour hire worker may encounter. In some circumstances, this means not placing workers in, or removing workers from, a workplace where you believe there is a risk to their health and safety or where risks have not been adequately controlled. Before placing labour hire workers Before you place labour hire workers, you should consider: • reviewing the host PCBU’s safety record to satisfy yourself that they provide a safe workplace • gathering information about the work and the workplace/s, including the work environment/s, accommodation arrangements, organisational arrangements, health and safety risks associated with the work and any skills and knowledge the worker will require to safely undertake the GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 5 of 7 work. This might include information about facilities, work schedules and environmental factors, such as whether work will be conducted outdoors • providing workers with suitable, adequate and readily understandable WHS induction and training. Include any risks you have identified and consultation methods you have established with workers and the host PCBU/s • verifying and working with the host PCBU to ensure site specific and task specific induction, training and PPE is provided to labour hire workers in a way that is suitable, adequate and readily understandable to them • assessing the workplace/s for any risks to health and safety, as appropriate. Work with the host PCBU/s to gather enough information to make an assessment, for example, by arranging a workplace visit. Where risks are identified, consult with the host/s to ensure they are eliminated, or if that is not reasonably practicable, minimised • ensuring that workers have the necessary qualifications, licences, skills and training to safely carry out the work. In limited circumstances you may be required to verify the worker/s are medically fit to carry out the work (see regulations 168 and 417(3)(b) of the model WHS Regulations). • consulting with the host PCBU and workers to ensure you and the workers understand and are confident in your understanding of the WHS policies, procedures and practices of the host PCBU/s • discussing with the host PCBU arrangements for health monitoring and vaccinations • establishing communication methods workers can use to contact you if they consider there is any risk to their health or safety • discussing consultation arrangements with the host PCBU/s • ensuring workers have the means to identify and take action in an unsafe situation at the host workplace, such as stopping work or bringing it to the attention of the host PCBU/s, a health and safety committee representative or health and safety representative • ensuring workers have the means to raise safety issues with you if they are unsatisfied with the host PCBU’s response • establishing, in consultation with the host PCBU/s, a review process for ensuring the ongoing WHS of workers, and • any more you can do to ensure the health and safety of the labour hire worker. During a labour hire worker’s placement While your workers are placed with the host PCBU, you should consider: • consulting with the host PCBU/s and labour hire workers on any changes which may affect their health and safety. For example, this may include consultation about the use of plant and equipment not envisaged prior to placement • working with the host PCBU/s to undertake workplace safety assessments in accordance with agreed arrangements GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 6 of 7 • where WHS advice or workplace assessments are required, working with the host PCBU to ensure the person/s engaged to conduct those assessments are suitably qualified • monitoring the workplace for new risks to health and safety and consulting with the host PCBU/s about how they might be addressed. This might include regular visits to the host/s workplace • encouraging workers to maintain contact with you and to provide feedback on health and safety matters in the host/s workplace • taking effective action when the worker or host PCBU/s identifies risks or raises concerns about health and safety. This might include removing the worker from the workplace, and • in the event of an incident, working with the host PCBU/s to respond effectively. Further information More information on the topics covered in this Guide can be found here: • How to determine what is reasonably practicable to meet a health and safety duty • The meaning of ‘persons conducting a business or undertaking’ • Work health and safety consultation, cooperation and coordination You can also find further information about other WHS topics on the Safe Work Australia website swa.gov.au. Safe Work Australia is a national policy body responsible for WHS and workers’ compensation arrangements. We do not regulate or enforce WHS or workers’ compensation laws. This guide provides information on the model WHS laws. It is important to consider the WHS laws that apply in your circumstances. To find out more, contact your WHS regulator. Where your business arrangements span multiple jurisdictions, you may need to contact more than one WHS regulator. The relevant contact details are available on our website swa.gov.au/whs-authorities-contactinformation. In most jurisdictions the labour hire PCBU (not the host PCBU) is responsible for providing workers’ compensation to the worker, however there are exemptions to this. However, labour hire and host PCBUs should work together to coordinate return to work arrangements and support workers through the return to work process. It is important to contact your workers’ compensation authority for more information on understanding and complying with your workers’ compensation obligations as penalties can apply. Some jurisdictions have implemented a labour hire licensing scheme. Safe Work Australia cannot provide advice in relation to these schemes. It is your responsibility to identify whether these requirements apply to you. GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 7 of 7 Disclaimer Safe Work Australia is an Australian Government statutory agency established in 2009. Safe Work Australia includes Members from the Commonwealth, and each state and territory, Members representing the interests of workers and Members representing the interests of employers. Safe Work Australia works with the Commonwealth, state and territory governments to improve work health and safety and workers’ compensation arrangements. Safe Work Australia is a national policy body, not a regulator of work health and safety. The Commonwealth, states and territories have responsibility for regulating and enforcing work health and safety laws in their jurisdiction. ISBN 978-1-76051-811-0 (PDF) ISBN 978-1-76051-812-7 (DOCX) Creative Commons With the exception of the Safe Work Australia logo, this copyright work is licensed under a Creative Commons AttributionNoncommercial 4.0 International licence. To view a copy of this licence, visit creativecommons.org/licenses In essence, you are free to copy, communicate and adapt the work for non-commercial purposes, as long as you attribute the work to Safe Work Australia and abide by the other licence terms. Contact information Safe Work Australia \| [email protected] \| www.swa.gov.au	When responding, restrict yourself to only information found within the given article - no other information is valid or necessary. How should we as a labor hire provider respond if a labor hire worker refuses to carry out work due to safety concerns? GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 1 of 7 Labour hire: duties of persons conducting a business or undertaking This Guide provides information for persons conducting a business or undertaking (PCBUs) involving the supply of workers (labour hire PCBUs) to work for another business or undertaking (host PCBUs) on complying with their health and safety duties under the model Work Health and Safety (WHS) laws. Model Work Health and Safety Act and labour hire arrangements Labour hire arrangements are covered by the model WHS Act. The primary duty of care under the model WHS Act is owed by a PCBU to a ‘worker’, which includes a labour hire worker. All labour hire PCBUs and host PCBUs have a primary duty of care to ensure, so far as is reasonably practicable, the health and safety of labour hire workers engaged by, or caused to be engaged by them, or whose activities are influenced or directed by the PCBU. The model WHS Act provides that more than one duty holder may have the same duty, in this instance a labour hire PCBU and a host PCBU. Labour hire arrangements can be complex. In some circumstances, there may be more than one labour hire or host PCBU. If more than one person has a duty for the same matter, each person must meet their duty to the extent to which they have the capacity to influence and control the matter. A labour hire PCBU or host PCBU may exercise influence and control over a relevant matter through, for example, the terms of a contract or directing workers in a practical sense. However, duty holders cannot contract out of or transfer their WHS obligations to another person. Consultation between PCBUs All duty holders in a labour hire arrangement must consult, cooperate and coordinate with each other so far as is reasonably practicable. Each duty holder should share information to find out who is doing what and work together in a cooperative and coordinated way to ensure compliance with WHS laws. For example, host and labour hire PCBUs must discuss consultation arrangements, the hazards and risks associated with the work, what precautions will be taken to ensure the health and safety of the labour hire worker and the respective roles the organisations in responding to an incident. Some labour hire PCBUs may have substantial knowledge of WHS issues and risk management practices in their industry that may assist in assessing the practices of a host PCBU and ensuring compliance with WHS laws. Duty holders should not assume that someone else is taking care of a health and GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 2 of 7 safety matter. Find out who is doing what and work together with other duty holders so risks are eliminated or minimised as far as is reasonably practicable. What is reasonable practicable will depend on the circumstances. Relevant issues for duty holders to discuss will depend on the circumstances. These may include: • hazards and risks that may arise, taking into account things like the physical environment where work will occur • control measures to eliminate or minimise risks and the suitability of those measures • compliance with minimum requirements set by legislation, such as the WHS laws • how work will be carried out (including safe work methods and processes that are already in place or need to be in place) • the people involved in the work (including supervision arrangements) • competency and training requirements, including arrangements for the provision of additional training required for the particular work • arrangements for facilitating assessments of the individual worker’s needs and/or competencies, as appropriate • arrangements for health monitoring and relevant vaccinations • the respective roles of the organisations in responding to an incident, as well as relevant policies and procedures, and • any other factors which may impact the work environment and how work is carried out. Like all PCBUs, labour hire and host PCBUs are required to be proactive in managing hazards and risks. The duties in the model WHS Act are ongoing and must be complied with throughout the labour hire arrangement. Be aware that circumstances can change over time and this may result in a change in the hazards and risks or in the ways they may be eliminated or minimised. Changes that may necessitate a review of hazards, risks and control measures may include: • change in a work process • change in the physical environment • different people undertaking the work, with different skills or means of co-ordinating activities • new hazards are identified, and • new ways to eliminate or minimise risks are identified or invented. If a labour hire worker has a reasonable concern that to carry out the work would expose them to a serious health or safety risk, they may cease, or refuse to carry out work. A labour hire and host PCBU must not discriminate against a worker for exercising this or any other right under the model WHS Act. Duties of a host PCBU As a host PCBU under the model WHS Act, you have the same health and safety duties to labour hire workers as you do to other types of workers. It is your duty to ensure, so far as is reasonably practicable, the health and safety of all workers while at work. This duty requires you to eliminate or, if that is not reasonably practicable, to minimise risks to their health and safety. To identify what is reasonably practicable to do, you must take into account all the relevant matters and work with the labour hire PCBU/s to provide the highest level of protection that is both possible and reasonable in the circumstances. GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 3 of 7 As a host PCBU, you must also consult, cooperate and coordinate activities with the labour hire PCBU/s to ensure you meet your obligations. The model WHS Act specifically provides that you cannot contract out of or transfer your WHS obligations to another party, including labour hire or other host PCBUs. Before engaging labour hire workers Before you engage labour hire workers to carry out work, you should consider: • providing the labour hire PCBU/s with detailed information about the nature of work to be carried out including details of, and where possible supporting material, relating to: o the work environment/s o tasks to be performed o accommodation arrangements o any known hazards or risks o any plant or equipment to be used o organisational and WHS arrangements, including supervision arrangements and any other organisations responsible for the worker during the arrangement o health and safety risks associated with the work, and o any skills, knowledge, licenses and qualifications required to safely undertake the work. • verifying, in consultation with the labour hire PCBU, that the selected worker/s have any necessary qualifications, licences, skills and training to carry out the work safely. In limited circumstances, you may be required to verify the worker/s are medically fit to carry out the work (see regulations 168 and 417(3)(b) of the model WHS Regulations) • discussing with the labour hire PCBU arrangements for health monitoring and vaccinations • consulting with the labour hire PCBU/s on WHS matters including in relation to who will provide any necessary equipment such as personal protective equipment (PPE), and relevant points of contact for health and safety between the organisations • ensuring that general health and safety information about the work, workplace and work environment has been provided to the worker/s. Check that you have provided this information in a way that is suitable, adequate and readily understandable for the worker/s • eliminating or, if that is not reasonably practicable, minimising risks in the workplace • establishing, in consultation with the labour hire PCBU/s, a review process for ensuring the ongoing WHS of workers, and • any more you can do to ensure the health and safety of all your workers. During a labour hire worker’s placement While labour hire workers are carrying out work, you should consider: • providing the worker/s with a site specific safety induction outlining WHS duties, policies, procedures and practices in the workplace including consultation methods • where WHS advice or workplace assessments are required, ensuring the persons engaged to conduct GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 4 of 7 those assessments are suitably qualified • treating labour hire workers as you would employees and other workers with respect to health and safety and the provision of a safe working environment and PPE (if PPE is not provided by the labour hire PCBU/s) • providing adequate supervision of the worker/s at all times to ensure that work is being performed safely • consulting with the labour hire PCBU/s and worker/s regarding any changes which may affect WHS. Ensure you do not transfer workers to new tasks or change the nature of their work tasks, work environment or work location until you have consulted with the worker/s and obtained the approval of the labour hire PCBU/s • encouraging labour hire workers to participate in the identification of hazards and risks specific to their work • supporting and encouraging labour hire workers to participate in workplace safety consultative arrangements • working with the labour hire PCBU/s to facilitate appropriate WHS arrangements. For example, allow the labour hire PCBU/s access to workers, the workplace and relevant documents for the purpose of workplace safety assessments and to fulfil their WHS duties as a PCBU • facilitating any assessments conducted by the labour hire PCBU/s, for example, WHS management assessments or work site assessments • providing any further training, instruction or information prior to transferring a labour hire worker to new tasks, in a way that is suitable, adequate and readily understandable to the worker. • encouraging labour hire workers to maintain contact with the labour hire PCBU/s throughout their placement, and • in the event of an incident, notifying the labour hire PCBU/s as soon as practicable and working with them to implement agreed arrangements. For example, allowing the labour hire PCBU/s access to the workplace and to relevant documents to fulfil their WHS duties as a PCBU. Duties of a labour hire PCBU As a labour hire PCBU under the model WHS laws, it is your duty to ensure, so far as is reasonably practicable, the health and safety of workers during their placement with the host PCBU/s. It is your duty to eliminate or, if that is not reasonably practicable, minimise risks to health and safety a labour hire worker may encounter. In some circumstances, this means not placing workers in, or removing workers from, a workplace where you believe there is a risk to their health and safety or where risks have not been adequately controlled. Before placing labour hire workers Before you place labour hire workers, you should consider: • reviewing the host PCBU’s safety record to satisfy yourself that they provide a safe workplace • gathering information about the work and the workplace/s, including the work environment/s, accommodation arrangements, organisational arrangements, health and safety risks associated with the work and any skills and knowledge the worker will require to safely undertake the GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 5 of 7 work. This might include information about facilities, work schedules and environmental factors, such as whether work will be conducted outdoors • providing workers with suitable, adequate and readily understandable WHS induction and training. Include any risks you have identified and consultation methods you have established with workers and the host PCBU/s • verifying and working with the host PCBU to ensure site specific and task specific induction, training and PPE is provided to labour hire workers in a way that is suitable, adequate and readily understandable to them • assessing the workplace/s for any risks to health and safety, as appropriate. Work with the host PCBU/s to gather enough information to make an assessment, for example, by arranging a workplace visit. Where risks are identified, consult with the host/s to ensure they are eliminated, or if that is not reasonably practicable, minimised • ensuring that workers have the necessary qualifications, licences, skills and training to safely carry out the work. In limited circumstances you may be required to verify the worker/s are medically fit to carry out the work (see regulations 168 and 417(3)(b) of the model WHS Regulations). • consulting with the host PCBU and workers to ensure you and the workers understand and are confident in your understanding of the WHS policies, procedures and practices of the host PCBU/s • discussing with the host PCBU arrangements for health monitoring and vaccinations • establishing communication methods workers can use to contact you if they consider there is any risk to their health or safety • discussing consultation arrangements with the host PCBU/s • ensuring workers have the means to identify and take action in an unsafe situation at the host workplace, such as stopping work or bringing it to the attention of the host PCBU/s, a health and safety committee representative or health and safety representative • ensuring workers have the means to raise safety issues with you if they are unsatisfied with the host PCBU’s response • establishing, in consultation with the host PCBU/s, a review process for ensuring the ongoing WHS of workers, and • any more you can do to ensure the health and safety of the labour hire worker. During a labour hire worker’s placement While your workers are placed with the host PCBU, you should consider: • consulting with the host PCBU/s and labour hire workers on any changes which may affect their health and safety. For example, this may include consultation about the use of plant and equipment not envisaged prior to placement • working with the host PCBU/s to undertake workplace safety assessments in accordance with agreed arrangements GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 6 of 7 • where WHS advice or workplace assessments are required, working with the host PCBU to ensure the person/s engaged to conduct those assessments are suitably qualified • monitoring the workplace for new risks to health and safety and consulting with the host PCBU/s about how they might be addressed. This might include regular visits to the host/s workplace • encouraging workers to maintain contact with you and to provide feedback on health and safety matters in the host/s workplace • taking effective action when the worker or host PCBU/s identifies risks or raises concerns about health and safety. This might include removing the worker from the workplace, and • in the event of an incident, working with the host PCBU/s to respond effectively. Further information More information on the topics covered in this Guide can be found here: • How to determine what is reasonably practicable to meet a health and safety duty • The meaning of ‘persons conducting a business or undertaking’ • Work health and safety consultation, cooperation and coordination You can also find further information about other WHS topics on the Safe Work Australia website swa.gov.au. Safe Work Australia is a national policy body responsible for WHS and workers’ compensation arrangements. We do not regulate or enforce WHS or workers’ compensation laws. This guide provides information on the model WHS laws. It is important to consider the WHS laws that apply in your circumstances. To find out more, contact your WHS regulator. Where your business arrangements span multiple jurisdictions, you may need to contact more than one WHS regulator. The relevant contact details are available on our website swa.gov.au/whs-authorities-contactinformation. In most jurisdictions the labour hire PCBU (not the host PCBU) is responsible for providing workers’ compensation to the worker, however there are exemptions to this. However, labour hire and host PCBUs should work together to coordinate return to work arrangements and support workers through the return to work process. It is important to contact your workers’ compensation authority for more information on understanding and complying with your workers’ compensation obligations as penalties can apply. Some jurisdictions have implemented a labour hire licensing scheme. Safe Work Australia cannot provide advice in relation to these schemes. It is your responsibility to identify whether these requirements apply to you. GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 7 of 7 Disclaimer Safe Work Australia is an Australian Government statutory agency established in 2009. Safe Work Australia includes Members from the Commonwealth, and each state and territory, Members representing the interests of workers and Members representing the interests of employers. Safe Work Australia works with the Commonwealth, state and territory governments to improve work health and safety and workers’ compensation arrangements. Safe Work Australia is a national policy body, not a regulator of work health and safety. The Commonwealth, states and territories have responsibility for regulating and enforcing work health and safety laws in their jurisdiction. ISBN 978-1-76051-811-0 (PDF) ISBN 978-1-76051-812-7 (DOCX) Creative Commons With the exception of the Safe Work Australia logo, this copyright work is licensed under a Creative Commons AttributionNoncommercial 4.0 International licence. To view a copy of this licence, visit creativecommons.org/licenses In essence, you are free to copy, communicate and adapt the work for non-commercial purposes, as long as you attribute the work to Safe Work Australia and abide by the other licence terms. Contact information Safe Work Australia \| [email protected] \| www.swa.gov.au	When responding, restrict yourself to only information found within the given article - no other information is valid or necessary. EVIDENCE: GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 1 of 7 Labour hire: duties of persons conducting a business or undertaking This Guide provides information for persons conducting a business or undertaking (PCBUs) involving the supply of workers (labour hire PCBUs) to work for another business or undertaking (host PCBUs) on complying with their health and safety duties under the model Work Health and Safety (WHS) laws. Model Work Health and Safety Act and labour hire arrangements Labour hire arrangements are covered by the model WHS Act. The primary duty of care under the model WHS Act is owed by a PCBU to a ‘worker’, which includes a labour hire worker. All labour hire PCBUs and host PCBUs have a primary duty of care to ensure, so far as is reasonably practicable, the health and safety of labour hire workers engaged by, or caused to be engaged by them, or whose activities are influenced or directed by the PCBU. The model WHS Act provides that more than one duty holder may have the same duty, in this instance a labour hire PCBU and a host PCBU. Labour hire arrangements can be complex. In some circumstances, there may be more than one labour hire or host PCBU. If more than one person has a duty for the same matter, each person must meet their duty to the extent to which they have the capacity to influence and control the matter. A labour hire PCBU or host PCBU may exercise influence and control over a relevant matter through, for example, the terms of a contract or directing workers in a practical sense. However, duty holders cannot contract out of or transfer their WHS obligations to another person. Consultation between PCBUs All duty holders in a labour hire arrangement must consult, cooperate and coordinate with each other so far as is reasonably practicable. Each duty holder should share information to find out who is doing what and work together in a cooperative and coordinated way to ensure compliance with WHS laws. For example, host and labour hire PCBUs must discuss consultation arrangements, the hazards and risks associated with the work, what precautions will be taken to ensure the health and safety of the labour hire worker and the respective roles the organisations in responding to an incident. Some labour hire PCBUs may have substantial knowledge of WHS issues and risk management practices in their industry that may assist in assessing the practices of a host PCBU and ensuring compliance with WHS laws. Duty holders should not assume that someone else is taking care of a health and GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 2 of 7 safety matter. Find out who is doing what and work together with other duty holders so risks are eliminated or minimised as far as is reasonably practicable. What is reasonable practicable will depend on the circumstances. Relevant issues for duty holders to discuss will depend on the circumstances. These may include: • hazards and risks that may arise, taking into account things like the physical environment where work will occur • control measures to eliminate or minimise risks and the suitability of those measures • compliance with minimum requirements set by legislation, such as the WHS laws • how work will be carried out (including safe work methods and processes that are already in place or need to be in place) • the people involved in the work (including supervision arrangements) • competency and training requirements, including arrangements for the provision of additional training required for the particular work • arrangements for facilitating assessments of the individual worker’s needs and/or competencies, as appropriate • arrangements for health monitoring and relevant vaccinations • the respective roles of the organisations in responding to an incident, as well as relevant policies and procedures, and • any other factors which may impact the work environment and how work is carried out. Like all PCBUs, labour hire and host PCBUs are required to be proactive in managing hazards and risks. The duties in the model WHS Act are ongoing and must be complied with throughout the labour hire arrangement. Be aware that circumstances can change over time and this may result in a change in the hazards and risks or in the ways they may be eliminated or minimised. Changes that may necessitate a review of hazards, risks and control measures may include: • change in a work process • change in the physical environment • different people undertaking the work, with different skills or means of co-ordinating activities • new hazards are identified, and • new ways to eliminate or minimise risks are identified or invented. If a labour hire worker has a reasonable concern that to carry out the work would expose them to a serious health or safety risk, they may cease, or refuse to carry out work. A labour hire and host PCBU must not discriminate against a worker for exercising this or any other right under the model WHS Act. Duties of a host PCBU As a host PCBU under the model WHS Act, you have the same health and safety duties to labour hire workers as you do to other types of workers. It is your duty to ensure, so far as is reasonably practicable, the health and safety of all workers while at work. This duty requires you to eliminate or, if that is not reasonably practicable, to minimise risks to their health and safety. To identify what is reasonably practicable to do, you must take into account all the relevant matters and work with the labour hire PCBU/s to provide the highest level of protection that is both possible and reasonable in the circumstances. GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 3 of 7 As a host PCBU, you must also consult, cooperate and coordinate activities with the labour hire PCBU/s to ensure you meet your obligations. The model WHS Act specifically provides that you cannot contract out of or transfer your WHS obligations to another party, including labour hire or other host PCBUs. Before engaging labour hire workers Before you engage labour hire workers to carry out work, you should consider: • providing the labour hire PCBU/s with detailed information about the nature of work to be carried out including details of, and where possible supporting material, relating to: o the work environment/s o tasks to be performed o accommodation arrangements o any known hazards or risks o any plant or equipment to be used o organisational and WHS arrangements, including supervision arrangements and any other organisations responsible for the worker during the arrangement o health and safety risks associated with the work, and o any skills, knowledge, licenses and qualifications required to safely undertake the work. • verifying, in consultation with the labour hire PCBU, that the selected worker/s have any necessary qualifications, licences, skills and training to carry out the work safely. In limited circumstances, you may be required to verify the worker/s are medically fit to carry out the work (see regulations 168 and 417(3)(b) of the model WHS Regulations) • discussing with the labour hire PCBU arrangements for health monitoring and vaccinations • consulting with the labour hire PCBU/s on WHS matters including in relation to who will provide any necessary equipment such as personal protective equipment (PPE), and relevant points of contact for health and safety between the organisations • ensuring that general health and safety information about the work, workplace and work environment has been provided to the worker/s. Check that you have provided this information in a way that is suitable, adequate and readily understandable for the worker/s • eliminating or, if that is not reasonably practicable, minimising risks in the workplace • establishing, in consultation with the labour hire PCBU/s, a review process for ensuring the ongoing WHS of workers, and • any more you can do to ensure the health and safety of all your workers. During a labour hire worker’s placement While labour hire workers are carrying out work, you should consider: • providing the worker/s with a site specific safety induction outlining WHS duties, policies, procedures and practices in the workplace including consultation methods • where WHS advice or workplace assessments are required, ensuring the persons engaged to conduct GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 4 of 7 those assessments are suitably qualified • treating labour hire workers as you would employees and other workers with respect to health and safety and the provision of a safe working environment and PPE (if PPE is not provided by the labour hire PCBU/s) • providing adequate supervision of the worker/s at all times to ensure that work is being performed safely • consulting with the labour hire PCBU/s and worker/s regarding any changes which may affect WHS. Ensure you do not transfer workers to new tasks or change the nature of their work tasks, work environment or work location until you have consulted with the worker/s and obtained the approval of the labour hire PCBU/s • encouraging labour hire workers to participate in the identification of hazards and risks specific to their work • supporting and encouraging labour hire workers to participate in workplace safety consultative arrangements • working with the labour hire PCBU/s to facilitate appropriate WHS arrangements. For example, allow the labour hire PCBU/s access to workers, the workplace and relevant documents for the purpose of workplace safety assessments and to fulfil their WHS duties as a PCBU • facilitating any assessments conducted by the labour hire PCBU/s, for example, WHS management assessments or work site assessments • providing any further training, instruction or information prior to transferring a labour hire worker to new tasks, in a way that is suitable, adequate and readily understandable to the worker. • encouraging labour hire workers to maintain contact with the labour hire PCBU/s throughout their placement, and • in the event of an incident, notifying the labour hire PCBU/s as soon as practicable and working with them to implement agreed arrangements. For example, allowing the labour hire PCBU/s access to the workplace and to relevant documents to fulfil their WHS duties as a PCBU. Duties of a labour hire PCBU As a labour hire PCBU under the model WHS laws, it is your duty to ensure, so far as is reasonably practicable, the health and safety of workers during their placement with the host PCBU/s. It is your duty to eliminate or, if that is not reasonably practicable, minimise risks to health and safety a labour hire worker may encounter. In some circumstances, this means not placing workers in, or removing workers from, a workplace where you believe there is a risk to their health and safety or where risks have not been adequately controlled. Before placing labour hire workers Before you place labour hire workers, you should consider: • reviewing the host PCBU’s safety record to satisfy yourself that they provide a safe workplace • gathering information about the work and the workplace/s, including the work environment/s, accommodation arrangements, organisational arrangements, health and safety risks associated with the work and any skills and knowledge the worker will require to safely undertake the GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 5 of 7 work. This might include information about facilities, work schedules and environmental factors, such as whether work will be conducted outdoors • providing workers with suitable, adequate and readily understandable WHS induction and training. Include any risks you have identified and consultation methods you have established with workers and the host PCBU/s • verifying and working with the host PCBU to ensure site specific and task specific induction, training and PPE is provided to labour hire workers in a way that is suitable, adequate and readily understandable to them • assessing the workplace/s for any risks to health and safety, as appropriate. Work with the host PCBU/s to gather enough information to make an assessment, for example, by arranging a workplace visit. Where risks are identified, consult with the host/s to ensure they are eliminated, or if that is not reasonably practicable, minimised • ensuring that workers have the necessary qualifications, licences, skills and training to safely carry out the work. In limited circumstances you may be required to verify the worker/s are medically fit to carry out the work (see regulations 168 and 417(3)(b) of the model WHS Regulations). • consulting with the host PCBU and workers to ensure you and the workers understand and are confident in your understanding of the WHS policies, procedures and practices of the host PCBU/s • discussing with the host PCBU arrangements for health monitoring and vaccinations • establishing communication methods workers can use to contact you if they consider there is any risk to their health or safety • discussing consultation arrangements with the host PCBU/s • ensuring workers have the means to identify and take action in an unsafe situation at the host workplace, such as stopping work or bringing it to the attention of the host PCBU/s, a health and safety committee representative or health and safety representative • ensuring workers have the means to raise safety issues with you if they are unsatisfied with the host PCBU’s response • establishing, in consultation with the host PCBU/s, a review process for ensuring the ongoing WHS of workers, and • any more you can do to ensure the health and safety of the labour hire worker. During a labour hire worker’s placement While your workers are placed with the host PCBU, you should consider: • consulting with the host PCBU/s and labour hire workers on any changes which may affect their health and safety. For example, this may include consultation about the use of plant and equipment not envisaged prior to placement • working with the host PCBU/s to undertake workplace safety assessments in accordance with agreed arrangements GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 6 of 7 • where WHS advice or workplace assessments are required, working with the host PCBU to ensure the person/s engaged to conduct those assessments are suitably qualified • monitoring the workplace for new risks to health and safety and consulting with the host PCBU/s about how they might be addressed. This might include regular visits to the host/s workplace • encouraging workers to maintain contact with you and to provide feedback on health and safety matters in the host/s workplace • taking effective action when the worker or host PCBU/s identifies risks or raises concerns about health and safety. This might include removing the worker from the workplace, and • in the event of an incident, working with the host PCBU/s to respond effectively. Further information More information on the topics covered in this Guide can be found here: • How to determine what is reasonably practicable to meet a health and safety duty • The meaning of ‘persons conducting a business or undertaking’ • Work health and safety consultation, cooperation and coordination You can also find further information about other WHS topics on the Safe Work Australia website swa.gov.au. Safe Work Australia is a national policy body responsible for WHS and workers’ compensation arrangements. We do not regulate or enforce WHS or workers’ compensation laws. This guide provides information on the model WHS laws. It is important to consider the WHS laws that apply in your circumstances. To find out more, contact your WHS regulator. Where your business arrangements span multiple jurisdictions, you may need to contact more than one WHS regulator. The relevant contact details are available on our website swa.gov.au/whs-authorities-contactinformation. In most jurisdictions the labour hire PCBU (not the host PCBU) is responsible for providing workers’ compensation to the worker, however there are exemptions to this. However, labour hire and host PCBUs should work together to coordinate return to work arrangements and support workers through the return to work process. It is important to contact your workers’ compensation authority for more information on understanding and complying with your workers’ compensation obligations as penalties can apply. Some jurisdictions have implemented a labour hire licensing scheme. Safe Work Australia cannot provide advice in relation to these schemes. It is your responsibility to identify whether these requirements apply to you. GUIDE \| Labour hire: duties of persons conducting a business or undertaking Page 7 of 7 Disclaimer Safe Work Australia is an Australian Government statutory agency established in 2009. Safe Work Australia includes Members from the Commonwealth, and each state and territory, Members representing the interests of workers and Members representing the interests of employers. Safe Work Australia works with the Commonwealth, state and territory governments to improve work health and safety and workers’ compensation arrangements. Safe Work Australia is a national policy body, not a regulator of work health and safety. The Commonwealth, states and territories have responsibility for regulating and enforcing work health and safety laws in their jurisdiction. ISBN 978-1-76051-811-0 (PDF) ISBN 978-1-76051-812-7 (DOCX) Creative Commons With the exception of the Safe Work Australia logo, this copyright work is licensed under a Creative Commons AttributionNoncommercial 4.0 International licence. To view a copy of this licence, visit creativecommons.org/licenses In essence, you are free to copy, communicate and adapt the work for non-commercial purposes, as long as you attribute the work to Safe Work Australia and abide by the other licence terms. Contact information Safe Work Australia \| [email protected] \| www.swa.gov.au USER: How should we as a labor hire provider respond if a labor hire worker refuses to carry out work due to safety concerns? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	20	23	2,923	null	477
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]	Simplify this passage about gene therapy for sickle cell. Explain what the therapy is and how it works. Also explain the type of sickle cell the patient had. Use bullets an headers so it can be easier to read<	Sickle cell disease results from a homozygous missense mutation in the β-globin gene that causes polymerization of hemoglobin S. Gene therapy for patients with this disorder is complicated by the complex cellular abnormalities and challenges in achieving effective, persistent inhibition of polymerization of hemoglobin S. We describe our first patient treated with lentiviral vector–mediated addition of an antisickling β-globin gene into autologous hematopoietic stem cells. Adverse events were consistent with busulfan conditioning. Fifteen months after treatment, the level of therapeutic antisickling β-globin remained high (approximately 50% of β-like–globin chains) without recurrence of sickle crises and with correction of the biologic hallmarks of the disease. (Funded by Bluebird Bio and others; HGB-205 ClinicalTrials.gov number, NCT02151526.) Sickle cell disease is among the most prevalent inherited monogenic disorders. Approximately 90,000 people in the United States have sickle cell disease, and worldwide more than 275,000 infants are born with the disease annually.1,2 Sickle cell disease was the first disease for which the molecular basis was identified: a single amino acid substitution in “adult” βA-globin (Glu6Val) stemming from a single base substitution (A→T) in the first exon of the human βA-globin gene (HBB) was discovered in 1956.3 Sickle hemoglobin (HbS) polymerizes on deoxygenation, reducing the deformability of red cells. Patients have intensely painful vaso-occlusive crises, leading to irreversible organ damage, poor quality of life, and reduced life expectancy. Hydroxyurea, a cytotoxic agent that is capable of boosting fetal hemoglobin levels in some patients, is the only disease-modifying therapy approved for sickle cell disease.4 Allogeneic hematopoietic stem-cell transplantation currently offers the only curative option for patients with severe sickle cell disease.5,6 However, fewer than 18% of patients have access to a matched sibling donor.7,8 Therapeutic ex vivo gene transfer into autologous hematopoietic stem cells, referred to here as gene therapy, may provide a long-term and potentially curative treatment for sickle cell disease.9 We previously reported proof of effective, sustained gene therapy in mouse models of sickle cell disease by lentiviral transfer of a modified HBB encoding an antisickling variant (βA87Thr:Gln [βA-T87Q]).10,11 Here we report the results for a patient who received lentiviral gene therapy in the HGB-205 clinical study and who had complete clinical remission with correction of hemolysis and biologic hallmarks of the disease. Case Report A boy with the βS/βS genotype, a single 3.7-kb α-globin gene deletion, and no glucose 6-phosphate dehydrogenase deficiency received a diagnosis of sickle cell disease at birth and was followed at the Reference Centre for Sickle Cell Disease of Necker Children’s Hospital in Paris. He had a history of numerous vaso-occlusive crises, two episodes of the acute chest syndrome, and bilateral hip osteonecrosis. He had undergone cholecystectomy and splenectomy. During screening, a cerebral hypodensity without characteristics of cerebral vasculopathy was detected. Because hydroxyurea therapy administered when the boy was between 2 and 9 years of age did not reduce his symptoms significantly, a prophylactic red-cell transfusion program was initiated in 2010, including iron chelation with deferasirox (at a dose of 17 mg per kilogram of body weight per day). He had had an average of 1.6 sickle cell disease–related events annually in the 9 years before transfusions were initiated. In May 2014, he was enrolled in our clinical study. His verbal assent and his mother’s written informed consent were obtained. In October 2014, when the patient was 13 years of age, he received an infusion of the drug product LentiGlobin BB305. Methods Study Oversight The study protocol, which is available with the full text of this article at NEJM.org, was designed by the last two authors and Bluebird Bio, the study sponsor. The protocol was reviewed by the French Comité de Protection des Personnes and relevant institutional ethics committees. Clinical data were collected by the first author, and laboratory data were generated by the sponsor, the last author, and other authors. The authors had access to all data, and data analysis was performed by them. The first author and one author employed by the sponsor wrote the first draft of the manuscript, which was substantively revised by the last two authors and further edited and approved by all the authors with writing assistance provided by an employee of the sponsor. The authors vouch for the accuracy and completeness of the data and adherence to the protocol. Antisickling Gene Therapy Vector The structure of the LentiGlobin BB305 vector has been previously described (see Fig. S1 in the Supplementary Appendix, available at NEJM.org).12 This self-inactivating lentiviral vector encodes the human HBB variant βA-T87Q. In addition to inhibiting HbS polymerization, the T87Q substitution allows for the β-globin chain of adult hemoglobin (HbA)T87Q to be differentially quantified by means of reverse-phase high-performance liquid chromatography.12 Gene Transfer and Transplantation Procedures Bone marrow was obtained twice from the patient to collect sufficient stem cells for gene transfer and backup (6.2×108 per kilogram and 5.4×108 per kilogram, respectively, of total nucleated cells obtained). Both procedures were preceded by exchange transfusion, and bone marrow was obtained without clinical sequelae. Anemia was the only grade 3 adverse event reported during these procedures. Bone marrow–enriched CD34+ cells were transduced with LentiGlobin BB305 vector (see the Methods section in the Supplementary Appendix).13 The mean vector copy numbers for the two batches of transduced cells were 1.0 and 1.2 copies per cell. The patient underwent myeloablation with intravenous busulfan (see the Methods section in the Supplementary Appendix). The total busulfan area under the curve achieved was 19,363 μmol per minute. After a 2-day washout period, transduced CD34+ cells (5.6×106 CD34+ cells per kilogram) were infused. Red-cell transfusions were to be continued after transplantation until a large proportion of HbAT87Q (25 to 30% of total hemoglobin) was detected. The patient was followed for engraftment; toxic effects (graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.03); vector copy number in total nucleated blood cells and in different lineages; quantification of HbAT87Q, HbS, and fetal hemoglobin levels by means of high-performance liquid chromatography; DNA integration-site mapping by linear amplification–mediated polymerase chain reaction in nucleated blood cells; and replication-competent lentivirus analysis by p24 antibody enzyme-linked immunosorbent assay. Red-cell analyses were performed at month 12 (see the Methods section in the Supplementary Appendix). Results Engraftment and Gene Expression Neutrophil engraftment was achieved on day 38 after transplantation, and platelet engraftment was achieved on day 91 after transplantation. Figure 1A shows the trajectory of vector copy numbers and Figure 1B shows production of HbAT87Q. Gene marking increased progressively in whole blood, CD15 cells, B cells, and monocytes (Fig. S2 in the Supplementary Appendix), stabilizing 3 months after transplantation. Increases in levels of vector-bearing T cells were more gradual. Figure 1 Engraftment with Transduced Cells and Therapeutic Gene Expression in the Patient. HbAT87Q levels also increased steadily (Figure 1B) and red-cell transfusions were discontinued, with the last transfusion on day 88. Levels of HbAT87Q reached 5.5 g per deciliter (46%) at month 9 and continued to increase to 5.7 g per deciliter (48%) at month 15, with a reciprocal decrease in HbS levels to 5.5 g per deciliter (46%) at month 9 and 5.8 g per deciliter (49%) at month 15. Total hemoglobin levels were stable between 10.6 and 12.0 g per deciliter after post-transplantation month 6. Fetal hemoglobin levels remained below 1.0 g per deciliter.	Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Simplify this passage about gene therapy for sickle cell. Explain what the therapy is and how it works. Also explain the type of sickle cell the patient had. Use bullets an headers so it can be easier to read< Sickle cell disease results from a homozygous missense mutation in the β-globin gene that causes polymerization of hemoglobin S. Gene therapy for patients with this disorder is complicated by the complex cellular abnormalities and challenges in achieving effective, persistent inhibition of polymerization of hemoglobin S. We describe our first patient treated with lentiviral vector–mediated addition of an antisickling β-globin gene into autologous hematopoietic stem cells. Adverse events were consistent with busulfan conditioning. Fifteen months after treatment, the level of therapeutic antisickling β-globin remained high (approximately 50% of β-like–globin chains) without recurrence of sickle crises and with correction of the biologic hallmarks of the disease. (Funded by Bluebird Bio and others; HGB-205 ClinicalTrials.gov number, NCT02151526.) Sickle cell disease is among the most prevalent inherited monogenic disorders. Approximately 90,000 people in the United States have sickle cell disease, and worldwide more than 275,000 infants are born with the disease annually.1,2 Sickle cell disease was the first disease for which the molecular basis was identified: a single amino acid substitution in “adult” βA-globin (Glu6Val) stemming from a single base substitution (A→T) in the first exon of the human βA-globin gene (HBB) was discovered in 1956.3 Sickle hemoglobin (HbS) polymerizes on deoxygenation, reducing the deformability of red cells. Patients have intensely painful vaso-occlusive crises, leading to irreversible organ damage, poor quality of life, and reduced life expectancy. Hydroxyurea, a cytotoxic agent that is capable of boosting fetal hemoglobin levels in some patients, is the only disease-modifying therapy approved for sickle cell disease.4 Allogeneic hematopoietic stem-cell transplantation currently offers the only curative option for patients with severe sickle cell disease.5,6 However, fewer than 18% of patients have access to a matched sibling donor.7,8 Therapeutic ex vivo gene transfer into autologous hematopoietic stem cells, referred to here as gene therapy, may provide a long-term and potentially curative treatment for sickle cell disease.9 We previously reported proof of effective, sustained gene therapy in mouse models of sickle cell disease by lentiviral transfer of a modified HBB encoding an antisickling variant (βA87Thr:Gln [βA-T87Q]).10,11 Here we report the results for a patient who received lentiviral gene therapy in the HGB-205 clinical study and who had complete clinical remission with correction of hemolysis and biologic hallmarks of the disease. Case Report A boy with the βS/βS genotype, a single 3.7-kb α-globin gene deletion, and no glucose 6-phosphate dehydrogenase deficiency received a diagnosis of sickle cell disease at birth and was followed at the Reference Centre for Sickle Cell Disease of Necker Children’s Hospital in Paris. He had a history of numerous vaso-occlusive crises, two episodes of the acute chest syndrome, and bilateral hip osteonecrosis. He had undergone cholecystectomy and splenectomy. During screening, a cerebral hypodensity without characteristics of cerebral vasculopathy was detected. Because hydroxyurea therapy administered when the boy was between 2 and 9 years of age did not reduce his symptoms significantly, a prophylactic red-cell transfusion program was initiated in 2010, including iron chelation with deferasirox (at a dose of 17 mg per kilogram of body weight per day). He had had an average of 1.6 sickle cell disease–related events annually in the 9 years before transfusions were initiated. In May 2014, he was enrolled in our clinical study. His verbal assent and his mother’s written informed consent were obtained. In October 2014, when the patient was 13 years of age, he received an infusion of the drug product LentiGlobin BB305. Methods Study Oversight The study protocol, which is available with the full text of this article at NEJM.org, was designed by the last two authors and Bluebird Bio, the study sponsor. The protocol was reviewed by the French Comité de Protection des Personnes and relevant institutional ethics committees. Clinical data were collected by the first author, and laboratory data were generated by the sponsor, the last author, and other authors. The authors had access to all data, and data analysis was performed by them. The first author and one author employed by the sponsor wrote the first draft of the manuscript, which was substantively revised by the last two authors and further edited and approved by all the authors with writing assistance provided by an employee of the sponsor. The authors vouch for the accuracy and completeness of the data and adherence to the protocol. Antisickling Gene Therapy Vector The structure of the LentiGlobin BB305 vector has been previously described (see Fig. S1 in the Supplementary Appendix, available at NEJM.org).12 This self-inactivating lentiviral vector encodes the human HBB variant βA-T87Q. In addition to inhibiting HbS polymerization, the T87Q substitution allows for the β-globin chain of adult hemoglobin (HbA)T87Q to be differentially quantified by means of reverse-phase high-performance liquid chromatography.12 Gene Transfer and Transplantation Procedures Bone marrow was obtained twice from the patient to collect sufficient stem cells for gene transfer and backup (6.2×108 per kilogram and 5.4×108 per kilogram, respectively, of total nucleated cells obtained). Both procedures were preceded by exchange transfusion, and bone marrow was obtained without clinical sequelae. Anemia was the only grade 3 adverse event reported during these procedures. Bone marrow–enriched CD34+ cells were transduced with LentiGlobin BB305 vector (see the Methods section in the Supplementary Appendix).13 The mean vector copy numbers for the two batches of transduced cells were 1.0 and 1.2 copies per cell. The patient underwent myeloablation with intravenous busulfan (see the Methods section in the Supplementary Appendix). The total busulfan area under the curve achieved was 19,363 μmol per minute. After a 2-day washout period, transduced CD34+ cells (5.6×106 CD34+ cells per kilogram) were infused. Red-cell transfusions were to be continued after transplantation until a large proportion of HbAT87Q (25 to 30% of total hemoglobin) was detected. The patient was followed for engraftment; toxic effects (graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.03); vector copy number in total nucleated blood cells and in different lineages; quantification of HbAT87Q, HbS, and fetal hemoglobin levels by means of high-performance liquid chromatography; DNA integration-site mapping by linear amplification–mediated polymerase chain reaction in nucleated blood cells; and replication-competent lentivirus analysis by p24 antibody enzyme-linked immunosorbent assay. Red-cell analyses were performed at month 12 (see the Methods section in the Supplementary Appendix). Results Engraftment and Gene Expression Neutrophil engraftment was achieved on day 38 after transplantation, and platelet engraftment was achieved on day 91 after transplantation. Figure 1A shows the trajectory of vector copy numbers and Figure 1B shows production of HbAT87Q. Gene marking increased progressively in whole blood, CD15 cells, B cells, and monocytes (Fig. S2 in the Supplementary Appendix), stabilizing 3 months after transplantation. Increases in levels of vector-bearing T cells were more gradual. Figure 1 Engraftment with Transduced Cells and Therapeutic Gene Expression in the Patient. HbAT87Q levels also increased steadily (Figure 1B) and red-cell transfusions were discontinued, with the last transfusion on day 88. Levels of HbAT87Q reached 5.5 g per deciliter (46%) at month 9 and continued to increase to 5.7 g per deciliter (48%) at month 15, with a reciprocal decrease in HbS levels to 5.5 g per deciliter (46%) at month 9 and 5.8 g per deciliter (49%) at month 15. Total hemoglobin levels were stable between 10.6 and 12.0 g per deciliter after post-transplantation month 6. Fetal hemoglobin levels remained below 1.0 g per deciliter. https://www.nejm.org/doi/full/10.1056/NEJMoa1609677#:~:text=HbAT87Q%20levels%20also%20increased,below%201.0%20g%20per%20deciliter.	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: Sickle cell disease results from a homozygous missense mutation in the β-globin gene that causes polymerization of hemoglobin S. Gene therapy for patients with this disorder is complicated by the complex cellular abnormalities and challenges in achieving effective, persistent inhibition of polymerization of hemoglobin S. We describe our first patient treated with lentiviral vector–mediated addition of an antisickling β-globin gene into autologous hematopoietic stem cells. Adverse events were consistent with busulfan conditioning. Fifteen months after treatment, the level of therapeutic antisickling β-globin remained high (approximately 50% of β-like–globin chains) without recurrence of sickle crises and with correction of the biologic hallmarks of the disease. (Funded by Bluebird Bio and others; HGB-205 ClinicalTrials.gov number, NCT02151526.) Sickle cell disease is among the most prevalent inherited monogenic disorders. Approximately 90,000 people in the United States have sickle cell disease, and worldwide more than 275,000 infants are born with the disease annually.1,2 Sickle cell disease was the first disease for which the molecular basis was identified: a single amino acid substitution in “adult” βA-globin (Glu6Val) stemming from a single base substitution (A→T) in the first exon of the human βA-globin gene (HBB) was discovered in 1956.3 Sickle hemoglobin (HbS) polymerizes on deoxygenation, reducing the deformability of red cells. Patients have intensely painful vaso-occlusive crises, leading to irreversible organ damage, poor quality of life, and reduced life expectancy. Hydroxyurea, a cytotoxic agent that is capable of boosting fetal hemoglobin levels in some patients, is the only disease-modifying therapy approved for sickle cell disease.4 Allogeneic hematopoietic stem-cell transplantation currently offers the only curative option for patients with severe sickle cell disease.5,6 However, fewer than 18% of patients have access to a matched sibling donor.7,8 Therapeutic ex vivo gene transfer into autologous hematopoietic stem cells, referred to here as gene therapy, may provide a long-term and potentially curative treatment for sickle cell disease.9 We previously reported proof of effective, sustained gene therapy in mouse models of sickle cell disease by lentiviral transfer of a modified HBB encoding an antisickling variant (βA87Thr:Gln [βA-T87Q]).10,11 Here we report the results for a patient who received lentiviral gene therapy in the HGB-205 clinical study and who had complete clinical remission with correction of hemolysis and biologic hallmarks of the disease. Case Report A boy with the βS/βS genotype, a single 3.7-kb α-globin gene deletion, and no glucose 6-phosphate dehydrogenase deficiency received a diagnosis of sickle cell disease at birth and was followed at the Reference Centre for Sickle Cell Disease of Necker Children’s Hospital in Paris. He had a history of numerous vaso-occlusive crises, two episodes of the acute chest syndrome, and bilateral hip osteonecrosis. He had undergone cholecystectomy and splenectomy. During screening, a cerebral hypodensity without characteristics of cerebral vasculopathy was detected. Because hydroxyurea therapy administered when the boy was between 2 and 9 years of age did not reduce his symptoms significantly, a prophylactic red-cell transfusion program was initiated in 2010, including iron chelation with deferasirox (at a dose of 17 mg per kilogram of body weight per day). He had had an average of 1.6 sickle cell disease–related events annually in the 9 years before transfusions were initiated. In May 2014, he was enrolled in our clinical study. His verbal assent and his mother’s written informed consent were obtained. In October 2014, when the patient was 13 years of age, he received an infusion of the drug product LentiGlobin BB305. Methods Study Oversight The study protocol, which is available with the full text of this article at NEJM.org, was designed by the last two authors and Bluebird Bio, the study sponsor. The protocol was reviewed by the French Comité de Protection des Personnes and relevant institutional ethics committees. Clinical data were collected by the first author, and laboratory data were generated by the sponsor, the last author, and other authors. The authors had access to all data, and data analysis was performed by them. The first author and one author employed by the sponsor wrote the first draft of the manuscript, which was substantively revised by the last two authors and further edited and approved by all the authors with writing assistance provided by an employee of the sponsor. The authors vouch for the accuracy and completeness of the data and adherence to the protocol. Antisickling Gene Therapy Vector The structure of the LentiGlobin BB305 vector has been previously described (see Fig. S1 in the Supplementary Appendix, available at NEJM.org).12 This self-inactivating lentiviral vector encodes the human HBB variant βA-T87Q. In addition to inhibiting HbS polymerization, the T87Q substitution allows for the β-globin chain of adult hemoglobin (HbA)T87Q to be differentially quantified by means of reverse-phase high-performance liquid chromatography.12 Gene Transfer and Transplantation Procedures Bone marrow was obtained twice from the patient to collect sufficient stem cells for gene transfer and backup (6.2×108 per kilogram and 5.4×108 per kilogram, respectively, of total nucleated cells obtained). Both procedures were preceded by exchange transfusion, and bone marrow was obtained without clinical sequelae. Anemia was the only grade 3 adverse event reported during these procedures. Bone marrow–enriched CD34+ cells were transduced with LentiGlobin BB305 vector (see the Methods section in the Supplementary Appendix).13 The mean vector copy numbers for the two batches of transduced cells were 1.0 and 1.2 copies per cell. The patient underwent myeloablation with intravenous busulfan (see the Methods section in the Supplementary Appendix). The total busulfan area under the curve achieved was 19,363 μmol per minute. After a 2-day washout period, transduced CD34+ cells (5.6×106 CD34+ cells per kilogram) were infused. Red-cell transfusions were to be continued after transplantation until a large proportion of HbAT87Q (25 to 30% of total hemoglobin) was detected. The patient was followed for engraftment; toxic effects (graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.03); vector copy number in total nucleated blood cells and in different lineages; quantification of HbAT87Q, HbS, and fetal hemoglobin levels by means of high-performance liquid chromatography; DNA integration-site mapping by linear amplification–mediated polymerase chain reaction in nucleated blood cells; and replication-competent lentivirus analysis by p24 antibody enzyme-linked immunosorbent assay. Red-cell analyses were performed at month 12 (see the Methods section in the Supplementary Appendix). Results Engraftment and Gene Expression Neutrophil engraftment was achieved on day 38 after transplantation, and platelet engraftment was achieved on day 91 after transplantation. Figure 1A shows the trajectory of vector copy numbers and Figure 1B shows production of HbAT87Q. Gene marking increased progressively in whole blood, CD15 cells, B cells, and monocytes (Fig. S2 in the Supplementary Appendix), stabilizing 3 months after transplantation. Increases in levels of vector-bearing T cells were more gradual. Figure 1 Engraftment with Transduced Cells and Therapeutic Gene Expression in the Patient. HbAT87Q levels also increased steadily (Figure 1B) and red-cell transfusions were discontinued, with the last transfusion on day 88. Levels of HbAT87Q reached 5.5 g per deciliter (46%) at month 9 and continued to increase to 5.7 g per deciliter (48%) at month 15, with a reciprocal decrease in HbS levels to 5.5 g per deciliter (46%) at month 9 and 5.8 g per deciliter (49%) at month 15. Total hemoglobin levels were stable between 10.6 and 12.0 g per deciliter after post-transplantation month 6. Fetal hemoglobin levels remained below 1.0 g per deciliter. USER: Simplify this passage about gene therapy for sickle cell. Explain what the therapy is and how it works. Also explain the type of sickle cell the patient had. Use bullets an headers so it can be easier to read< Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	24	39	1,204	null	265
"================ <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."	In the context of Large Language Models(LLMs) like ChatGPT, how can ethical concerns be effectively integrated into their development and deployment? Also, explain the importance of applying multiple ethical perspectives.	The development of Large Language Models (LLMs) has been an incremental process, but particularly the public release of ChatGPT, an LLM-based conversational agent, in November 2022, sparked a worldwide hype and even speculation about impeding Artificial General Intelligence (AGI). Articles in both popular and academic publications have discussed diverse opportunities, challenges, and implications of conversational agents (e.g., Dwivedi et al. 2023). The field is developing so fast, that there is hardly time to properly assess what is going on. For many organizations, governments, companies, and citizens, key questions are: What can it do exactly? Is it hype or real? What are the various ethical issues? It is this last question that we aim to (partially) address in this paper. Below, we will discuss several ethical issues aspects of one LLM-based conversational agent: ChatGPT. The authors have worked in multiple applied research and innovation projects, with numerous clients and partners, on the development and evaluation of AI systems, and aiming to integrate concerns for ethical aspects in these projects. It is from this vantage point that we are interested in the ethical aspects of conversational agents. We have observed that ethical concerns often remain implicit; the people involved rarely explicitly discuss ethical perspectives and aspects. Conversely, we propose that making such perspectives and aspects more explicit, and organizing reflection and deliberation, is necessary, if we want to move ‘from principles to practices’ (Morley et al. 2020). Such ethical reflection and deliberation are urgent when AI systems are deployed in practice; especially if people’s safety and fundamental rights are at stake. In this article we discuss an approach to organize ethical reflection and deliberation, around the seven key requirements of the European Commission’s High-Level Expert Group on AI (HLEG) (2019). There are diverse approaches to integrate ethical aspects in the development and deployment of technologies; methods can be used at the start of development, during development, or after development (Reijers et al. 2018). We propose that integrating ethical aspects during development and deployment would be most useful, especially when this is part of an iterative development process, like CRISP-DM (Martínez-Plumed et al. 2021; Shearer 2000). Furthermore, we propose to use different ethical perspectives more explicitly. Notably, we propose to use consequentialism, duty ethics, relational ethics, and virtue ethics (Van de Poel and Royakkers 2011), and to use them in parallel, as complimentary perspectives. Moreover, we understand ethics as an iterative and participatory process of ethical reflection, inquiry, and deliberation (REF removed for review). The task for the people involved is then to make room for such a process and to facilitate relevant people to participate. Such a process can have three (iterative) steps: Identify issues that are (potentially) at play in the project and reflect on these. A handful of issues works best (if there are more, one can cluster; if there are less, one can explore more.) Organize dialogues with relevant people, both inside and outside the organization, for example, stakeholders, to inquire into these issues from diverse perspectives and to hear diverse voices. Make decisions, for example, between different design options and test these in experiments; this promotes transparency and accountability. The key is to steer the project more consciously, explicitly, and carefully. Our focus is on the first step (identify issues); below, we identify and discuss a range of ethical aspects of one specific LLM-based conversational agent: ChatGPT. The second step (organize dialogues) and the third step (make decisions) are outside the current article’s scope. Below, we will introduce the ingredients of our approach: a modest form of systems thinking; four complementary ethical perspectives; and the HLEG’s seven key requirements. Then we illustrate our approach with a case study of ChatGPT. This case study is also meant to explore how different ethical perspectives are relevant to different key requirements. We close the paper with a discussion of our approach. Human agency and oversight, including fundamental rights; the HLEG proposes the principle of respect for human autonomy (2019, p. 12), which they describe as follows: ‘Humans interacting with AI systems must be able to keep full and effective self-determination over themselves […]. AI systems […] should be designed to augment, complement and empower human cognitive, social and cultural skills.’ Human oversight refers to measures that help ‘ensuring that an AI system does not undermine human autonomy’ (HLEG, 2019, p. 16). Technical robustness and safety; this requirement refers to resilience to attacks and other security risks; to having effective fallback plans to promote safety; and to accuracy, reliability, and reproducibility. The evaluation of many of these aspects would require technical tests or experiments. In this article, however, we will only identify and discuss these aspects, and not actually conduct tests or experiments. Privacy and data governance; various concerns are at play, notably: that privacy sensitive information has probably been part of the training corpus many LLMs; and that users can submit privacy sensitive data through their prompts, thus submitting these data to the organizations that owns these LLMs and the conversational agents built on them. This information can also be used for subsequent finetuning of the model. Transparency; the HLEG argues (2019, p. 12) that ‘[e]xplicability is crucial for building and maintaining users’ trust in AI systems. This means that processes need to be transparent, the capabilities and purpose of AI systems openly communicated, and decisions—to the extent possible—explainable to those directly and indirectly affected. […] The degree to which explicability is needed is highly dependent on the context and the severity of the consequences if that output is erroneous or otherwise inaccurate.’ It also includes traceability, explainability, and communication. Moreover, it refers not only to the explicability of the AI system itself, but also to the processes in which this AI system is used, the capabilities and purposes of this system, and to communication about these processes, capabilities, and purposes. Diversity, non-discrimination and fairness; the HLEG (2019, p. 12) describes fairness as having ‘both a substantive and a procedural dimension. The substantive dimension implies a commitment to: ensuring equal and just distribution of both benefits and costs, and ensuring that individuals and groups are free from unfair bias, discrimination and stigmatisation. […] The procedural dimension […] entails the ability to contest and seek effective redress against decisions made by AI systems and by the humans operating them.’ Fairness not only refers narrowly to an application, but also to the processes and organizations in which this application is used (REF removed). Related aspects are: accessibility and universal design, and involving stakeholders in design and deployment. Societal and environmental well-being; the HLEG proposes the principle of prevention of harm (2019, p. 12): ‘AI systems should neither cause nor exacerbate harm or otherwise adversely affect human beings’; they draw attention to ‘situations where AI systems can cause or exacerbate adverse impacts due to asymmetries of power or information, such as between employers and employees, businesses and consumers or governments and citizens’ and to harms to ‘the natural environment and all living beings.’ Accountability; the HLEG describes this as ‘the assessment of algorithms, data and design processes’, through either internal or external audits; especially of applications that may affect fundamental rights or safety-critical applications (2019, pp. 19–20). It includes concerns for the auditability of systems and the ability to obtain redress for users; the HLEG recommends ‘accessible mechanisms… that ensure adequate redress’ (2019, p. 20).	"================ <TEXT PASSAGE> ======= The development of Large Language Models (LLMs) has been an incremental process, but particularly the public release of ChatGPT, an LLM-based conversational agent, in November 2022, sparked a worldwide hype and even speculation about impeding Artificial General Intelligence (AGI). Articles in both popular and academic publications have discussed diverse opportunities, challenges, and implications of conversational agents (e.g., Dwivedi et al. 2023). The field is developing so fast, that there is hardly time to properly assess what is going on. For many organizations, governments, companies, and citizens, key questions are: What can it do exactly? Is it hype or real? What are the various ethical issues? It is this last question that we aim to (partially) address in this paper. Below, we will discuss several ethical issues aspects of one LLM-based conversational agent: ChatGPT. The authors have worked in multiple applied research and innovation projects, with numerous clients and partners, on the development and evaluation of AI systems, and aiming to integrate concerns for ethical aspects in these projects. It is from this vantage point that we are interested in the ethical aspects of conversational agents. We have observed that ethical concerns often remain implicit; the people involved rarely explicitly discuss ethical perspectives and aspects. Conversely, we propose that making such perspectives and aspects more explicit, and organizing reflection and deliberation, is necessary, if we want to move ‘from principles to practices’ (Morley et al. 2020). Such ethical reflection and deliberation are urgent when AI systems are deployed in practice; especially if people’s safety and fundamental rights are at stake. In this article we discuss an approach to organize ethical reflection and deliberation, around the seven key requirements of the European Commission’s High-Level Expert Group on AI (HLEG) (2019). There are diverse approaches to integrate ethical aspects in the development and deployment of technologies; methods can be used at the start of development, during development, or after development (Reijers et al. 2018). We propose that integrating ethical aspects during development and deployment would be most useful, especially when this is part of an iterative development process, like CRISP-DM (Martínez-Plumed et al. 2021; Shearer 2000). Furthermore, we propose to use different ethical perspectives more explicitly. Notably, we propose to use consequentialism, duty ethics, relational ethics, and virtue ethics (Van de Poel and Royakkers 2011), and to use them in parallel, as complimentary perspectives. Moreover, we understand ethics as an iterative and participatory process of ethical reflection, inquiry, and deliberation (REF removed for review). The task for the people involved is then to make room for such a process and to facilitate relevant people to participate. Such a process can have three (iterative) steps: Identify issues that are (potentially) at play in the project and reflect on these. A handful of issues works best (if there are more, one can cluster; if there are less, one can explore more.) Organize dialogues with relevant people, both inside and outside the organization, for example, stakeholders, to inquire into these issues from diverse perspectives and to hear diverse voices. Make decisions, for example, between different design options and test these in experiments; this promotes transparency and accountability. The key is to steer the project more consciously, explicitly, and carefully. Our focus is on the first step (identify issues); below, we identify and discuss a range of ethical aspects of one specific LLM-based conversational agent: ChatGPT. The second step (organize dialogues) and the third step (make decisions) are outside the current article’s scope. Below, we will introduce the ingredients of our approach: a modest form of systems thinking; four complementary ethical perspectives; and the HLEG’s seven key requirements. Then we illustrate our approach with a case study of ChatGPT. This case study is also meant to explore how different ethical perspectives are relevant to different key requirements. We close the paper with a discussion of our approach. Human agency and oversight, including fundamental rights; the HLEG proposes the principle of respect for human autonomy (2019, p. 12), which they describe as follows: ‘Humans interacting with AI systems must be able to keep full and effective self-determination over themselves […]. AI systems […] should be designed to augment, complement and empower human cognitive, social and cultural skills.’ Human oversight refers to measures that help ‘ensuring that an AI system does not undermine human autonomy’ (HLEG, 2019, p. 16). Technical robustness and safety; this requirement refers to resilience to attacks and other security risks; to having effective fallback plans to promote safety; and to accuracy, reliability, and reproducibility. The evaluation of many of these aspects would require technical tests or experiments. In this article, however, we will only identify and discuss these aspects, and not actually conduct tests or experiments. Privacy and data governance; various concerns are at play, notably: that privacy sensitive information has probably been part of the training corpus many LLMs; and that users can submit privacy sensitive data through their prompts, thus submitting these data to the organizations that owns these LLMs and the conversational agents built on them. This information can also be used for subsequent finetuning of the model. Transparency; the HLEG argues (2019, p. 12) that ‘[e]xplicability is crucial for building and maintaining users’ trust in AI systems. This means that processes need to be transparent, the capabilities and purpose of AI systems openly communicated, and decisions—to the extent possible—explainable to those directly and indirectly affected. […] The degree to which explicability is needed is highly dependent on the context and the severity of the consequences if that output is erroneous or otherwise inaccurate.’ It also includes traceability, explainability, and communication. Moreover, it refers not only to the explicability of the AI system itself, but also to the processes in which this AI system is used, the capabilities and purposes of this system, and to communication about these processes, capabilities, and purposes. Diversity, non-discrimination and fairness; the HLEG (2019, p. 12) describes fairness as having ‘both a substantive and a procedural dimension. The substantive dimension implies a commitment to: ensuring equal and just distribution of both benefits and costs, and ensuring that individuals and groups are free from unfair bias, discrimination and stigmatisation. […] The procedural dimension […] entails the ability to contest and seek effective redress against decisions made by AI systems and by the humans operating them.’ Fairness not only refers narrowly to an application, but also to the processes and organizations in which this application is used (REF removed). Related aspects are: accessibility and universal design, and involving stakeholders in design and deployment. Societal and environmental well-being; the HLEG proposes the principle of prevention of harm (2019, p. 12): ‘AI systems should neither cause nor exacerbate harm or otherwise adversely affect human beings’; they draw attention to ‘situations where AI systems can cause or exacerbate adverse impacts due to asymmetries of power or information, such as between employers and employees, businesses and consumers or governments and citizens’ and to harms to ‘the natural environment and all living beings.’ Accountability; the HLEG describes this as ‘the assessment of algorithms, data and design processes’, through either internal or external audits; especially of applications that may affect fundamental rights or safety-critical applications (2019, pp. 19–20). It includes concerns for the auditability of systems and the ability to obtain redress for users; the HLEG recommends ‘accessible mechanisms… that ensure adequate redress’ (2019, p. 20). https://link.springer.com/article/10.1007/s43681-024-00571-x ================ <QUESTION> ======= In the context of Large Language Models(LLMs) like ChatGPT, how can ethical concerns be effectively integrated into their development and deployment? Also, explain the importance of applying multiple ethical perspectives. ================ <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: The development of Large Language Models (LLMs) has been an incremental process, but particularly the public release of ChatGPT, an LLM-based conversational agent, in November 2022, sparked a worldwide hype and even speculation about impeding Artificial General Intelligence (AGI). Articles in both popular and academic publications have discussed diverse opportunities, challenges, and implications of conversational agents (e.g., Dwivedi et al. 2023). The field is developing so fast, that there is hardly time to properly assess what is going on. For many organizations, governments, companies, and citizens, key questions are: What can it do exactly? Is it hype or real? What are the various ethical issues? It is this last question that we aim to (partially) address in this paper. Below, we will discuss several ethical issues aspects of one LLM-based conversational agent: ChatGPT. The authors have worked in multiple applied research and innovation projects, with numerous clients and partners, on the development and evaluation of AI systems, and aiming to integrate concerns for ethical aspects in these projects. It is from this vantage point that we are interested in the ethical aspects of conversational agents. We have observed that ethical concerns often remain implicit; the people involved rarely explicitly discuss ethical perspectives and aspects. Conversely, we propose that making such perspectives and aspects more explicit, and organizing reflection and deliberation, is necessary, if we want to move ‘from principles to practices’ (Morley et al. 2020). Such ethical reflection and deliberation are urgent when AI systems are deployed in practice; especially if people’s safety and fundamental rights are at stake. In this article we discuss an approach to organize ethical reflection and deliberation, around the seven key requirements of the European Commission’s High-Level Expert Group on AI (HLEG) (2019). There are diverse approaches to integrate ethical aspects in the development and deployment of technologies; methods can be used at the start of development, during development, or after development (Reijers et al. 2018). We propose that integrating ethical aspects during development and deployment would be most useful, especially when this is part of an iterative development process, like CRISP-DM (Martínez-Plumed et al. 2021; Shearer 2000). Furthermore, we propose to use different ethical perspectives more explicitly. Notably, we propose to use consequentialism, duty ethics, relational ethics, and virtue ethics (Van de Poel and Royakkers 2011), and to use them in parallel, as complimentary perspectives. Moreover, we understand ethics as an iterative and participatory process of ethical reflection, inquiry, and deliberation (REF removed for review). The task for the people involved is then to make room for such a process and to facilitate relevant people to participate. Such a process can have three (iterative) steps: Identify issues that are (potentially) at play in the project and reflect on these. A handful of issues works best (if there are more, one can cluster; if there are less, one can explore more.) Organize dialogues with relevant people, both inside and outside the organization, for example, stakeholders, to inquire into these issues from diverse perspectives and to hear diverse voices. Make decisions, for example, between different design options and test these in experiments; this promotes transparency and accountability. The key is to steer the project more consciously, explicitly, and carefully. Our focus is on the first step (identify issues); below, we identify and discuss a range of ethical aspects of one specific LLM-based conversational agent: ChatGPT. The second step (organize dialogues) and the third step (make decisions) are outside the current article’s scope. Below, we will introduce the ingredients of our approach: a modest form of systems thinking; four complementary ethical perspectives; and the HLEG’s seven key requirements. Then we illustrate our approach with a case study of ChatGPT. This case study is also meant to explore how different ethical perspectives are relevant to different key requirements. We close the paper with a discussion of our approach. Human agency and oversight, including fundamental rights; the HLEG proposes the principle of respect for human autonomy (2019, p. 12), which they describe as follows: ‘Humans interacting with AI systems must be able to keep full and effective self-determination over themselves […]. AI systems […] should be designed to augment, complement and empower human cognitive, social and cultural skills.’ Human oversight refers to measures that help ‘ensuring that an AI system does not undermine human autonomy’ (HLEG, 2019, p. 16). Technical robustness and safety; this requirement refers to resilience to attacks and other security risks; to having effective fallback plans to promote safety; and to accuracy, reliability, and reproducibility. The evaluation of many of these aspects would require technical tests or experiments. In this article, however, we will only identify and discuss these aspects, and not actually conduct tests or experiments. Privacy and data governance; various concerns are at play, notably: that privacy sensitive information has probably been part of the training corpus many LLMs; and that users can submit privacy sensitive data through their prompts, thus submitting these data to the organizations that owns these LLMs and the conversational agents built on them. This information can also be used for subsequent finetuning of the model. Transparency; the HLEG argues (2019, p. 12) that ‘[e]xplicability is crucial for building and maintaining users’ trust in AI systems. This means that processes need to be transparent, the capabilities and purpose of AI systems openly communicated, and decisions—to the extent possible—explainable to those directly and indirectly affected. […] The degree to which explicability is needed is highly dependent on the context and the severity of the consequences if that output is erroneous or otherwise inaccurate.’ It also includes traceability, explainability, and communication. Moreover, it refers not only to the explicability of the AI system itself, but also to the processes in which this AI system is used, the capabilities and purposes of this system, and to communication about these processes, capabilities, and purposes. Diversity, non-discrimination and fairness; the HLEG (2019, p. 12) describes fairness as having ‘both a substantive and a procedural dimension. The substantive dimension implies a commitment to: ensuring equal and just distribution of both benefits and costs, and ensuring that individuals and groups are free from unfair bias, discrimination and stigmatisation. […] The procedural dimension […] entails the ability to contest and seek effective redress against decisions made by AI systems and by the humans operating them.’ Fairness not only refers narrowly to an application, but also to the processes and organizations in which this application is used (REF removed). Related aspects are: accessibility and universal design, and involving stakeholders in design and deployment. Societal and environmental well-being; the HLEG proposes the principle of prevention of harm (2019, p. 12): ‘AI systems should neither cause nor exacerbate harm or otherwise adversely affect human beings’; they draw attention to ‘situations where AI systems can cause or exacerbate adverse impacts due to asymmetries of power or information, such as between employers and employees, businesses and consumers or governments and citizens’ and to harms to ‘the natural environment and all living beings.’ Accountability; the HLEG describes this as ‘the assessment of algorithms, data and design processes’, through either internal or external audits; especially of applications that may affect fundamental rights or safety-critical applications (2019, pp. 19–20). It includes concerns for the auditability of systems and the ability to obtain redress for users; the HLEG recommends ‘accessible mechanisms… that ensure adequate redress’ (2019, p. 20). USER: In the context of Large Language Models(LLMs) like ChatGPT, how can ethical concerns be effectively integrated into their development and deployment? Also, explain the importance of applying multiple ethical perspectives. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	49	30	1,221	null	700
[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.	Could you explain two key aspects of the U.S. legal system - first, by explaining the different functions of federal and state courts, and then explaining the differences between a civil and criminal case? Answer in a minimum of 300 words.	The legal system in the United States is not composed of a single set of laws and courts. Instead, an inter-connected web of laws, regulations, and courts stretches across the country at the state and federal levels. Courts interpret state and federal law to refine the rules through case law. The federal and state court systems have a hierarchy that allows higher courts to review decisions made by lower courts. Also, both systems have civil and criminal courts. FindLaw's Legal System section provides a closer look at the U.S. court system, including the federal court system and state court cases. This section also includes information about civil courts, including articles about class action lawsuits, tips on negotiating a settlement, the judge's role in court, and a helpful glossary with terms related to courts and the law. The United States Judiciary: Federal and State Courts The United States has two court systems: federal and state courts. Each court system hears criminal and civil cases. This section describes the differences and similarities between the federal and state court systems. Federal Courts Explained Article III of the U.S. Constitution allows Congress to create a federal court system. The federal judiciary has 13 courts of appeals, 94 U.S. district courts, a court of federal claims, and a court of international trade. The United States Supreme Court, the final arbiter of any case, is also a federal court. If you file a case in the federal system, your case begins at the district court level with a federal judge. If you appeal your case, a federal circuit court will hear the appeal. If you appeal the circuit court's decision, you must petition the U.S. Supreme Court to hear your case. The Supreme Court grants reviews (certiorari) of about 100 cases a year and is not obligated to hear your case. You can learn more about Supreme Court justices from FindLaw's Supreme Court Center. Federal District Courts have jurisdiction (i.e., the ability to hear a case) over the following types of cases: Cases where the U.S. government is a party to the lawsuit Disputes that raise constitutional questions or involve federal law (i.e., federal question jurisdiction) Controversies between the U.S. government and a state or foreign entity Sometimes, a plaintiff (the person or entity filing a lawsuit) may file a civil case in federal or state court. Two ways this happens is through diversity jurisdiction and federal question jurisdiction. Whether the plaintiff has this option depends on the circumstances of their case. A plaintiff who claims a person or entity violated their constitutional rights or broke a federal law may invoke federal question jurisdiction. If they can show that their case involved either a constitutional violation or that it arose under federal law, the federal district court may hear it. For a federal district court to have diversity jurisdiction, the plaintiff must show that they and the defendant(s) in a case live in different states and the amount in controversy exceeds $75,000. Read FindLaw's article on federal courts for more information. State Courts Explained The U.S. Constitution and state law establish each state's court system. Because of this, not every state has the same type of court system. Check your state's laws for more specific information about your state's courts. Because each state's court system is different, no absolute structure applies to the states. But generally, a plaintiff files their civil case in a state court, sometimes known as a trial court or state district court. If they appeal the trial court's decision, most states have an appellate court system that hears the appeal. If a party appeals from the appellate court, most states have a supreme court to review the case (although, again, the name of the highest court in your state may differ). If the highest court in your state issues a decision, you may generally petition the U.S. Supreme Court to consider your case. But, just like a federal circuit court appeal, the U.S. Supreme Court is not obligated to hear your case. Generally, state courts have jurisdiction over criminal and civil cases that involve that state's laws. For example, a Wisconsin state court could hear a civil case that invokes Wisconsin state law. The Wisconsin state court generally could not hear a civil case where the cause of action arose in Florida and broke Florida's state laws, as the Wisconsin court generally would not have jurisdiction over the subject matter of the case nor personal jurisdiction over the parties to the case. Read FindLaw's article on state courts for more in-depth information. Civil vs. Criminal Cases Deciding whether to file your case in a federal or state court is important. Another defining factor of your case is whether it is civil or criminal. Generally, civil cases involve claims between private parties. For example, if you borrowed tools from your neighbor and refused to return them, the neighbor could file a civil case against you in state court. Or, if you believe the school board at a local public school infringed your First Amendment right to free speech, you could file a civil claim against them in federal court. Criminal cases involve alleged offenses against society. Instead of a dispute between private parties, criminal cases involve the government bringing criminal charges against someone and prosecuting them. The following section describes the differences between civil and criminal cases. Civil Cases When a person, organization, or entity (such as a corporation) claims that another person, organization, or entity breached a legal duty owed to the plaintiff, they have a potential civil case. Common claims in civil lawsuits include the following: Intentional torts (e.g., infliction of emotional distress or assault) Negligence Nuisance Personal injury Breach of contract Property damage Child custody, child support, and other family law disputes Whether to file a civil lawsuit in federal or state court depends on the circumstances of your case. But, most plaintiffs file their civil lawsuits in state courts. Filing a civil case in federal court is only appropriate in certain circumstances. In civil litigation, the plaintiff has the burden of proof at trial. They must prove their case by a preponderance of the evidence. This standard means that the plaintiff must prove to the trier of fact (judge or jury) that it is more likely than not that the defendant is liable for the plaintiff's claimed relief or damages. Browse FindLaw's article on the basics of civil court for more information. Criminal Cases Unlike civil cases, where the injured party files a lawsuit, criminal cases involve the government bringing charges against the accused person. Most crimes in the United States involve violations of state laws rather than federal laws. So, state courts hear most criminal cases. In a state criminal case, district attorneys prosecute the defendant. But, suppose the government charges the defendant with a federal crime. In that case, a United States Attorney will prosecute the case in federal court. The prosecution has the burden of proof in a criminal case. They must prove the defendant's guilt beyond a reasonable doubt. Not every criminal case involves actual crime victims. For example, the government can prosecute someone for driving under the influence even if they did not injure anyone or cause property damage.	[question] Could you explain two key aspects of the U.S. legal system - first, by explaining the different functions of federal and state courts, and then explaining the differences between a civil and criminal case? Answer in a minimum of 300 words. ===================== [text] The legal system in the United States is not composed of a single set of laws and courts. Instead, an inter-connected web of laws, regulations, and courts stretches across the country at the state and federal levels. Courts interpret state and federal law to refine the rules through case law. The federal and state court systems have a hierarchy that allows higher courts to review decisions made by lower courts. Also, both systems have civil and criminal courts. FindLaw's Legal System section provides a closer look at the U.S. court system, including the federal court system and state court cases. This section also includes information about civil courts, including articles about class action lawsuits, tips on negotiating a settlement, the judge's role in court, and a helpful glossary with terms related to courts and the law. The United States Judiciary: Federal and State Courts The United States has two court systems: federal and state courts. Each court system hears criminal and civil cases. This section describes the differences and similarities between the federal and state court systems. Federal Courts Explained Article III of the U.S. Constitution allows Congress to create a federal court system. The federal judiciary has 13 courts of appeals, 94 U.S. district courts, a court of federal claims, and a court of international trade. The United States Supreme Court, the final arbiter of any case, is also a federal court. If you file a case in the federal system, your case begins at the district court level with a federal judge. If you appeal your case, a federal circuit court will hear the appeal. If you appeal the circuit court's decision, you must petition the U.S. Supreme Court to hear your case. The Supreme Court grants reviews (certiorari) of about 100 cases a year and is not obligated to hear your case. You can learn more about Supreme Court justices from FindLaw's Supreme Court Center. Federal District Courts have jurisdiction (i.e., the ability to hear a case) over the following types of cases: Cases where the U.S. government is a party to the lawsuit Disputes that raise constitutional questions or involve federal law (i.e., federal question jurisdiction) Controversies between the U.S. government and a state or foreign entity Sometimes, a plaintiff (the person or entity filing a lawsuit) may file a civil case in federal or state court. Two ways this happens is through diversity jurisdiction and federal question jurisdiction. Whether the plaintiff has this option depends on the circumstances of their case. A plaintiff who claims a person or entity violated their constitutional rights or broke a federal law may invoke federal question jurisdiction. If they can show that their case involved either a constitutional violation or that it arose under federal law, the federal district court may hear it. For a federal district court to have diversity jurisdiction, the plaintiff must show that they and the defendant(s) in a case live in different states and the amount in controversy exceeds $75,000. Read FindLaw's article on federal courts for more information. State Courts Explained The U.S. Constitution and state law establish each state's court system. Because of this, not every state has the same type of court system. Check your state's laws for more specific information about your state's courts. Because each state's court system is different, no absolute structure applies to the states. But generally, a plaintiff files their civil case in a state court, sometimes known as a trial court or state district court. If they appeal the trial court's decision, most states have an appellate court system that hears the appeal. If a party appeals from the appellate court, most states have a supreme court to review the case (although, again, the name of the highest court in your state may differ). If the highest court in your state issues a decision, you may generally petition the U.S. Supreme Court to consider your case. But, just like a federal circuit court appeal, the U.S. Supreme Court is not obligated to hear your case. Generally, state courts have jurisdiction over criminal and civil cases that involve that state's laws. For example, a Wisconsin state court could hear a civil case that invokes Wisconsin state law. The Wisconsin state court generally could not hear a civil case where the cause of action arose in Florida and broke Florida's state laws, as the Wisconsin court generally would not have jurisdiction over the subject matter of the case nor personal jurisdiction over the parties to the case. Read FindLaw's article on state courts for more in-depth information. Civil vs. Criminal Cases Deciding whether to file your case in a federal or state court is important. Another defining factor of your case is whether it is civil or criminal. Generally, civil cases involve claims between private parties. For example, if you borrowed tools from your neighbor and refused to return them, the neighbor could file a civil case against you in state court. Or, if you believe the school board at a local public school infringed your First Amendment right to free speech, you could file a civil claim against them in federal court. Criminal cases involve alleged offenses against society. Instead of a dispute between private parties, criminal cases involve the government bringing criminal charges against someone and prosecuting them. The following section describes the differences between civil and criminal cases. Civil Cases When a person, organization, or entity (such as a corporation) claims that another person, organization, or entity breached a legal duty owed to the plaintiff, they have a potential civil case. Common claims in civil lawsuits include the following: Intentional torts (e.g., infliction of emotional distress or assault) Negligence Nuisance Personal injury Breach of contract Property damage Child custody, child support, and other family law disputes Whether to file a civil lawsuit in federal or state court depends on the circumstances of your case. But, most plaintiffs file their civil lawsuits in state courts. Filing a civil case in federal court is only appropriate in certain circumstances. In civil litigation, the plaintiff has the burden of proof at trial. They must prove their case by a preponderance of the evidence. This standard means that the plaintiff must prove to the trier of fact (judge or jury) that it is more likely than not that the defendant is liable for the plaintiff's claimed relief or damages. Browse FindLaw's article on the basics of civil court for more information. Criminal Cases Unlike civil cases, where the injured party files a lawsuit, criminal cases involve the government bringing charges against the accused person. Most crimes in the United States involve violations of state laws rather than federal laws. So, state courts hear most criminal cases. In a state criminal case, district attorneys prosecute the defendant. But, suppose the government charges the defendant with a federal crime. In that case, a United States Attorney will prosecute the case in federal court. The prosecution has the burden of proof in a criminal case. They must prove the defendant's guilt beyond a reasonable doubt. Not every criminal case involves actual crime victims. For example, the government can prosecute someone for driving under the influence even if they did not injure anyone or cause property damage. https://www.findlaw.com/litigation/legal-system/introduction-to-the-u-s-legal-system.html ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.	[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 legal system in the United States is not composed of a single set of laws and courts. Instead, an inter-connected web of laws, regulations, and courts stretches across the country at the state and federal levels. Courts interpret state and federal law to refine the rules through case law. The federal and state court systems have a hierarchy that allows higher courts to review decisions made by lower courts. Also, both systems have civil and criminal courts. FindLaw's Legal System section provides a closer look at the U.S. court system, including the federal court system and state court cases. This section also includes information about civil courts, including articles about class action lawsuits, tips on negotiating a settlement, the judge's role in court, and a helpful glossary with terms related to courts and the law. The United States Judiciary: Federal and State Courts The United States has two court systems: federal and state courts. Each court system hears criminal and civil cases. This section describes the differences and similarities between the federal and state court systems. Federal Courts Explained Article III of the U.S. Constitution allows Congress to create a federal court system. The federal judiciary has 13 courts of appeals, 94 U.S. district courts, a court of federal claims, and a court of international trade. The United States Supreme Court, the final arbiter of any case, is also a federal court. If you file a case in the federal system, your case begins at the district court level with a federal judge. If you appeal your case, a federal circuit court will hear the appeal. If you appeal the circuit court's decision, you must petition the U.S. Supreme Court to hear your case. The Supreme Court grants reviews (certiorari) of about 100 cases a year and is not obligated to hear your case. You can learn more about Supreme Court justices from FindLaw's Supreme Court Center. Federal District Courts have jurisdiction (i.e., the ability to hear a case) over the following types of cases: Cases where the U.S. government is a party to the lawsuit Disputes that raise constitutional questions or involve federal law (i.e., federal question jurisdiction) Controversies between the U.S. government and a state or foreign entity Sometimes, a plaintiff (the person or entity filing a lawsuit) may file a civil case in federal or state court. Two ways this happens is through diversity jurisdiction and federal question jurisdiction. Whether the plaintiff has this option depends on the circumstances of their case. A plaintiff who claims a person or entity violated their constitutional rights or broke a federal law may invoke federal question jurisdiction. If they can show that their case involved either a constitutional violation or that it arose under federal law, the federal district court may hear it. For a federal district court to have diversity jurisdiction, the plaintiff must show that they and the defendant(s) in a case live in different states and the amount in controversy exceeds $75,000. Read FindLaw's article on federal courts for more information. State Courts Explained The U.S. Constitution and state law establish each state's court system. Because of this, not every state has the same type of court system. Check your state's laws for more specific information about your state's courts. Because each state's court system is different, no absolute structure applies to the states. But generally, a plaintiff files their civil case in a state court, sometimes known as a trial court or state district court. If they appeal the trial court's decision, most states have an appellate court system that hears the appeal. If a party appeals from the appellate court, most states have a supreme court to review the case (although, again, the name of the highest court in your state may differ). If the highest court in your state issues a decision, you may generally petition the U.S. Supreme Court to consider your case. But, just like a federal circuit court appeal, the U.S. Supreme Court is not obligated to hear your case. Generally, state courts have jurisdiction over criminal and civil cases that involve that state's laws. For example, a Wisconsin state court could hear a civil case that invokes Wisconsin state law. The Wisconsin state court generally could not hear a civil case where the cause of action arose in Florida and broke Florida's state laws, as the Wisconsin court generally would not have jurisdiction over the subject matter of the case nor personal jurisdiction over the parties to the case. Read FindLaw's article on state courts for more in-depth information. Civil vs. Criminal Cases Deciding whether to file your case in a federal or state court is important. Another defining factor of your case is whether it is civil or criminal. Generally, civil cases involve claims between private parties. For example, if you borrowed tools from your neighbor and refused to return them, the neighbor could file a civil case against you in state court. Or, if you believe the school board at a local public school infringed your First Amendment right to free speech, you could file a civil claim against them in federal court. Criminal cases involve alleged offenses against society. Instead of a dispute between private parties, criminal cases involve the government bringing criminal charges against someone and prosecuting them. The following section describes the differences between civil and criminal cases. Civil Cases When a person, organization, or entity (such as a corporation) claims that another person, organization, or entity breached a legal duty owed to the plaintiff, they have a potential civil case. Common claims in civil lawsuits include the following: Intentional torts (e.g., infliction of emotional distress or assault) Negligence Nuisance Personal injury Breach of contract Property damage Child custody, child support, and other family law disputes Whether to file a civil lawsuit in federal or state court depends on the circumstances of your case. But, most plaintiffs file their civil lawsuits in state courts. Filing a civil case in federal court is only appropriate in certain circumstances. In civil litigation, the plaintiff has the burden of proof at trial. They must prove their case by a preponderance of the evidence. This standard means that the plaintiff must prove to the trier of fact (judge or jury) that it is more likely than not that the defendant is liable for the plaintiff's claimed relief or damages. Browse FindLaw's article on the basics of civil court for more information. Criminal Cases Unlike civil cases, where the injured party files a lawsuit, criminal cases involve the government bringing charges against the accused person. Most crimes in the United States involve violations of state laws rather than federal laws. So, state courts hear most criminal cases. In a state criminal case, district attorneys prosecute the defendant. But, suppose the government charges the defendant with a federal crime. In that case, a United States Attorney will prosecute the case in federal court. The prosecution has the burden of proof in a criminal case. They must prove the defendant's guilt beyond a reasonable doubt. Not every criminal case involves actual crime victims. For example, the government can prosecute someone for driving under the influence even if they did not injure anyone or cause property damage. USER: Could you explain two key aspects of the U.S. legal system - first, by explaining the different functions of federal and state courts, and then explaining the differences between a civil and criminal case? Answer in a minimum of 300 words. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	28	41	1,205	null	247
Respond to questions or requests using only the information contained in the text that is provided to you.	Summarize and list the cases used to support the policy in this document in chronological order.	Attorney Fees The Freedom of Information Act is one of more than a hundred different federal statutes that contain a "fee-shifting" provision permitting the trial court to award reasonable attorney fees and litigation costs to a plaintiff who has "substantially prevailed."1 The FOIA's attorney fees provision requires courts to engage in a two-step substantive inquiry. The court must determine first if the plaintiff is eligible for an award of fees and/or costs and it must then determine if the plaintiff is entitled to the award.2 Even if a plaintiff meets both of these tests, the award of fees and costs is entirely within the discretion of the court.3 Threshold Issues The FOIA's attorney fees provision limits an award to fees and costs incurred in litigating a case brought pursuant to the FOIA;4 accordingly, fees and other costs are generally 1 5 U.S.C. § 552(a)(4)(E)(i) (2006), amended by OPEN Government Act of 2007, Pub. L. No. 110-175, 121 Stat. 2524. 2 See, e.g., Tax Analysts v. DOJ, 965 F.2d 1092, 1093 (D.C. Cir. 1992); Church of Scientology v. USPS, 700 F.2d 486, 489 (9th Cir. 1983); see also Wheeler v. IRS, 37 F. Supp. 2d 407, 411 n.1 (W.D. Pa. 1998) ("The test for whether the court should award a FOIA plaintiff litigation costs is the same as the test for whether attorney fees should be awarded."). 3 See, e.g., Lissner v. U.S. Customs Serv., 56 F. App'x 330, 331 (9th Cir. 2002) (stating that review of attorney fee award is for abuse of discretion); Anderson v. HHS, 80 F.3d 1500, 1504 (10th Cir. 1996) ("Assessment of attorney's fees in an FOIA case is discretionary with the district court."); Detroit Free Press, Inc. v. DOJ, 73 F.3d 93, 98 (6th Cir. 1996) ("We review the court's determination [to grant fees] for an abuse of discretion."); Young v. Dir., No. 92-2561, 1993 WL 305970, at 2 (4th Cir. 1993) (noting that court has discretion to deny fees even if eligibility threshold is met); Maynard v. CIA, 986 F.2d 547, 567 (1st Cir. 1993) (holding that a decision on whether to award attorney fees "will be reversed only for an abuse of . . . discretion"); Tax Analysts, 965 F.2d at 1094 ("sifting of those [fee] criteria over the facts of a case is a matter of district court discretion"); Hersh & Hersh v. HHS, No. 06-4234, 2008 WL 2725497, at 1 (N.D. Cal. July 10, 2008) ("If a plaintiff demonstrates eligibility for fees, the district court may then, in the exercise of its discretion, determine that the plaintiff is entitled to an award of fees and costs."); Bangor Hydro-Elec. Co. v. U.S. Dep't of the Interior, 903 F. Supp. 160, 170 (D. Me. 1995) ("Awards of litigation costs and attorney fees under FOIA are left to the sound discretion of the trial court."). 4 See Nichols v. Pierce, 740 F.2d 1249, 1252-54 (D.C. Cir. 1984) (refusing to award fees for (continued...) not awarded for services rendered at the administrative level.5 Furthermore, the Court of Appeals for the District of Columbia Circuit has held that FOIA litigation costs related to disputes with third parties, "who are not within the government's authority or control, with respect to litigation issues that were neither raised nor pursued by the government, cannot form the basis of a fee award under 5 U.S.C. § 552(a)(4)(E)."6 A threshold eligibility matter concerns precisely who can qualify for an award of attorney fees. The D.C. Circuit has found that the Supreme Court's decision in Kay v. Ehrler7 establishes that subsection (a)(4)(E)(i) of the FOIA does not authorize the award of fees to a pro se non-attorney plaintiff, because "the word 'attorney,' when used in the context of a feeshifting statute, does not encompass a layperson proceeding on his own behalf."8 In order to 4 (...continued) plaintiff's success under Administrative Procedure Act, 5 U.S.C. §§ 701-706 (2006), resulting in order to agency to issue regulations, despite plaintiff's claim of victory under FOIA subsection (a)(1)), because Complaint failed to assert claim under or rely specifically on FOIA). 5 See AutoAlliance Int'l, Inc. v. U.S. Customs Serv., No. 02-72369, slip op. at 3 (E.D. Mich. Mar. 23, 2004) (denying attorney fees for time spent on "administrative appeals that should have been completed prior to filing suit"); Inst. for Wildlife Prot. v. U.S. Fish & Wildlife Serv., No. 02-6178, slip op. at 6 (D. Or. Dec. 3, 2003) (deducting hours spent on FOIA administrative process for fee-calculation purposes); Nw. Coal. for Alternatives to Pesticides v. Browner, 965 F. Supp. 59, 65 (D.D.C. 1997) ("FOIA does not authorize fees for work performed at the administrative stage."); Associated Gen. Contractors v. EPA, 488 F. Supp. 861, 864 (D. Nev. 1980) (concluding that attorney fees are unavailable for work performed at administrative level); cf. Kennedy v. Andrus, 459 F. Supp. 240, 244 (D.D.C. 1978) (rejecting attorney fees claim for services rendered at administrative level under Privacy Act, 5 U.S.C. § 552a (2006)), aff'd, 612 F.2d 586 (D.C. Cir. 1980) (unpublished table decision). But see Or. Natural Desert Ass'n v. Gutierrez, 442 F. Supp. 2d 1096, 1101 (D. Or. 2006) (awarding fees for work performed at the administrative level, on the rationale that "exhaustion of remedies is required and provides a sufficient record for the civil action") (appeal pending); McCoy v. BOP, No. 03-383, 2005 WL 1972600, at 4 (E.D. Ky. Aug. 16, 2005) (permitting fees for work on plaintiff's administrative appeal, on the rationale that it "was necessary to exhaust administrative remedies"), reconsideration denied, No. 03-383 (E.D. Ky. Oct. 6, 2005); cf. Tule River Conservancy v. U.S. Forest Serv., No. 97-5720, slip op. at 16-17 (E.D. Cal. Sept. 12, 2000) (allowing attorney fees for pre-litigation research on "how to exhaust [plaintiff's] administration remedies prior to filing suit" and on "how to file FOIA complaint"). 6 Judicial Watch, Inc. v. U.S. Dep't of Commerce, 470 F.3d 363, 373 (D.C. Cir. 2006). 7 499 U.S. 432 (1991). 8 Benavides v. BOP, 993 F.2d 257, 259 (D.C. Cir. 1993) (explaining Kay decision); see Bensman v. U.S. Fish & Wildlife Serv., 49 F. App'x 646, 647 (7th Cir. 2002) ("Even when a pro se litigant performs the same tasks as an attorney, he is not entitled to reimbursement for his time."); Sukup v. EOUSA, No. 02-0355, 2007 WL 2405716, at 1 (D.D.C. Aug. 23, 2007) ("Pro se plaintiffs may not recover attorney's fees under the FOIA."); Deichman v. United States, No. 2:05cv680, 2006 WL 3000448, at 7 (E.D. Va. Oct. 20, 2006) (holding that pro see litigant cannot (continued...) be eligible for attorney fees, therefore, a FOIA plaintiff must have a representational relationship with an attorney.9 Furthermore, Kay indicated that no award of attorney fees should be made to a pro se plaintiff who also is an attorney. 10 Because the fee-shifting provision of the FOIA was intended "'to encourage potential claimants to seek legal advice before commencing litigation,'"11 and because a pro se attorney, by definition, does not seek out the "'detached and objective perspective necessary'" to litigate his FOIA case,12 the overwhelming majority of courts have agreed with Kay and have held that a pro se attorney is not eligible for a fee award that otherwise would have had to be paid to counsel.13 This is particularly so because 8 (...continued) recover attorney fees under FOIA); Lair v. Dep't of the Treasury, No. 03-827, 2005 WL 645228, at 6 (D.D.C. Mar. 21, 2005) (explaining that "pro-se non-attorney . . . may not collect attorney fees" (citing Benavides)), reconsideration denied, 2005 WL 1330722 (D.D.C. June 3, 2005). 9 See Kooritzky v. Herman, 178 F.3d 1315, 1323 (D.C. Cir. 1999) (holding that for all similarly worded fee-shifting statutes, "the term 'attorney' contemplates an agency relationship between a litigant and an independent lawyer"); see also Blazy v. Tenet, 194 F.3d 90, 94 (D.C. Cir. 1999) (concluding that attorney need not file formal appearance in order for litigant to claim fees for consultations, so long as attorney-client relationship existed) (Privacy Act case); cf. Anderson v. U.S. Dep't of the Treasury, 648 F.2d 1, 3 (D.C. Cir. 1979) (indicating that when an organization litigates through in-house counsel, any payable attorney fees should not "exceed[] the expenses incurred by [that party] in terms of [in-house counsel] salaries and other out-of-pocket expenses").	Respond to questions or requests using only the information contained in the text that is provided to you. Summarize and list the cases used to support the policy in this document in chronological order. Attorney Fees The Freedom of Information Act is one of more than a hundred different federal statutes that contain a "fee-shifting" provision permitting the trial court to award reasonable attorney fees and litigation costs to a plaintiff who has "substantially prevailed."1 The FOIA's attorney fees provision requires courts to engage in a two-step substantive inquiry. The court must determine first if the plaintiff is eligible for an award of fees and/or costs and it must then determine if the plaintiff is entitled to the award.2 Even if a plaintiff meets both of these tests, the award of fees and costs is entirely within the discretion of the court.3 Threshold Issues The FOIA's attorney fees provision limits an award to fees and costs incurred in litigating a case brought pursuant to the FOIA;4 accordingly, fees and other costs are generally 1 5 U.S.C. § 552(a)(4)(E)(i) (2006), amended by OPEN Government Act of 2007, Pub. L. No. 110-175, 121 Stat. 2524. 2 See, e.g., Tax Analysts v. DOJ, 965 F.2d 1092, 1093 (D.C. Cir. 1992); Church of Scientology v. USPS, 700 F.2d 486, 489 (9th Cir. 1983); see also Wheeler v. IRS, 37 F. Supp. 2d 407, 411 n.1 (W.D. Pa. 1998) ("The test for whether the court should award a FOIA plaintiff litigation costs is the same as the test for whether attorney fees should be awarded."). 3 See, e.g., Lissner v. U.S. Customs Serv., 56 F. App'x 330, 331 (9th Cir. 2002) (stating that review of attorney fee award is for abuse of discretion); Anderson v. HHS, 80 F.3d 1500, 1504 (10th Cir. 1996) ("Assessment of attorney's fees in an FOIA case is discretionary with the district court."); Detroit Free Press, Inc. v. DOJ, 73 F.3d 93, 98 (6th Cir. 1996) ("We review the court's determination [to grant fees] for an abuse of discretion."); Young v. Dir., No. 92-2561, 1993 WL 305970, at 2 (4th Cir. 1993) (noting that court has discretion to deny fees even if eligibility threshold is met); Maynard v. CIA, 986 F.2d 547, 567 (1st Cir. 1993) (holding that a decision on whether to award attorney fees "will be reversed only for an abuse of . . . discretion"); Tax Analysts, 965 F.2d at 1094 ("sifting of those [fee] criteria over the facts of a case is a matter of district court discretion"); Hersh & Hersh v. HHS, No. 06-4234, 2008 WL 2725497, at 1 (N.D. Cal. July 10, 2008) ("If a plaintiff demonstrates eligibility for fees, the district court may then, in the exercise of its discretion, determine that the plaintiff is entitled to an award of fees and costs."); Bangor Hydro-Elec. Co. v. U.S. Dep't of the Interior, 903 F. Supp. 160, 170 (D. Me. 1995) ("Awards of litigation costs and attorney fees under FOIA are left to the sound discretion of the trial court."). 4 See Nichols v. Pierce, 740 F.2d 1249, 1252-54 (D.C. Cir. 1984) (refusing to award fees for (continued...) not awarded for services rendered at the administrative level.5 Furthermore, the Court of Appeals for the District of Columbia Circuit has held that FOIA litigation costs related to disputes with third parties, "who are not within the government's authority or control, with respect to litigation issues that were neither raised nor pursued by the government, cannot form the basis of a fee award under 5 U.S.C. § 552(a)(4)(E)."6 A threshold eligibility matter concerns precisely who can qualify for an award of attorney fees. The D.C. Circuit has found that the Supreme Court's decision in Kay v. Ehrler7 establishes that subsection (a)(4)(E)(i) of the FOIA does not authorize the award of fees to a pro se non-attorney plaintiff, because "the word 'attorney,' when used in the context of a feeshifting statute, does not encompass a layperson proceeding on his own behalf."8 In order to 4 (...continued) plaintiff's success under Administrative Procedure Act, 5 U.S.C. §§ 701-706 (2006), resulting in order to agency to issue regulations, despite plaintiff's claim of victory under FOIA subsection (a)(1)), because Complaint failed to assert claim under or rely specifically on FOIA). 5 See AutoAlliance Int'l, Inc. v. U.S. Customs Serv., No. 02-72369, slip op. at 3 (E.D. Mich. Mar. 23, 2004) (denying attorney fees for time spent on "administrative appeals that should have been completed prior to filing suit"); Inst. for Wildlife Prot. v. U.S. Fish & Wildlife Serv., No. 02-6178, slip op. at 6 (D. Or. Dec. 3, 2003) (deducting hours spent on FOIA administrative process for fee-calculation purposes); Nw. Coal. for Alternatives to Pesticides v. Browner, 965 F. Supp. 59, 65 (D.D.C. 1997) ("FOIA does not authorize fees for work performed at the administrative stage."); Associated Gen. Contractors v. EPA, 488 F. Supp. 861, 864 (D. Nev. 1980) (concluding that attorney fees are unavailable for work performed at administrative level); cf. Kennedy v. Andrus, 459 F. Supp. 240, 244 (D.D.C. 1978) (rejecting attorney fees claim for services rendered at administrative level under Privacy Act, 5 U.S.C. § 552a (2006)), aff'd, 612 F.2d 586 (D.C. Cir. 1980) (unpublished table decision). But see Or. Natural Desert Ass'n v. Gutierrez, 442 F. Supp. 2d 1096, 1101 (D. Or. 2006) (awarding fees for work performed at the administrative level, on the rationale that "exhaustion of remedies is required and provides a sufficient record for the civil action") (appeal pending); McCoy v. BOP, No. 03-383, 2005 WL 1972600, at 4 (E.D. Ky. Aug. 16, 2005) (permitting fees for work on plaintiff's administrative appeal, on the rationale that it "was necessary to exhaust administrative remedies"), reconsideration denied, No. 03-383 (E.D. Ky. Oct. 6, 2005); cf. Tule River Conservancy v. U.S. Forest Serv., No. 97-5720, slip op. at 16-17 (E.D. Cal. Sept. 12, 2000) (allowing attorney fees for pre-litigation research on "how to exhaust [plaintiff's] administration remedies prior to filing suit" and on "how to file FOIA complaint"). 6 Judicial Watch, Inc. v. U.S. Dep't of Commerce, 470 F.3d 363, 373 (D.C. Cir. 2006). 7 499 U.S. 432 (1991). 8 Benavides v. BOP, 993 F.2d 257, 259 (D.C. Cir. 1993) (explaining Kay decision); see Bensman v. U.S. Fish & Wildlife Serv., 49 F. App'x 646, 647 (7th Cir. 2002) ("Even when a pro se litigant performs the same tasks as an attorney, he is not entitled to reimbursement for his time."); Sukup v. EOUSA, No. 02-0355, 2007 WL 2405716, at 1 (D.D.C. Aug. 23, 2007) ("Pro se plaintiffs may not recover attorney's fees under the FOIA."); Deichman v. United States, No. 2:05cv680, 2006 WL 3000448, at 7 (E.D. Va. Oct. 20, 2006) (holding that pro see litigant cannot (continued...) be eligible for attorney fees, therefore, a FOIA plaintiff must have a representational relationship with an attorney.9 Furthermore, Kay indicated that no award of attorney fees should be made to a pro se plaintiff who also is an attorney. 10 Because the fee-shifting provision of the FOIA was intended "'to encourage potential claimants to seek legal advice before commencing litigation,'"11 and because a pro se attorney, by definition, does not seek out the "'detached and objective perspective necessary'" to litigate his FOIA case,12 the overwhelming majority of courts have agreed with Kay and have held that a pro se attorney is not eligible for a fee award that otherwise would have had to be paid to counsel.13 This is particularly so because 8 (...continued) recover attorney fees under FOIA); Lair v. Dep't of the Treasury, No. 03-827, 2005 WL 645228, at 6 (D.D.C. Mar. 21, 2005) (explaining that "pro-se non-attorney . . . may not collect attorney fees" (citing Benavides)), reconsideration denied, 2005 WL 1330722 (D.D.C. June 3, 2005). 9 See Kooritzky v. Herman, 178 F.3d 1315, 1323 (D.C. Cir. 1999) (holding that for all similarly worded fee-shifting statutes, "the term 'attorney' contemplates an agency relationship between a litigant and an independent lawyer"); see also Blazy v. Tenet, 194 F.3d 90, 94 (D.C. Cir. 1999) (concluding that attorney need not file formal appearance in order for litigant to claim fees for consultations, so long as attorney-client relationship existed) (Privacy Act case); cf. Anderson v. U.S. Dep't of the Treasury, 648 F.2d 1, 3 (D.C. Cir. 1979) (indicating that when an organization litigates through in-house counsel, any payable attorney fees should not "exceed[] the expenses incurred by [that party] in terms of [in-house counsel] salaries and other out-of-pocket expenses").	Respond to questions or requests using only the information contained in the text that is provided to you. EVIDENCE: Attorney Fees The Freedom of Information Act is one of more than a hundred different federal statutes that contain a "fee-shifting" provision permitting the trial court to award reasonable attorney fees and litigation costs to a plaintiff who has "substantially prevailed."1 The FOIA's attorney fees provision requires courts to engage in a two-step substantive inquiry. The court must determine first if the plaintiff is eligible for an award of fees and/or costs and it must then determine if the plaintiff is entitled to the award.2 Even if a plaintiff meets both of these tests, the award of fees and costs is entirely within the discretion of the court.3 Threshold Issues The FOIA's attorney fees provision limits an award to fees and costs incurred in litigating a case brought pursuant to the FOIA;4 accordingly, fees and other costs are generally 1 5 U.S.C. § 552(a)(4)(E)(i) (2006), amended by OPEN Government Act of 2007, Pub. L. No. 110-175, 121 Stat. 2524. 2 See, e.g., Tax Analysts v. DOJ, 965 F.2d 1092, 1093 (D.C. Cir. 1992); Church of Scientology v. USPS, 700 F.2d 486, 489 (9th Cir. 1983); see also Wheeler v. IRS, 37 F. Supp. 2d 407, 411 n.1 (W.D. Pa. 1998) ("The test for whether the court should award a FOIA plaintiff litigation costs is the same as the test for whether attorney fees should be awarded."). 3 See, e.g., Lissner v. U.S. Customs Serv., 56 F. App'x 330, 331 (9th Cir. 2002) (stating that review of attorney fee award is for abuse of discretion); Anderson v. HHS, 80 F.3d 1500, 1504 (10th Cir. 1996) ("Assessment of attorney's fees in an FOIA case is discretionary with the district court."); Detroit Free Press, Inc. v. DOJ, 73 F.3d 93, 98 (6th Cir. 1996) ("We review the court's determination [to grant fees] for an abuse of discretion."); Young v. Dir., No. 92-2561, 1993 WL 305970, at 2 (4th Cir. 1993) (noting that court has discretion to deny fees even if eligibility threshold is met); Maynard v. CIA, 986 F.2d 547, 567 (1st Cir. 1993) (holding that a decision on whether to award attorney fees "will be reversed only for an abuse of . . . discretion"); Tax Analysts, 965 F.2d at 1094 ("sifting of those [fee] criteria over the facts of a case is a matter of district court discretion"); Hersh & Hersh v. HHS, No. 06-4234, 2008 WL 2725497, at 1 (N.D. Cal. July 10, 2008) ("If a plaintiff demonstrates eligibility for fees, the district court may then, in the exercise of its discretion, determine that the plaintiff is entitled to an award of fees and costs."); Bangor Hydro-Elec. Co. v. U.S. Dep't of the Interior, 903 F. Supp. 160, 170 (D. Me. 1995) ("Awards of litigation costs and attorney fees under FOIA are left to the sound discretion of the trial court."). 4 See Nichols v. Pierce, 740 F.2d 1249, 1252-54 (D.C. Cir. 1984) (refusing to award fees for (continued...) not awarded for services rendered at the administrative level.5 Furthermore, the Court of Appeals for the District of Columbia Circuit has held that FOIA litigation costs related to disputes with third parties, "who are not within the government's authority or control, with respect to litigation issues that were neither raised nor pursued by the government, cannot form the basis of a fee award under 5 U.S.C. § 552(a)(4)(E)."6 A threshold eligibility matter concerns precisely who can qualify for an award of attorney fees. The D.C. Circuit has found that the Supreme Court's decision in Kay v. Ehrler7 establishes that subsection (a)(4)(E)(i) of the FOIA does not authorize the award of fees to a pro se non-attorney plaintiff, because "the word 'attorney,' when used in the context of a feeshifting statute, does not encompass a layperson proceeding on his own behalf."8 In order to 4 (...continued) plaintiff's success under Administrative Procedure Act, 5 U.S.C. §§ 701-706 (2006), resulting in order to agency to issue regulations, despite plaintiff's claim of victory under FOIA subsection (a)(1)), because Complaint failed to assert claim under or rely specifically on FOIA). 5 See AutoAlliance Int'l, Inc. v. U.S. Customs Serv., No. 02-72369, slip op. at 3 (E.D. Mich. Mar. 23, 2004) (denying attorney fees for time spent on "administrative appeals that should have been completed prior to filing suit"); Inst. for Wildlife Prot. v. U.S. Fish & Wildlife Serv., No. 02-6178, slip op. at 6 (D. Or. Dec. 3, 2003) (deducting hours spent on FOIA administrative process for fee-calculation purposes); Nw. Coal. for Alternatives to Pesticides v. Browner, 965 F. Supp. 59, 65 (D.D.C. 1997) ("FOIA does not authorize fees for work performed at the administrative stage."); Associated Gen. Contractors v. EPA, 488 F. Supp. 861, 864 (D. Nev. 1980) (concluding that attorney fees are unavailable for work performed at administrative level); cf. Kennedy v. Andrus, 459 F. Supp. 240, 244 (D.D.C. 1978) (rejecting attorney fees claim for services rendered at administrative level under Privacy Act, 5 U.S.C. § 552a (2006)), aff'd, 612 F.2d 586 (D.C. Cir. 1980) (unpublished table decision). But see Or. Natural Desert Ass'n v. Gutierrez, 442 F. Supp. 2d 1096, 1101 (D. Or. 2006) (awarding fees for work performed at the administrative level, on the rationale that "exhaustion of remedies is required and provides a sufficient record for the civil action") (appeal pending); McCoy v. BOP, No. 03-383, 2005 WL 1972600, at 4 (E.D. Ky. Aug. 16, 2005) (permitting fees for work on plaintiff's administrative appeal, on the rationale that it "was necessary to exhaust administrative remedies"), reconsideration denied, No. 03-383 (E.D. Ky. Oct. 6, 2005); cf. Tule River Conservancy v. U.S. Forest Serv., No. 97-5720, slip op. at 16-17 (E.D. Cal. Sept. 12, 2000) (allowing attorney fees for pre-litigation research on "how to exhaust [plaintiff's] administration remedies prior to filing suit" and on "how to file FOIA complaint"). 6 Judicial Watch, Inc. v. U.S. Dep't of Commerce, 470 F.3d 363, 373 (D.C. Cir. 2006). 7 499 U.S. 432 (1991). 8 Benavides v. BOP, 993 F.2d 257, 259 (D.C. Cir. 1993) (explaining Kay decision); see Bensman v. U.S. Fish & Wildlife Serv., 49 F. App'x 646, 647 (7th Cir. 2002) ("Even when a pro se litigant performs the same tasks as an attorney, he is not entitled to reimbursement for his time."); Sukup v. EOUSA, No. 02-0355, 2007 WL 2405716, at 1 (D.D.C. Aug. 23, 2007) ("Pro se plaintiffs may not recover attorney's fees under the FOIA."); Deichman v. United States, No. 2:05cv680, 2006 WL 3000448, at 7 (E.D. Va. Oct. 20, 2006) (holding that pro see litigant cannot (continued...) be eligible for attorney fees, therefore, a FOIA plaintiff must have a representational relationship with an attorney.9 Furthermore, Kay indicated that no award of attorney fees should be made to a pro se plaintiff who also is an attorney. 10 Because the fee-shifting provision of the FOIA was intended "'to encourage potential claimants to seek legal advice before commencing litigation,'"11 and because a pro se attorney, by definition, does not seek out the "'detached and objective perspective necessary'" to litigate his FOIA case,12 the overwhelming majority of courts have agreed with Kay and have held that a pro se attorney is not eligible for a fee award that otherwise would have had to be paid to counsel.13 This is particularly so because 8 (...continued) recover attorney fees under FOIA); Lair v. Dep't of the Treasury, No. 03-827, 2005 WL 645228, at 6 (D.D.C. Mar. 21, 2005) (explaining that "pro-se non-attorney . . . may not collect attorney fees" (citing Benavides)), reconsideration denied, 2005 WL 1330722 (D.D.C. June 3, 2005). 9 See Kooritzky v. Herman, 178 F.3d 1315, 1323 (D.C. Cir. 1999) (holding that for all similarly worded fee-shifting statutes, "the term 'attorney' contemplates an agency relationship between a litigant and an independent lawyer"); see also Blazy v. Tenet, 194 F.3d 90, 94 (D.C. Cir. 1999) (concluding that attorney need not file formal appearance in order for litigant to claim fees for consultations, so long as attorney-client relationship existed) (Privacy Act case); cf. Anderson v. U.S. Dep't of the Treasury, 648 F.2d 1, 3 (D.C. Cir. 1979) (indicating that when an organization litigates through in-house counsel, any payable attorney fees should not "exceed[] the expenses incurred by [that party] in terms of [in-house counsel] salaries and other out-of-pocket expenses"). USER: Summarize and list the cases used to support the policy in this document in chronological order. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	18	16	1,375	null	829
Response must not be more than 150 words. Response must be in bullet points. Model must only respond using information contained in the context block Model must not rely on its own knowledge or outside sources of information when responding.	What methods does the NYSDOH AIDS Institute suggest HIV doctors use to keep their HIV-positive patients consistently engaged in their medical care?	NYSDOH AIDS Institute Linkage and Retention Workgroup Updated 6.20.2019 HIV Medical Providers: Strategies and Resources for Retention in Care The purpose of this document is to provide resources and information to support HIV health care practitioners’ efforts to retain HIV-positive people in medical care. Ensuring that people with HIV have access to HIV primary care is a cornerstone of both New York State’s Ending the Epidemic Blueprint and the National HIV/AIDS Strategy. Persons engaged in health care have better health outcomes such as improved viral suppression, which helps patients live longer and healthier lives and avoid transmission of the virus. On April 1, 2014, Public Health Law Section 2135 was amended to promote linkage and retention in care for HIV-positive persons. The law allows the New York State Department of Health (NYSDOH) and New York City Department of Health and Mental Hygiene (NYC DOHMH) to share information with health care providers for purposes of patient linkage and retention in care. The NYSDOH AIDS Institute recommends that health care providers take a multi-pronged approach to support their patients’ retention in care, including but not limited to the following: Have a proactive patient plan: Do not wait for a lapse in care to discuss what to do if the patient becomes lost-to-care. ▪ Create a patient-centered atmosphere, where all members of medical care teams (e.g., reception staff, phlebotomists, medical providers, etc.) promote patient engagement, linkage, and retention in care. ▪ When acceptable to patients, expand authorization dates on Authorization for Release of Health Information and Confidential HIV-Related Information forms (DOH-2557) to at least 2 years. Extending consent timeframes allows collaboration across sectors. ▪ Have DOH-2557 consent forms on file for every patient. This will permit you to contact community based organizations (CBOs) and others in the event of a lapse in care. Examples of CBOs that can help return patients to care include but are not limited to: HIV/AIDS CBOs; Health Homes and their downstream providers; food and nutrition programs; shelters; substance use treatment facilities; housing providers; mental health providers; prenatal care providers, etc. ▪ Encourage patients to add your practice’s name to any releases they sign with other organizations. ▪ Work with patients to update releases prior to when the releases expire (if applicable). ▪ Become a member of your area’s Health Home network(s) if you have not already done so. o for more information go to: https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/hh_map/index.htm Leverage existing resources for patient re-engagement. ▪ Use information from the Regional Health Information Organization (RHIO), if available, to determine if the patient is in care with another provider or if updated personal contact information is available. ▪ Conduct a health insurance benefits check, if available, on the patient to determine if s/he changed insurance or is in care with another provider. ▪ If the patient is in a Managed Care plan, the plan will have updated contact information, recent use of care, and medications on file. If this is a Medicaid Managed Care Plan, the plan can identify which Health Home the patient may be enrolled in and this information may be useful to your follow-up efforts. o If your patient is enrolled in a Health Home and has signed a release, contact the Health Home to determine whether the patient is actively enrolled. If yes, request assistance to contact or re-engage the patient in care. o If your patient has Medicaid but has not been enrolled in a Health Home, contact the Health Home to make an “upstream referral.” The patient will be referred to a provider who may conduct outreach to the patient’s home. ▪ Try multiple modes of contact (phone, text, letter, email, and social media) at varying times of the day/week to reach the patient (special consideration for social media sites – contact patient from an agency social media account and not a staff person’s personal account). ▪ If your patient uses other services within the facility (e.g., WIC, dental, child’s provider), place an alert on the Electronic Medical Record (EMR) to reconnect to the HIV Primary Care Provider and, if pregnant, to her prenatal care provider. ▪ As authorized in patient releases and/or medical charts, work with emergency contacts and other agencies/providers to determine whether they have had recent patient contact. ▪ Conduct a home visit if resources allow. If you have a peer program, utilize peers to provide outreach to the patient’s home. NYSDOH AIDS Institute Linkage and Retention Workgroup Updated 6.20.2019 Use external systems to expand your search when you cannot find a patient. ▪ Review public records such as: o Property tax rolls, municipal tax rolls, etc.: http://publicrecords.onlinesearches.com/NewYork.htm o Parole Lookup: http://www.doccs.ny.gov/lookup.html o NYS County Jail inmate lookup: https://vinelink.vineapps.com/login/NY o NYC Department of Corrections inmate lookup: http://www1.nyc.gov/site/doc/inmateinfo/inmate-lookup.page o NYS Department of Corrections and Community Supervision Inmate lookup: http://nysdoccslookup.doccs.ny.gov/ o Consider using people search engines, local newspapers, and police blotters. ▪ Social Security Death Master File Portal: https://www.npcrcss.cdc.gov/ssdi/ (A user ID and password are required to access the site and may be obtained by calling (301) 572-0502.) Pregnant women and exposed infants lost-to-care require immediate action for reengagement. HIV-positive pregnant women and their exposed infants are a priority when identified as lost-to-care and require immediate action for re-engagement. Reengagement in care is especially important for HIV-positive pregnant women who are in their third trimester due to possible increasing viral loads from being non-adherent to ART, leading to increased risk of transmitting HIV to their infants. Ensuring exposed infants are engaged in care is critical during the first 4-6 months to ensure appropriate antiretroviral and opportunistic infection prophylaxis, as well as definitive documentation of the infant’s HIV infection status. If routine attempts for reengagement of the HIV-positive pregnant woman or her exposed or infected infant(s) are not successful, please contact the NYSDOH Perinatal HIV Prevention Program at (518) 486-6048 or submit a request via the NYSDOH HIV/AIDS Provider Portal (see below) for assistance. NYC providers should call the NYC DOHMH Field Services Unit at (347) 396-7601 for assistance with reengagement of pregnant women. NYC-based providers (located within the 5 boroughs): Eligible NYC providers with patients who have been out-of-care for 6 months or longer can use the NYC DOHMH’s HIV Care Status Reports System (CSR) to obtain information on patients’ current care status in NYC. Information from the CSR may be useful to your follow-up efforts. For more information, see https://www1.nyc.gov/site/doh/health/health-topics/aids-hiv-care-status-reports-system.page Eligible NYC providers may also call the NYC DOHMH Provider Call Line at (212) 442-3388 to obtain information that may help link or retain patients in care. For providers based in NYS outside of NYC: After exploring the investigation tools and strategies listed above and if patient follow-up is warranted, the Bureau of HIV/AIDS Epidemiology (BHAE) may be able to provide information regarding a patient’s care status through the NYSDOH HIV/AIDS Provider Portal. The HIV/AIDS Provider Portal is an electronic system which enables clinicians to: 1) meet their reporting requirements electronically; 2) provide a mechanism for clinicians statewide to notify the NYS DOH that a patient needs linkage to Health Department Partner Services; and, 3) submit inquiries for patients with diagnosed HIV infection who are thought to be in need of assistance with linkage to or retention in HIV medical care. A NYSDOH Health Commerce System (HCS) Medical Professionals account is required. To apply for an HCS Medial Professions account, navigate to: https://apps.health.ny.gov/pub/top.html. After logging into the HCS at https://commerce.health.ny.gov/, select “Refresh My Applications List” on the left side and then under “My Applications” select HIV/AIDS Provider Portal. Follow the prompts to set up an account. Urgent requests will be responded to within 1 business day. For routine requests to the HIV/AIDS Provider Portal, the turn-around time is typically within 1-3 business days.	Response must not be more than 150 words. Response must be in bullet points. Model must only respond using information contained in the context block Model must not rely on its own knowledge or outside sources of information when responding. What methods does the NYSDOH AIDS Institute suggest HIV doctors use to keep their HIV-positive patients consistently engaged in their medical care? NYSDOH AIDS Institute Linkage and Retention Workgroup Updated 6.20.2019 HIV Medical Providers: Strategies and Resources for Retention in Care The purpose of this document is to provide resources and information to support HIV health care practitioners’ efforts to retain HIV-positive people in medical care. Ensuring that people with HIV have access to HIV primary care is a cornerstone of both New York State’s Ending the Epidemic Blueprint and the National HIV/AIDS Strategy. Persons engaged in health care have better health outcomes such as improved viral suppression, which helps patients live longer and healthier lives and avoid transmission of the virus. On April 1, 2014, Public Health Law Section 2135 was amended to promote linkage and retention in care for HIV-positive persons. The law allows the New York State Department of Health (NYSDOH) and New York City Department of Health and Mental Hygiene (NYC DOHMH) to share information with health care providers for purposes of patient linkage and retention in care. The NYSDOH AIDS Institute recommends that health care providers take a multi-pronged approach to support their patients’ retention in care, including but not limited to the following: Have a proactive patient plan: Do not wait for a lapse in care to discuss what to do if the patient becomes lost-to-care. ▪ Create a patient-centered atmosphere, where all members of medical care teams (e.g., reception staff, phlebotomists, medical providers, etc.) promote patient engagement, linkage, and retention in care. ▪ When acceptable to patients, expand authorization dates on Authorization for Release of Health Information and Confidential HIV-Related Information forms (DOH-2557) to at least 2 years. Extending consent timeframes allows collaboration across sectors. ▪ Have DOH-2557 consent forms on file for every patient. This will permit you to contact community based organizations (CBOs) and others in the event of a lapse in care. Examples of CBOs that can help return patients to care include but are not limited to: HIV/AIDS CBOs; Health Homes and their downstream providers; food and nutrition programs; shelters; substance use treatment facilities; housing providers; mental health providers; prenatal care providers, etc. ▪ Encourage patients to add your practice’s name to any releases they sign with other organizations. ▪ Work with patients to update releases prior to when the releases expire (if applicable). ▪ Become a member of your area’s Health Home network(s) if you have not already done so. o for more information go to: https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/hh_map/index.htm Leverage existing resources for patient re-engagement. ▪ Use information from the Regional Health Information Organization (RHIO), if available, to determine if the patient is in care with another provider or if updated personal contact information is available. ▪ Conduct a health insurance benefits check, if available, on the patient to determine if s/he changed insurance or is in care with another provider. ▪ If the patient is in a Managed Care plan, the plan will have updated contact information, recent use of care, and medications on file. If this is a Medicaid Managed Care Plan, the plan can identify which Health Home the patient may be enrolled in and this information may be useful to your follow-up efforts. o If your patient is enrolled in a Health Home and has signed a release, contact the Health Home to determine whether the patient is actively enrolled. If yes, request assistance to contact or re-engage the patient in care. o If your patient has Medicaid but has not been enrolled in a Health Home, contact the Health Home to make an “upstream referral.” The patient will be referred to a provider who may conduct outreach to the patient’s home. ▪ Try multiple modes of contact (phone, text, letter, email, and social media) at varying times of the day/week to reach the patient (special consideration for social media sites – contact patient from an agency social media account and not a staff person’s personal account). ▪ If your patient uses other services within the facility (e.g., WIC, dental, child’s provider), place an alert on the Electronic Medical Record (EMR) to reconnect to the HIV Primary Care Provider and, if pregnant, to her prenatal care provider. ▪ As authorized in patient releases and/or medical charts, work with emergency contacts and other agencies/providers to determine whether they have had recent patient contact. ▪ Conduct a home visit if resources allow. If you have a peer program, utilize peers to provide outreach to the patient’s home. NYSDOH AIDS Institute Linkage and Retention Workgroup Updated 6.20.2019 Use external systems to expand your search when you cannot find a patient. ▪ Review public records such as: o Property tax rolls, municipal tax rolls, etc.: http://publicrecords.onlinesearches.com/NewYork.htm o Parole Lookup: http://www.doccs.ny.gov/lookup.html o NYS County Jail inmate lookup: https://vinelink.vineapps.com/login/NY o NYC Department of Corrections inmate lookup: http://www1.nyc.gov/site/doc/inmateinfo/inmate-lookup.page o NYS Department of Corrections and Community Supervision Inmate lookup: http://nysdoccslookup.doccs.ny.gov/ o Consider using people search engines, local newspapers, and police blotters. ▪ Social Security Death Master File Portal: https://www.npcrcss.cdc.gov/ssdi/ (A user ID and password are required to access the site and may be obtained by calling (301) 572-0502.) Pregnant women and exposed infants lost-to-care require immediate action for reengagement. HIV-positive pregnant women and their exposed infants are a priority when identified as lost-to-care and require immediate action for re-engagement. Reengagement in care is especially important for HIV-positive pregnant women who are in their third trimester due to possible increasing viral loads from being non-adherent to ART, leading to increased risk of transmitting HIV to their infants. Ensuring exposed infants are engaged in care is critical during the first 4-6 months to ensure appropriate antiretroviral and opportunistic infection prophylaxis, as well as definitive documentation of the infant’s HIV infection status. If routine attempts for reengagement of the HIV-positive pregnant woman or her exposed or infected infant(s) are not successful, please contact the NYSDOH Perinatal HIV Prevention Program at (518) 486-6048 or submit a request via the NYSDOH HIV/AIDS Provider Portal (see below) for assistance. NYC providers should call the NYC DOHMH Field Services Unit at (347) 396-7601 for assistance with reengagement of pregnant women. NYC-based providers (located within the 5 boroughs): Eligible NYC providers with patients who have been out-of-care for 6 months or longer can use the NYC DOHMH’s HIV Care Status Reports System (CSR) to obtain information on patients’ current care status in NYC. Information from the CSR may be useful to your follow-up efforts. For more information, see https://www1.nyc.gov/site/doh/health/health-topics/aids-hiv-care-status-reports-system.page Eligible NYC providers may also call the NYC DOHMH Provider Call Line at (212) 442-3388 to obtain information that may help link or retain patients in care. For providers based in NYS outside of NYC: After exploring the investigation tools and strategies listed above and if patient follow-up is warranted, the Bureau of HIV/AIDS Epidemiology (BHAE) may be able to provide information regarding a patient’s care status through the NYSDOH HIV/AIDS Provider Portal. The HIV/AIDS Provider Portal is an electronic system which enables clinicians to: 1) meet their reporting requirements electronically; 2) provide a mechanism for clinicians statewide to notify the NYS DOH that a patient needs linkage to Health Department Partner Services; and, 3) submit inquiries for patients with diagnosed HIV infection who are thought to be in need of assistance with linkage to or retention in HIV medical care. A NYSDOH Health Commerce System (HCS) Medical Professionals account is required. To apply for an HCS Medial Professions account, navigate to: https://apps.health.ny.gov/pub/top.html. After logging into the HCS at https://commerce.health.ny.gov/, select “Refresh My Applications List” on the left side and then under “My Applications” select HIV/AIDS Provider Portal. Follow the prompts to set up an account. Urgent requests will be responded to within 1 business day. For routine requests to the HIV/AIDS Provider Portal, the turn-around time is typically within 1-3 business days.	Response must not be more than 150 words. Response must be in bullet points. Model must only respond using information contained in the context block Model must not rely on its own knowledge or outside sources of information when responding. EVIDENCE: NYSDOH AIDS Institute Linkage and Retention Workgroup Updated 6.20.2019 HIV Medical Providers: Strategies and Resources for Retention in Care The purpose of this document is to provide resources and information to support HIV health care practitioners’ efforts to retain HIV-positive people in medical care. Ensuring that people with HIV have access to HIV primary care is a cornerstone of both New York State’s Ending the Epidemic Blueprint and the National HIV/AIDS Strategy. Persons engaged in health care have better health outcomes such as improved viral suppression, which helps patients live longer and healthier lives and avoid transmission of the virus. On April 1, 2014, Public Health Law Section 2135 was amended to promote linkage and retention in care for HIV-positive persons. The law allows the New York State Department of Health (NYSDOH) and New York City Department of Health and Mental Hygiene (NYC DOHMH) to share information with health care providers for purposes of patient linkage and retention in care. The NYSDOH AIDS Institute recommends that health care providers take a multi-pronged approach to support their patients’ retention in care, including but not limited to the following: Have a proactive patient plan: Do not wait for a lapse in care to discuss what to do if the patient becomes lost-to-care. ▪ Create a patient-centered atmosphere, where all members of medical care teams (e.g., reception staff, phlebotomists, medical providers, etc.) promote patient engagement, linkage, and retention in care. ▪ When acceptable to patients, expand authorization dates on Authorization for Release of Health Information and Confidential HIV-Related Information forms (DOH-2557) to at least 2 years. Extending consent timeframes allows collaboration across sectors. ▪ Have DOH-2557 consent forms on file for every patient. This will permit you to contact community based organizations (CBOs) and others in the event of a lapse in care. Examples of CBOs that can help return patients to care include but are not limited to: HIV/AIDS CBOs; Health Homes and their downstream providers; food and nutrition programs; shelters; substance use treatment facilities; housing providers; mental health providers; prenatal care providers, etc. ▪ Encourage patients to add your practice’s name to any releases they sign with other organizations. ▪ Work with patients to update releases prior to when the releases expire (if applicable). ▪ Become a member of your area’s Health Home network(s) if you have not already done so. o for more information go to: https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/hh_map/index.htm Leverage existing resources for patient re-engagement. ▪ Use information from the Regional Health Information Organization (RHIO), if available, to determine if the patient is in care with another provider or if updated personal contact information is available. ▪ Conduct a health insurance benefits check, if available, on the patient to determine if s/he changed insurance or is in care with another provider. ▪ If the patient is in a Managed Care plan, the plan will have updated contact information, recent use of care, and medications on file. If this is a Medicaid Managed Care Plan, the plan can identify which Health Home the patient may be enrolled in and this information may be useful to your follow-up efforts. o If your patient is enrolled in a Health Home and has signed a release, contact the Health Home to determine whether the patient is actively enrolled. If yes, request assistance to contact or re-engage the patient in care. o If your patient has Medicaid but has not been enrolled in a Health Home, contact the Health Home to make an “upstream referral.” The patient will be referred to a provider who may conduct outreach to the patient’s home. ▪ Try multiple modes of contact (phone, text, letter, email, and social media) at varying times of the day/week to reach the patient (special consideration for social media sites – contact patient from an agency social media account and not a staff person’s personal account). ▪ If your patient uses other services within the facility (e.g., WIC, dental, child’s provider), place an alert on the Electronic Medical Record (EMR) to reconnect to the HIV Primary Care Provider and, if pregnant, to her prenatal care provider. ▪ As authorized in patient releases and/or medical charts, work with emergency contacts and other agencies/providers to determine whether they have had recent patient contact. ▪ Conduct a home visit if resources allow. If you have a peer program, utilize peers to provide outreach to the patient’s home. NYSDOH AIDS Institute Linkage and Retention Workgroup Updated 6.20.2019 Use external systems to expand your search when you cannot find a patient. ▪ Review public records such as: o Property tax rolls, municipal tax rolls, etc.: http://publicrecords.onlinesearches.com/NewYork.htm o Parole Lookup: http://www.doccs.ny.gov/lookup.html o NYS County Jail inmate lookup: https://vinelink.vineapps.com/login/NY o NYC Department of Corrections inmate lookup: http://www1.nyc.gov/site/doc/inmateinfo/inmate-lookup.page o NYS Department of Corrections and Community Supervision Inmate lookup: http://nysdoccslookup.doccs.ny.gov/ o Consider using people search engines, local newspapers, and police blotters. ▪ Social Security Death Master File Portal: https://www.npcrcss.cdc.gov/ssdi/ (A user ID and password are required to access the site and may be obtained by calling (301) 572-0502.) Pregnant women and exposed infants lost-to-care require immediate action for reengagement. HIV-positive pregnant women and their exposed infants are a priority when identified as lost-to-care and require immediate action for re-engagement. Reengagement in care is especially important for HIV-positive pregnant women who are in their third trimester due to possible increasing viral loads from being non-adherent to ART, leading to increased risk of transmitting HIV to their infants. Ensuring exposed infants are engaged in care is critical during the first 4-6 months to ensure appropriate antiretroviral and opportunistic infection prophylaxis, as well as definitive documentation of the infant’s HIV infection status. If routine attempts for reengagement of the HIV-positive pregnant woman or her exposed or infected infant(s) are not successful, please contact the NYSDOH Perinatal HIV Prevention Program at (518) 486-6048 or submit a request via the NYSDOH HIV/AIDS Provider Portal (see below) for assistance. NYC providers should call the NYC DOHMH Field Services Unit at (347) 396-7601 for assistance with reengagement of pregnant women. NYC-based providers (located within the 5 boroughs): Eligible NYC providers with patients who have been out-of-care for 6 months or longer can use the NYC DOHMH’s HIV Care Status Reports System (CSR) to obtain information on patients’ current care status in NYC. Information from the CSR may be useful to your follow-up efforts. For more information, see https://www1.nyc.gov/site/doh/health/health-topics/aids-hiv-care-status-reports-system.page Eligible NYC providers may also call the NYC DOHMH Provider Call Line at (212) 442-3388 to obtain information that may help link or retain patients in care. For providers based in NYS outside of NYC: After exploring the investigation tools and strategies listed above and if patient follow-up is warranted, the Bureau of HIV/AIDS Epidemiology (BHAE) may be able to provide information regarding a patient’s care status through the NYSDOH HIV/AIDS Provider Portal. The HIV/AIDS Provider Portal is an electronic system which enables clinicians to: 1) meet their reporting requirements electronically; 2) provide a mechanism for clinicians statewide to notify the NYS DOH that a patient needs linkage to Health Department Partner Services; and, 3) submit inquiries for patients with diagnosed HIV infection who are thought to be in need of assistance with linkage to or retention in HIV medical care. A NYSDOH Health Commerce System (HCS) Medical Professionals account is required. To apply for an HCS Medial Professions account, navigate to: https://apps.health.ny.gov/pub/top.html. After logging into the HCS at https://commerce.health.ny.gov/, select “Refresh My Applications List” on the left side and then under “My Applications” select HIV/AIDS Provider Portal. Follow the prompts to set up an account. Urgent requests will be responded to within 1 business day. For routine requests to the HIV/AIDS Provider Portal, the turn-around time is typically within 1-3 business days. USER: What methods does the NYSDOH AIDS Institute suggest HIV doctors use to keep their HIV-positive patients consistently engaged in their medical care? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	true	40	22	1,278	null	228
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]	In what specific use cases should someone prefer o1-mini or o1-preview. Use evidence from the reference text wherever possible, including the name of the metric and the results.	OpenAI o1-mini Advancing cost-efficient reasoning. Contributions We're releasing OpenAI o1-mini, a cost-efficient reasoning model. o1-mini excels at STEM, especially math and coding—nearly matching the performance of OpenAI o1 on evaluation benchmarks such as AIME and Codeforces. We expect o1-mini will be a faster, cost-effective model for applications that require reasoning without broad world knowledge. Today, we are launching o1-mini to tier 5 API users(opens in a new window) at a cost that is 80% cheaper than OpenAI o1-preview. ChatGPT Plus, Team, Enterprise, and Edu users can use o1-mini as an alternative to o1-preview, with higher rate limits and lower latency (see Model Speed). Optimized for STEM Reasoning Large language models such as o1 are pre-trained on vast text datasets. While these high-capacity models have broad world knowledge, they can be expensive and slow for real-world applications. In contrast, o1-mini is a smaller model optimized for STEM reasoning during pretraining. After training with the same high-compute reinforcement learning (RL) pipeline as o1, o1-mini achieves comparable performance on many useful reasoning tasks, while being significantly more cost efficient. When evaluated on benchmarks requiring intelligence and reasoning, o1-mini performs well compared to o1-preview and o1. However, o1-mini performs worse on tasks requiring non-STEM factual knowledge (see Limitations). Math Performance vs Inference Cost GPT-4o GPT-4o mini o1-preview o1-mini o1 0 10 20 30 40 50 60 70 80 90 100 Inference Cost (%) 0% 20% 40% 60% 80% AIME Mathematics: In the high school AIME math competition, o1-mini (70.0%) is competitive with o1 (74.4%)–while being significantly cheaper–and outperforms o1-preview (44.6%). o1-mini’s score (about 11/15 questions) places it in approximately the top 500 US high-school students. Coding: On the Codeforces competition website, o1-mini achieves 1650 Elo, which is again competitive with o1 (1673) and higher than o1-preview (1258). This Elo score puts the model at approximately the 86th percentile of programmers who compete on the Codeforces platform. o1-mini also performs well on the HumanEval coding benchmark and high-school level cybersecurity capture the flag challenges (CTFs). Codeforces 1650 1258 900 o1-mini o1-preview GPT-4o 0 200 400 600 800 1,000 1,200 1,400 1,600 1,800 Elo HumanEval 92.4% 92.4% 90.2% o1-mini o1-preview GPT-4o 0 10 20 30 40 50 60 70 80 90 100 Accuracy Cybersecurity CTFs 28.7% 43.0% 20.0% o1-mini o1-preview GPT-4o 0 5 10 15 20 25 30 35 40 45 Accuracy (Pass@12) STEM: On some academic benchmarks requiring reasoning, such as GPQA (science) and MATH-500, o1-mini outperforms GPT-4o. o1-mini does not perform as well as GPT-4o on tasks such as MMLU and lags behind o1-preview on GPQA due to its lack of broad world knowledge. MMLU 0-shot CoT 88.7% 85.2% 90.8% 92.3% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 GPQA Diamond, 0-shot CoT 53.6% 60.0% 73.3% 77.3% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 MATH-500 0-shot CoT 60.3% 90.0% 85.5% 94.8% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 Human preference evaluation: We had human raters compare o1-mini to GPT-4o on challenging, open-ended prompts in various domains, using the same methodology as our o1-preview vs GPT-4o comparison. Similar to o1-preview, o1-mini is preferred to GPT-4o in reasoning-heavy domains, but is not preferred to GPT-4o in language-focused domains. Human preference evaluation vs chatgpt-4o-latest o1-preview o1-mini Personal Writing Editing Text Computer Programming Data Analysis Mathematical Calculation 0 20 40 60 80 100 Win Rate vs GPT-4o (%) Domain Model Speed As a concrete example, we compared responses from GPT-4o, o1-mini, and o1-preview on a word reasoning question. While GPT-4o did not answer correctly, both o1-mini and o1-preview did, and o1-mini reached the answer around 3-5x faster. Chat speed comparison Safety o1-mini is trained using the same alignment and safety techniques as o1-preview. The model has 59% higher jailbreak robustness on an internal version of the StrongREJECT dataset compared to GPT-4o. Before deployment, we carefully assessed the safety risks of o1-mini using the same approach to preparedness, external red-teaming, and safety evaluations as o1-preview. We are publishing the detailed results from these evaluations in the accompanying system card. Metric GPT-4o o1-mini % Safe completions refusal on harmful prompts (standard) 0.99 0.99 % Safe completions on harmful prompts (Challenging: jailbreaks & edge cases) 0.714 0.932 % Compliance on benign edge cases (“not over-refusal”) 0.91 0.923 [email protected] StrongREJECT jailbreak eval (Souly et al. 2024(opens in a new window)) 0.22 0.83 Human sourced jailbreak eval 0.77 0.95 Limitations and What’s Next Due to its specialization on STEM reasoning capabilities, o1-mini’s factual knowledge on non-STEM topics such as dates, biographies, and trivia is comparable to small LLMs such as GPT-4o mini. We will improve these limitations in future versions, as well as experiment with extending the model to other modalities and specialities outside of STEM.	Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. In what specific use cases should someone prefer o1-mini or o1-preview. Use evidence from the reference text wherever possible, including the name of the metric and the results. OpenAI o1-mini Advancing cost-efficient reasoning. Contributions We're releasing OpenAI o1-mini, a cost-efficient reasoning model. o1-mini excels at STEM, especially math and coding—nearly matching the performance of OpenAI o1 on evaluation benchmarks such as AIME and Codeforces. We expect o1-mini will be a faster, cost-effective model for applications that require reasoning without broad world knowledge. Today, we are launching o1-mini to tier 5 API users(opens in a new window) at a cost that is 80% cheaper than OpenAI o1-preview. ChatGPT Plus, Team, Enterprise, and Edu users can use o1-mini as an alternative to o1-preview, with higher rate limits and lower latency (see Model Speed). Optimized for STEM Reasoning Large language models such as o1 are pre-trained on vast text datasets. While these high-capacity models have broad world knowledge, they can be expensive and slow for real-world applications. In contrast, o1-mini is a smaller model optimized for STEM reasoning during pretraining. After training with the same high-compute reinforcement learning (RL) pipeline as o1, o1-mini achieves comparable performance on many useful reasoning tasks, while being significantly more cost efficient. When evaluated on benchmarks requiring intelligence and reasoning, o1-mini performs well compared to o1-preview and o1. However, o1-mini performs worse on tasks requiring non-STEM factual knowledge (see Limitations). Math Performance vs Inference Cost GPT-4o GPT-4o mini o1-preview o1-mini o1 0 10 20 30 40 50 60 70 80 90 100 Inference Cost (%) 0% 20% 40% 60% 80% AIME Mathematics: In the high school AIME math competition, o1-mini (70.0%) is competitive with o1 (74.4%)–while being significantly cheaper–and outperforms o1-preview (44.6%). o1-mini’s score (about 11/15 questions) places it in approximately the top 500 US high-school students. Coding: On the Codeforces competition website, o1-mini achieves 1650 Elo, which is again competitive with o1 (1673) and higher than o1-preview (1258). This Elo score puts the model at approximately the 86th percentile of programmers who compete on the Codeforces platform. o1-mini also performs well on the HumanEval coding benchmark and high-school level cybersecurity capture the flag challenges (CTFs). Codeforces 1650 1258 900 o1-mini o1-preview GPT-4o 0 200 400 600 800 1,000 1,200 1,400 1,600 1,800 Elo HumanEval 92.4% 92.4% 90.2% o1-mini o1-preview GPT-4o 0 10 20 30 40 50 60 70 80 90 100 Accuracy Cybersecurity CTFs 28.7% 43.0% 20.0% o1-mini o1-preview GPT-4o 0 5 10 15 20 25 30 35 40 45 Accuracy (Pass@12) STEM: On some academic benchmarks requiring reasoning, such as GPQA (science) and MATH-500, o1-mini outperforms GPT-4o. o1-mini does not perform as well as GPT-4o on tasks such as MMLU and lags behind o1-preview on GPQA due to its lack of broad world knowledge. MMLU 0-shot CoT 88.7% 85.2% 90.8% 92.3% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 GPQA Diamond, 0-shot CoT 53.6% 60.0% 73.3% 77.3% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 MATH-500 0-shot CoT 60.3% 90.0% 85.5% 94.8% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 Human preference evaluation: We had human raters compare o1-mini to GPT-4o on challenging, open-ended prompts in various domains, using the same methodology as our o1-preview vs GPT-4o comparison. Similar to o1-preview, o1-mini is preferred to GPT-4o in reasoning-heavy domains, but is not preferred to GPT-4o in language-focused domains. Human preference evaluation vs chatgpt-4o-latest o1-preview o1-mini Personal Writing Editing Text Computer Programming Data Analysis Mathematical Calculation 0 20 40 60 80 100 Win Rate vs GPT-4o (%) Domain Model Speed As a concrete example, we compared responses from GPT-4o, o1-mini, and o1-preview on a word reasoning question. While GPT-4o did not answer correctly, both o1-mini and o1-preview did, and o1-mini reached the answer around 3-5x faster. Chat speed comparison Safety o1-mini is trained using the same alignment and safety techniques as o1-preview. The model has 59% higher jailbreak robustness on an internal version of the StrongREJECT dataset compared to GPT-4o. Before deployment, we carefully assessed the safety risks of o1-mini using the same approach to preparedness, external red-teaming, and safety evaluations as o1-preview. We are publishing the detailed results from these evaluations in the accompanying system card. Metric GPT-4o o1-mini % Safe completions refusal on harmful prompts (standard) 0.99 0.99 % Safe completions on harmful prompts (Challenging: jailbreaks & edge cases) 0.714 0.932 % Compliance on benign edge cases (“not over-refusal”) 0.91 0.923 [email protected] StrongREJECT jailbreak eval (Souly et al. 2024(opens in a new window)) 0.22 0.83 Human sourced jailbreak eval 0.77 0.95 Limitations and What’s Next Due to its specialization on STEM reasoning capabilities, o1-mini’s factual knowledge on non-STEM topics such as dates, biographies, and trivia is comparable to small LLMs such as GPT-4o mini. We will improve these limitations in future versions, as well as experiment with extending the model to other modalities and specialities outside of STEM. https://openai.com/index/openai-o1-mini-advancing-cost-efficient-reasoning/	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: OpenAI o1-mini Advancing cost-efficient reasoning. Contributions We're releasing OpenAI o1-mini, a cost-efficient reasoning model. o1-mini excels at STEM, especially math and coding—nearly matching the performance of OpenAI o1 on evaluation benchmarks such as AIME and Codeforces. We expect o1-mini will be a faster, cost-effective model for applications that require reasoning without broad world knowledge. Today, we are launching o1-mini to tier 5 API users(opens in a new window) at a cost that is 80% cheaper than OpenAI o1-preview. ChatGPT Plus, Team, Enterprise, and Edu users can use o1-mini as an alternative to o1-preview, with higher rate limits and lower latency (see Model Speed). Optimized for STEM Reasoning Large language models such as o1 are pre-trained on vast text datasets. While these high-capacity models have broad world knowledge, they can be expensive and slow for real-world applications. In contrast, o1-mini is a smaller model optimized for STEM reasoning during pretraining. After training with the same high-compute reinforcement learning (RL) pipeline as o1, o1-mini achieves comparable performance on many useful reasoning tasks, while being significantly more cost efficient. When evaluated on benchmarks requiring intelligence and reasoning, o1-mini performs well compared to o1-preview and o1. However, o1-mini performs worse on tasks requiring non-STEM factual knowledge (see Limitations). Math Performance vs Inference Cost GPT-4o GPT-4o mini o1-preview o1-mini o1 0 10 20 30 40 50 60 70 80 90 100 Inference Cost (%) 0% 20% 40% 60% 80% AIME Mathematics: In the high school AIME math competition, o1-mini (70.0%) is competitive with o1 (74.4%)–while being significantly cheaper–and outperforms o1-preview (44.6%). o1-mini’s score (about 11/15 questions) places it in approximately the top 500 US high-school students. Coding: On the Codeforces competition website, o1-mini achieves 1650 Elo, which is again competitive with o1 (1673) and higher than o1-preview (1258). This Elo score puts the model at approximately the 86th percentile of programmers who compete on the Codeforces platform. o1-mini also performs well on the HumanEval coding benchmark and high-school level cybersecurity capture the flag challenges (CTFs). Codeforces 1650 1258 900 o1-mini o1-preview GPT-4o 0 200 400 600 800 1,000 1,200 1,400 1,600 1,800 Elo HumanEval 92.4% 92.4% 90.2% o1-mini o1-preview GPT-4o 0 10 20 30 40 50 60 70 80 90 100 Accuracy Cybersecurity CTFs 28.7% 43.0% 20.0% o1-mini o1-preview GPT-4o 0 5 10 15 20 25 30 35 40 45 Accuracy (Pass@12) STEM: On some academic benchmarks requiring reasoning, such as GPQA (science) and MATH-500, o1-mini outperforms GPT-4o. o1-mini does not perform as well as GPT-4o on tasks such as MMLU and lags behind o1-preview on GPQA due to its lack of broad world knowledge. MMLU 0-shot CoT 88.7% 85.2% 90.8% 92.3% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 GPQA Diamond, 0-shot CoT 53.6% 60.0% 73.3% 77.3% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 MATH-500 0-shot CoT 60.3% 90.0% 85.5% 94.8% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 Human preference evaluation: We had human raters compare o1-mini to GPT-4o on challenging, open-ended prompts in various domains, using the same methodology as our o1-preview vs GPT-4o comparison. Similar to o1-preview, o1-mini is preferred to GPT-4o in reasoning-heavy domains, but is not preferred to GPT-4o in language-focused domains. Human preference evaluation vs chatgpt-4o-latest o1-preview o1-mini Personal Writing Editing Text Computer Programming Data Analysis Mathematical Calculation 0 20 40 60 80 100 Win Rate vs GPT-4o (%) Domain Model Speed As a concrete example, we compared responses from GPT-4o, o1-mini, and o1-preview on a word reasoning question. While GPT-4o did not answer correctly, both o1-mini and o1-preview did, and o1-mini reached the answer around 3-5x faster. Chat speed comparison Safety o1-mini is trained using the same alignment and safety techniques as o1-preview. The model has 59% higher jailbreak robustness on an internal version of the StrongREJECT dataset compared to GPT-4o. Before deployment, we carefully assessed the safety risks of o1-mini using the same approach to preparedness, external red-teaming, and safety evaluations as o1-preview. We are publishing the detailed results from these evaluations in the accompanying system card. Metric GPT-4o o1-mini % Safe completions refusal on harmful prompts (standard) 0.99 0.99 % Safe completions on harmful prompts (Challenging: jailbreaks & edge cases) 0.714 0.932 % Compliance on benign edge cases (“not over-refusal”) 0.91 0.923 [email protected] StrongREJECT jailbreak eval (Souly et al. 2024(opens in a new window)) 0.22 0.83 Human sourced jailbreak eval 0.77 0.95 Limitations and What’s Next Due to its specialization on STEM reasoning capabilities, o1-mini’s factual knowledge on non-STEM topics such as dates, biographies, and trivia is comparable to small LLMs such as GPT-4o mini. We will improve these limitations in future versions, as well as experiment with extending the model to other modalities and specialities outside of STEM. USER: In what specific use cases should someone prefer o1-mini or o1-preview. Use evidence from the reference text wherever possible, including the name of the metric and the results. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	24	28	796	null	591
Answer in complete sentences, only use the context document, no outside knowledge.	According to the document, can a city make it illegal to be homeless?	Homelessness laws in Texas When is an individual considered homeless? The United State Department of Housing and Urban Development (HUD) provides four broad categories of homelessness:  Individuals and families who lack a fixed, regular, and adequate nighttime residence, which includes a subset for an individual who is exiting an institution where he or she resided for 90 days or less and who resided in an emergency shelter or a place not meant for human habitation immediately before entering that institution;  Individuals and families who will imminently lose their primary nighttime residence;  Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition; or  Individuals and families who are fleeing, or are attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member. What negative effects can a large homeless population have on a city? A large homeless population can be draining on a community. Homeless individuals that lack access to proper medical care may choose an emergency room at a hospital for medical services rather than a primary care medical office. This option is significantly more expensive and typically the homeless individual is unable to pay the bill, so the cost is passed on to insurance companies and the average customer in a community. Homeless individuals spend more time in local jails than the housed population for petty offenses, which increases the costs to run the facility. Additionally, a large homeless population can affect a city’s ability to attract tourists. What is affordable housing? Affordable housing is housing for which the occupant pays less than 30 percent of their income. Housing that is considered to be “affordable” will differ between communities, depending on the median family income of the area. What is Section 8 housing? “Section 8” refers to Section 8 of the federal Housing Act of 1937. This section authorizes project-based rental assistance programs under which a participating owner, or landlord, is required to reserve units in a building for low-income tenants, in return for a federal government guarantee to make up the difference between the tenant's contribution and the rent in the owner's contract with the government. What is a Section 8 voucher? Section 8 of the federal Housing Act also authorizes vouchers for low-income individuals. HUD manages the Housing Choice Voucher Program, which provides financial assistance directly to the landlord for a family that qualifies. The Housing Choice Voucher Program is the federal government's major program for assisting very low-income families, the elderly, and the disabled to afford decent, safe, and sanitary housing in the private market. Since housing assistance is provided on behalf of the family or individual, participants are able to find their own housing, including single-family homes, townhouses and apartments, and are free to choose any housing option that meets the requirements of the program. Housing choice vouchers are administered locally by public housing agencies (PHAs). The PHAs receive federal funds from HUD to administer the voucher program. A list of public housing authorities in Texas can be found at http://portal.hud.gov/hudportal/HUD?src=/program_offices/public_indian_housing/pha/contacts/ tx A housing subsidy is paid to the landlord directly by the PHA on behalf of the participating family. The family then pays the difference between the actual rent charged by the landlord and the amount subsidized by the program. Can a city make being homeless illegal? No. Laws that punish status or condition rather than criminal conduct have been struck down by courts as constituting cruel and unusual punishment. These types of laws fail to give fair notice of prohibited conduct and encourage arbitrary arrests and convictions. Additionally, courts have overturned vagrancy laws, or laws that criminalize being homeless, as impermissible restrictions on an individual’s right to travel. See Papachristou v. City of Jacksonville, 45 U.S. 156, 162(1972); Handler v. Denver, 77 P.2d 132, 135 (Colo. 1938); Pottinger v. City of Miami, 810 F. Supp. 1551, 1578 (S.D. Fla. 1992). Can the city enact a loitering prohibition? Maybe. In a 1983 decision in Kolender v. Lawson, the United State Supreme Court invalidated a California loitering statute requiring street wanderers to present valid identification when stopped by police officers. The Court held that the statute was too vague to satisfy due process requirements. The Court followed this decision with its decision in Chicago v. Morales, which struck down a Chicago ordinance preventing loitering by gang members on due process grounds. An ordinance that is general in nature that criminalizes loitering on a public street would most likely be struck down by a court for vagueness. However, if the wording of the ordinance is sufficient to set forth guidelines for law enforcement officers narrowly tailoring the restriction to those who loiter with a specific illegal purpose, then a loitering ordinance may pass constitutional muster. City officials will want to work closely with their local legal counsel if they desire to adopt such an ordinance. Can a city prevent homeless people from panhandling in all public places? No. Litigation related to bans on panhandling has centered on First Amendment free speech claims. Courts have ruled that outlawing panhandling in all public places was unconstitutional. See generally Young v. New York City Transit Auth., 903 F.2d 146 (2d Cir. 1990); Speet v. Schuette, 889 F. Supp. 2d 969 (W.D. Mich. 2012). Instead, any limits on panhandling on public sidewalks trigger strict scrutiny, meaning the regulations must be narrowly tailored to serve a significant governmental interest and must be the least restrictive means for achieving that interest. Courts have found that safety and traffic congestion may be significant interests but “mere annoyance” is not a sufficiently compelling reason to absolutely deprive an individual of his or her First Amendment rights. What strategies have cities used to reduce homelessness?  Participating in the “Mayors Challenge to End Veteran Homelessness,” a program designed to equip city leaders with tools to combat veteran homelessness. For more information on how to participate, you can visit the Department of Housing and Urban Development’s Mayors Challenge page at http://portal.hud.gov/hudportal/HUD?src=/program_offices/comm_planning/veteran_info rmation/mayors_challenge/mayors_and_staff;  Seeking state grants awarded by the Texas Department of Housing and Community Affairs or federal grants awarded by HUD;  Educating law enforcement officers on alternatives to issuing citations and supporting police department partnerships with mental health partners;  Recruiting landlords in the city to assist in providing housing opportunities for individuals and families experiencing homelessness;  Educating municipal court personnel on providing referrals to municipal court defendants to non-profit groups in the city that provide housing and other services;  Issuing general obligation bonds for the purpose of expanding affordable housing in the city;  Creating a housing authority to assist with providing affordable housing within the city. What is a housing authority? A housing authority is a public body that is created for clearance, replanning, and reconstruction of areas in which unsanitary or unsafe housing exists and for providing safe and sanitary housing for persons of low income. The housing authority may provide for the construction, improvement, alteration, or repair of a housing project, or part of a housing project, in its area of operation. A housing authority may also lease or rent housing, land, buildings, structures, or facilities included in a housing project. A housing authority is able to borrow money or accept grants or other financial assistance from the federal government for a housing project in the authority's area of operation, or form a partnership or another entity to raise capital for a housing project to be owned by the partnership or other entity. How does our city create a housing authority? The city council may declare by resolution that there is a need for a housing authority in the city if it finds that there is: (1) unsanitary or unsafe inhabited housing in the city; or (2) a shortage of safe or sanitary housing in the city available to persons of low income at rentals that they can afford. TEX. LOC. GOV’T CODE § 392.011. The council may determine on its own motion if there is a need for a housing authority but must determine there is a need upon receiving a petition signed by at least 100 qualified voters of the city. Who appoints members of a housing authority? Each municipal housing authority is governed by either five, seven, nine, or 11 commissioners. The mayor of the city appoints the commissioners of the authority, and an appointed commissioner of the authority may not be an officer or employee of the city. TEX. LOC. GOV’T CODE § 392.031. After the appointment, a certificate of the appointment of a commissioner must be filed with the city secretary. A city with a municipal housing authority composed of five commissioners must appoint at least one commissioner to the authority who is a tenant of a public housing project over which the authority has jurisdiction. TEX. LOC. GOV’T CODE § 392.0331. A city with a municipality with a municipal housing authority composed of seven or more commissioners must appoint at least two commissioners to the authority who are tenants of a public housing project over which the authority has jurisdiction. What is the term of office for a housing authority commissioner? Initially, a housing authority with five commissioners must have two designated to serve oneyear terms and three designated to serve two-year terms. A housing authority with seven commissioners must have three designated to serve one-year terms and four designated to serve two-year terms. A housing authority with nine commissioners must have four designated to serve one-year terms and five designated to serve two-year terms. Finally, a housing authority with 11 commissioners must have five designated to serve one-year terms and six designated to serve two-year terms. Subsequent municipal housing commissioners are appointed for two-year terms. If there is a vacancy on the housing authority board, the mayor appoints someone to fill the unexpired term. TEX. LOC. GOV’T CODE § 392.034.	[question] ================== According to the document, can a city make it illegal to be homeless? ================ [passage] ================== Homelessness laws in Texas When is an individual considered homeless? The United State Department of Housing and Urban Development (HUD) provides four broad categories of homelessness:  Individuals and families who lack a fixed, regular, and adequate nighttime residence, which includes a subset for an individual who is exiting an institution where he or she resided for 90 days or less and who resided in an emergency shelter or a place not meant for human habitation immediately before entering that institution;  Individuals and families who will imminently lose their primary nighttime residence;  Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition; or  Individuals and families who are fleeing, or are attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member. What negative effects can a large homeless population have on a city? A large homeless population can be draining on a community. Homeless individuals that lack access to proper medical care may choose an emergency room at a hospital for medical services rather than a primary care medical office. This option is significantly more expensive and typically the homeless individual is unable to pay the bill, so the cost is passed on to insurance companies and the average customer in a community. Homeless individuals spend more time in local jails than the housed population for petty offenses, which increases the costs to run the facility. Additionally, a large homeless population can affect a city’s ability to attract tourists. What is affordable housing? Affordable housing is housing for which the occupant pays less than 30 percent of their income. Housing that is considered to be “affordable” will differ between communities, depending on the median family income of the area. What is Section 8 housing? “Section 8” refers to Section 8 of the federal Housing Act of 1937. This section authorizes project-based rental assistance programs under which a participating owner, or landlord, is required to reserve units in a building for low-income tenants, in return for a federal government guarantee to make up the difference between the tenant's contribution and the rent in the owner's contract with the government. What is a Section 8 voucher? Section 8 of the federal Housing Act also authorizes vouchers for low-income individuals. HUD manages the Housing Choice Voucher Program, which provides financial assistance directly to the landlord for a family that qualifies. The Housing Choice Voucher Program is the federal government's major program for assisting very low-income families, the elderly, and the disabled to afford decent, safe, and sanitary housing in the private market. Since housing assistance is provided on behalf of the family or individual, participants are able to find their own housing, including single-family homes, townhouses and apartments, and are free to choose any housing option that meets the requirements of the program. Housing choice vouchers are administered locally by public housing agencies (PHAs). The PHAs receive federal funds from HUD to administer the voucher program. A list of public housing authorities in Texas can be found at http://portal.hud.gov/hudportal/HUD?src=/program_offices/public_indian_housing/pha/contacts/ tx A housing subsidy is paid to the landlord directly by the PHA on behalf of the participating family. The family then pays the difference between the actual rent charged by the landlord and the amount subsidized by the program. Can a city make being homeless illegal? No. Laws that punish status or condition rather than criminal conduct have been struck down by courts as constituting cruel and unusual punishment. These types of laws fail to give fair notice of prohibited conduct and encourage arbitrary arrests and convictions. Additionally, courts have overturned vagrancy laws, or laws that criminalize being homeless, as impermissible restrictions on an individual’s right to travel. See Papachristou v. City of Jacksonville, 45 U.S. 156, 162(1972); Handler v. Denver, 77 P.2d 132, 135 (Colo. 1938); Pottinger v. City of Miami, 810 F. Supp. 1551, 1578 (S.D. Fla. 1992). Can the city enact a loitering prohibition? Maybe. In a 1983 decision in Kolender v. Lawson, the United State Supreme Court invalidated a California loitering statute requiring street wanderers to present valid identification when stopped by police officers. The Court held that the statute was too vague to satisfy due process requirements. The Court followed this decision with its decision in Chicago v. Morales, which struck down a Chicago ordinance preventing loitering by gang members on due process grounds. An ordinance that is general in nature that criminalizes loitering on a public street would most likely be struck down by a court for vagueness. However, if the wording of the ordinance is sufficient to set forth guidelines for law enforcement officers narrowly tailoring the restriction to those who loiter with a specific illegal purpose, then a loitering ordinance may pass constitutional muster. City officials will want to work closely with their local legal counsel if they desire to adopt such an ordinance. Can a city prevent homeless people from panhandling in all public places? No. Litigation related to bans on panhandling has centered on First Amendment free speech claims. Courts have ruled that outlawing panhandling in all public places was unconstitutional. See generally Young v. New York City Transit Auth., 903 F.2d 146 (2d Cir. 1990); Speet v. Schuette, 889 F. Supp. 2d 969 (W.D. Mich. 2012). Instead, any limits on panhandling on public sidewalks trigger strict scrutiny, meaning the regulations must be narrowly tailored to serve a significant governmental interest and must be the least restrictive means for achieving that interest. Courts have found that safety and traffic congestion may be significant interests but “mere annoyance” is not a sufficiently compelling reason to absolutely deprive an individual of his or her First Amendment rights. What strategies have cities used to reduce homelessness?  Participating in the “Mayors Challenge to End Veteran Homelessness,” a program designed to equip city leaders with tools to combat veteran homelessness. For more information on how to participate, you can visit the Department of Housing and Urban Development’s Mayors Challenge page at http://portal.hud.gov/hudportal/HUD?src=/program_offices/comm_planning/veteran_info rmation/mayors_challenge/mayors_and_staff;  Seeking state grants awarded by the Texas Department of Housing and Community Affairs or federal grants awarded by HUD;  Educating law enforcement officers on alternatives to issuing citations and supporting police department partnerships with mental health partners;  Recruiting landlords in the city to assist in providing housing opportunities for individuals and families experiencing homelessness;  Educating municipal court personnel on providing referrals to municipal court defendants to non-profit groups in the city that provide housing and other services;  Issuing general obligation bonds for the purpose of expanding affordable housing in the city;  Creating a housing authority to assist with providing affordable housing within the city. What is a housing authority? A housing authority is a public body that is created for clearance, replanning, and reconstruction of areas in which unsanitary or unsafe housing exists and for providing safe and sanitary housing for persons of low income. The housing authority may provide for the construction, improvement, alteration, or repair of a housing project, or part of a housing project, in its area of operation. A housing authority may also lease or rent housing, land, buildings, structures, or facilities included in a housing project. A housing authority is able to borrow money or accept grants or other financial assistance from the federal government for a housing project in the authority's area of operation, or form a partnership or another entity to raise capital for a housing project to be owned by the partnership or other entity. How does our city create a housing authority? The city council may declare by resolution that there is a need for a housing authority in the city if it finds that there is: (1) unsanitary or unsafe inhabited housing in the city; or (2) a shortage of safe or sanitary housing in the city available to persons of low income at rentals that they can afford. TEX. LOC. GOV’T CODE § 392.011. The council may determine on its own motion if there is a need for a housing authority but must determine there is a need upon receiving a petition signed by at least 100 qualified voters of the city. Who appoints members of a housing authority? Each municipal housing authority is governed by either five, seven, nine, or 11 commissioners. The mayor of the city appoints the commissioners of the authority, and an appointed commissioner of the authority may not be an officer or employee of the city. TEX. LOC. GOV’T CODE § 392.031. After the appointment, a certificate of the appointment of a commissioner must be filed with the city secretary. A city with a municipal housing authority composed of five commissioners must appoint at least one commissioner to the authority who is a tenant of a public housing project over which the authority has jurisdiction. TEX. LOC. GOV’T CODE § 392.0331. A city with a municipality with a municipal housing authority composed of seven or more commissioners must appoint at least two commissioners to the authority who are tenants of a public housing project over which the authority has jurisdiction. What is the term of office for a housing authority commissioner? Initially, a housing authority with five commissioners must have two designated to serve oneyear terms and three designated to serve two-year terms. A housing authority with seven commissioners must have three designated to serve one-year terms and four designated to serve two-year terms. A housing authority with nine commissioners must have four designated to serve one-year terms and five designated to serve two-year terms. Finally, a housing authority with 11 commissioners must have five designated to serve one-year terms and six designated to serve two-year terms. Subsequent municipal housing commissioners are appointed for two-year terms. If there is a vacancy on the housing authority board, the mayor appoints someone to fill the unexpired term. TEX. LOC. GOV’T CODE § 392.034. ================ [task] ================== Answer in complete sentences, only use the context document, no outside knowledge.	Answer in complete sentences, only use the context document, no outside knowledge. EVIDENCE: Homelessness laws in Texas When is an individual considered homeless? The United State Department of Housing and Urban Development (HUD) provides four broad categories of homelessness:  Individuals and families who lack a fixed, regular, and adequate nighttime residence, which includes a subset for an individual who is exiting an institution where he or she resided for 90 days or less and who resided in an emergency shelter or a place not meant for human habitation immediately before entering that institution;  Individuals and families who will imminently lose their primary nighttime residence;  Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition; or  Individuals and families who are fleeing, or are attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member. What negative effects can a large homeless population have on a city? A large homeless population can be draining on a community. Homeless individuals that lack access to proper medical care may choose an emergency room at a hospital for medical services rather than a primary care medical office. This option is significantly more expensive and typically the homeless individual is unable to pay the bill, so the cost is passed on to insurance companies and the average customer in a community. Homeless individuals spend more time in local jails than the housed population for petty offenses, which increases the costs to run the facility. Additionally, a large homeless population can affect a city’s ability to attract tourists. What is affordable housing? Affordable housing is housing for which the occupant pays less than 30 percent of their income. Housing that is considered to be “affordable” will differ between communities, depending on the median family income of the area. What is Section 8 housing? “Section 8” refers to Section 8 of the federal Housing Act of 1937. This section authorizes project-based rental assistance programs under which a participating owner, or landlord, is required to reserve units in a building for low-income tenants, in return for a federal government guarantee to make up the difference between the tenant's contribution and the rent in the owner's contract with the government. What is a Section 8 voucher? Section 8 of the federal Housing Act also authorizes vouchers for low-income individuals. HUD manages the Housing Choice Voucher Program, which provides financial assistance directly to the landlord for a family that qualifies. The Housing Choice Voucher Program is the federal government's major program for assisting very low-income families, the elderly, and the disabled to afford decent, safe, and sanitary housing in the private market. Since housing assistance is provided on behalf of the family or individual, participants are able to find their own housing, including single-family homes, townhouses and apartments, and are free to choose any housing option that meets the requirements of the program. Housing choice vouchers are administered locally by public housing agencies (PHAs). The PHAs receive federal funds from HUD to administer the voucher program. A list of public housing authorities in Texas can be found at http://portal.hud.gov/hudportal/HUD?src=/program_offices/public_indian_housing/pha/contacts/ tx A housing subsidy is paid to the landlord directly by the PHA on behalf of the participating family. The family then pays the difference between the actual rent charged by the landlord and the amount subsidized by the program. Can a city make being homeless illegal? No. Laws that punish status or condition rather than criminal conduct have been struck down by courts as constituting cruel and unusual punishment. These types of laws fail to give fair notice of prohibited conduct and encourage arbitrary arrests and convictions. Additionally, courts have overturned vagrancy laws, or laws that criminalize being homeless, as impermissible restrictions on an individual’s right to travel. See Papachristou v. City of Jacksonville, 45 U.S. 156, 162(1972); Handler v. Denver, 77 P.2d 132, 135 (Colo. 1938); Pottinger v. City of Miami, 810 F. Supp. 1551, 1578 (S.D. Fla. 1992). Can the city enact a loitering prohibition? Maybe. In a 1983 decision in Kolender v. Lawson, the United State Supreme Court invalidated a California loitering statute requiring street wanderers to present valid identification when stopped by police officers. The Court held that the statute was too vague to satisfy due process requirements. The Court followed this decision with its decision in Chicago v. Morales, which struck down a Chicago ordinance preventing loitering by gang members on due process grounds. An ordinance that is general in nature that criminalizes loitering on a public street would most likely be struck down by a court for vagueness. However, if the wording of the ordinance is sufficient to set forth guidelines for law enforcement officers narrowly tailoring the restriction to those who loiter with a specific illegal purpose, then a loitering ordinance may pass constitutional muster. City officials will want to work closely with their local legal counsel if they desire to adopt such an ordinance. Can a city prevent homeless people from panhandling in all public places? No. Litigation related to bans on panhandling has centered on First Amendment free speech claims. Courts have ruled that outlawing panhandling in all public places was unconstitutional. See generally Young v. New York City Transit Auth., 903 F.2d 146 (2d Cir. 1990); Speet v. Schuette, 889 F. Supp. 2d 969 (W.D. Mich. 2012). Instead, any limits on panhandling on public sidewalks trigger strict scrutiny, meaning the regulations must be narrowly tailored to serve a significant governmental interest and must be the least restrictive means for achieving that interest. Courts have found that safety and traffic congestion may be significant interests but “mere annoyance” is not a sufficiently compelling reason to absolutely deprive an individual of his or her First Amendment rights. What strategies have cities used to reduce homelessness?  Participating in the “Mayors Challenge to End Veteran Homelessness,” a program designed to equip city leaders with tools to combat veteran homelessness. For more information on how to participate, you can visit the Department of Housing and Urban Development’s Mayors Challenge page at http://portal.hud.gov/hudportal/HUD?src=/program_offices/comm_planning/veteran_info rmation/mayors_challenge/mayors_and_staff;  Seeking state grants awarded by the Texas Department of Housing and Community Affairs or federal grants awarded by HUD;  Educating law enforcement officers on alternatives to issuing citations and supporting police department partnerships with mental health partners;  Recruiting landlords in the city to assist in providing housing opportunities for individuals and families experiencing homelessness;  Educating municipal court personnel on providing referrals to municipal court defendants to non-profit groups in the city that provide housing and other services;  Issuing general obligation bonds for the purpose of expanding affordable housing in the city;  Creating a housing authority to assist with providing affordable housing within the city. What is a housing authority? A housing authority is a public body that is created for clearance, replanning, and reconstruction of areas in which unsanitary or unsafe housing exists and for providing safe and sanitary housing for persons of low income. The housing authority may provide for the construction, improvement, alteration, or repair of a housing project, or part of a housing project, in its area of operation. A housing authority may also lease or rent housing, land, buildings, structures, or facilities included in a housing project. A housing authority is able to borrow money or accept grants or other financial assistance from the federal government for a housing project in the authority's area of operation, or form a partnership or another entity to raise capital for a housing project to be owned by the partnership or other entity. How does our city create a housing authority? The city council may declare by resolution that there is a need for a housing authority in the city if it finds that there is: (1) unsanitary or unsafe inhabited housing in the city; or (2) a shortage of safe or sanitary housing in the city available to persons of low income at rentals that they can afford. TEX. LOC. GOV’T CODE § 392.011. The council may determine on its own motion if there is a need for a housing authority but must determine there is a need upon receiving a petition signed by at least 100 qualified voters of the city. Who appoints members of a housing authority? Each municipal housing authority is governed by either five, seven, nine, or 11 commissioners. The mayor of the city appoints the commissioners of the authority, and an appointed commissioner of the authority may not be an officer or employee of the city. TEX. LOC. GOV’T CODE § 392.031. After the appointment, a certificate of the appointment of a commissioner must be filed with the city secretary. A city with a municipal housing authority composed of five commissioners must appoint at least one commissioner to the authority who is a tenant of a public housing project over which the authority has jurisdiction. TEX. LOC. GOV’T CODE § 392.0331. A city with a municipality with a municipal housing authority composed of seven or more commissioners must appoint at least two commissioners to the authority who are tenants of a public housing project over which the authority has jurisdiction. What is the term of office for a housing authority commissioner? Initially, a housing authority with five commissioners must have two designated to serve oneyear terms and three designated to serve two-year terms. A housing authority with seven commissioners must have three designated to serve one-year terms and four designated to serve two-year terms. A housing authority with nine commissioners must have four designated to serve one-year terms and five designated to serve two-year terms. Finally, a housing authority with 11 commissioners must have five designated to serve one-year terms and six designated to serve two-year terms. Subsequent municipal housing commissioners are appointed for two-year terms. If there is a vacancy on the housing authority board, the mayor appoints someone to fill the unexpired term. TEX. LOC. GOV’T CODE § 392.034. USER: According to the document, can a city make it illegal to be homeless? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	true	12	13	1,666	null	751
Respond only using the information within the provided text block. You must provide a direct answer to the question asked and format your reply in a paragraph without any bullets, headers, or other extraneous formatting. Limit your reply to 50 words.	Please extract all acronyms and provide the full name for any and all acronyms found in the text. You can ignore any acronyms that is not explicitly defined.	Recent advances in generative AI systems, which are trained on large volumes of data to generate new content that may mimic likenesses, voices, or other aspects of real people’s identities, have stimulated congressional interest. Like the above-noted uses of AI to imitate Tom Hanks and George Carlin, the examples below illustrate that some AI uses raise concerns under both ROP laws and myriad other laws. One example of AI’s capability to imitate voices was an AI-generated song called “Heart on My Sleeve,” which sounded like it was sung by the artist Drake and was heard by millions of listeners in 2023. Simulating an artist’s voice in this manner could make one liable under ROP laws, although these laws Congressional Research Service 4 differ as to whether they cover voice imitations or vocal styles as opposed to the artist’s actual voice. Voice imitations are not, however, prohibited by copyright laws. For example, the alleged copyright violation that caused YouTube to remove “Heart on My Sleeve”—namely, that it sampled another recording without permission—was unrelated to the Drake voice imitation. In August 2023, Google and Universal Music were in discussions to license artists’ melodies and voices for AI-generated songs. The potential for AI to replicate both voices and likenesses was also a point of contention in last year’s negotiations for a collective bargaining agreement between the Screen Actors Guild-American Federation of Television and Radio Artists (SAG-AFTRA)—a union that represents movie, television, and radio actors—and television and movie studios, including streaming services. SAG-AFTRA expressed concern that AI could be used to alter or replace actors’ performances without their permission, such as by using real film recordings to train AI to create “digital replicas” of actors and voice actors. The Memorandum of Agreement between SAG-AFTRA and studios approved in December 2023 requires studios to obtain “clear and conspicuous” consent from an actor or background actor to create or use a digital replica of the actor or to digitally alter the actor’s performance, with certain exceptions. It also requires that the actor’s consent for use of a digital replica or digital alterations be based on a “reasonably specific description” of the intended use or alteration. The agreement provides that consent continues after the actor’s death unless “explicitly limited,” while consent for additional postmortem uses must be obtained from the actor’s authorized representative or—if a representative cannot be identified or located—from the union. In January 2024, SAG-AFTRA announced it had also reached an agreement with a voice technology company regarding voice replicas for video games, while a negotiation to update SAG-AFTRA’s agreement with video game publishers is reportedly ongoing. Commentators have also raised concern with deceptive AI-generated or AI-altered content known as “deepfakes,” including some videos with sexually explicit content and others meant to denigrate public officials. To the extent this content includes real people’s NIL and is used commercially, ROP laws might provide a remedy. Where deepfakes are used to promote products or services—such as the AI replica of Tom Hanks used in a dental plan ad—they may also constitute false endorsement under the Lanham Act. In addition to these laws, some states have enacted laws prohibiting sexually explicit deepfakes, with California and New York giving victims a civil claim and Georgia and Virginia imposing criminal liability. In addition, Section 1309 of the federal Violence Against Women Act Reauthorization Act of 2022 (VAWA 2022) provides a civil claim for nonconsensual disclosure of “intimate visual depictions,” which might be interpreted to prohibit intimate deepfakes—as might some states’ “revenge porn” laws. A bill introduced in the House of Representatives in May 2023, the Preventing Deepfakes of Intimate Images Act, H.R. 3106, would amend VAWA 2022 by creating a separate civil claim for disclosing certain “intimate digital depictions” without the written consent of the depicted individual, as well as providing criminal liability for certain actual or threatened disclosures. Deepfakes may also give rise to liability under state defamation laws where a party uses them to communicate reputation-damaging falsehoods about a person with a requisite degree of fault. Regarding the use of AI in political advertisements, some proposed legislation would prohibit deepfakes or require disclaimers for them in federal campaigns, although such proposals may raise First Amendment concerns. The Protect Elections from Deceptive AI Act, S. 2770 (118th Cong.), for instance, would ban the use of AI to generate materially deceptive content falsely depicting federal candidates in political ads to influence federal elections, while excluding news, commentary, satires, and parodies from liability. Google announced that, as of mid-November 2023, verified election advertisers on its platform “must prominently disclose when their ads contain synthetic content that inauthentically depicts real or realisticlooking people or events.” Another concern some commentators raise is that AI-generated material might be falsely attributed to real persons without their permission. One writer who focuses on the publishing industry, for instance, found that books apparently generated by AI were being sold under her name on Amazon. Although the Congressional Research Service 5 company ultimately removed these titles, the writer claimed that her “initial infringement claim with Amazon went nowhere,” since her name was not trademarked and the books did not infringe existing copyrights. As she noted, however, this scenario might give rise to claims under state ROP laws as well as the Lanham Act. In addition, the Federal Trade Commission (FTC) states that “books sold as if authored by humans but in fact reflecting the output of [AI]” violate the FTC Act and may result in civil fines. It is unclear how Section 230 of the Communications Act of 1934 might apply when ROP-infringing content from a third party, including content made with AI, is disseminated through social media and other interactive computer services. Although the law generally bars any lawsuits that would hold online service providers and users liable for third party content, there is an exception allowing lawsuits under “any law pertaining to intellectual property.” Courts differ as to whether state ROP laws and the Lanham Act’s prohibition on false endorsement are laws “pertaining to” IP within the meaning of Section 230. Another Legal Sidebar discusses the application of Section 230 to generative AI more broadly. Considerations for Congress Some commentators have called for federal ROP legislation to provide more uniform and predictable protection for the ROP in the United States. Others have argued that Congress should leave ROP protection to the states on federalism grounds. If Congress decides to craft federal ROP legislation, it might consider the scope of the ROP protections it seeks to enact, the effect of those enactments on state ROP laws, and constitutional authorities and limitations on Congress’s power to enact ROP protections. As noted below, some Members have proposed legislation that would prohibit certain unauthorized uses of digital replicas or depictions of individuals while leaving state ROP laws in place.	Respond only using the information within the provided text block. You must provide a direct answer to the question asked and format your reply in a paragraph without any bullets, headers, or other extraneous formatting. Limit your reply to 50 words. Please extract all acronyms and provide the full name for any and all acronyms found in the text. You can ignore any acronyms that is not explicitly defined. Recent advances in generative AI systems, which are trained on large volumes of data to generate new content that may mimic likenesses, voices, or other aspects of real people’s identities, have stimulated congressional interest. Like the above-noted uses of AI to imitate Tom Hanks and George Carlin, the examples below illustrate that some AI uses raise concerns under both ROP laws and myriad other laws. One example of AI’s capability to imitate voices was an AI-generated song called “Heart on My Sleeve,” which sounded like it was sung by the artist Drake and was heard by millions of listeners in 2023. Simulating an artist’s voice in this manner could make one liable under ROP laws, although these laws Congressional Research Service 4 differ as to whether they cover voice imitations or vocal styles as opposed to the artist’s actual voice. Voice imitations are not, however, prohibited by copyright laws. For example, the alleged copyright violation that caused YouTube to remove “Heart on My Sleeve”—namely, that it sampled another recording without permission—was unrelated to the Drake voice imitation. In August 2023, Google and Universal Music were in discussions to license artists’ melodies and voices for AI-generated songs. The potential for AI to replicate both voices and likenesses was also a point of contention in last year’s negotiations for a collective bargaining agreement between the Screen Actors Guild-American Federation of Television and Radio Artists (SAG-AFTRA)—a union that represents movie, television, and radio actors—and television and movie studios, including streaming services. SAG-AFTRA expressed concern that AI could be used to alter or replace actors’ performances without their permission, such as by using real film recordings to train AI to create “digital replicas” of actors and voice actors. The Memorandum of Agreement between SAG-AFTRA and studios approved in December 2023 requires studios to obtain “clear and conspicuous” consent from an actor or background actor to create or use a digital replica of the actor or to digitally alter the actor’s performance, with certain exceptions. It also requires that the actor’s consent for use of a digital replica or digital alterations be based on a “reasonably specific description” of the intended use or alteration. The agreement provides that consent continues after the actor’s death unless “explicitly limited,” while consent for additional postmortem uses must be obtained from the actor’s authorized representative or—if a representative cannot be identified or located—from the union. In January 2024, SAG-AFTRA announced it had also reached an agreement with a voice technology company regarding voice replicas for video games, while a negotiation to update SAG-AFTRA’s agreement with video game publishers is reportedly ongoing. Commentators have also raised concern with deceptive AI-generated or AI-altered content known as “deepfakes,” including some videos with sexually explicit content and others meant to denigrate public officials. To the extent this content includes real people’s NIL and is used commercially, ROP laws might provide a remedy. Where deepfakes are used to promote products or services—such as the AI replica of Tom Hanks used in a dental plan ad—they may also constitute false endorsement under the Lanham Act. In addition to these laws, some states have enacted laws prohibiting sexually explicit deepfakes, with California and New York giving victims a civil claim and Georgia and Virginia imposing criminal liability. In addition, Section 1309 of the federal Violence Against Women Act Reauthorization Act of 2022 (VAWA 2022) provides a civil claim for nonconsensual disclosure of “intimate visual depictions,” which might be interpreted to prohibit intimate deepfakes—as might some states’ “revenge porn” laws. A bill introduced in the House of Representatives in May 2023, the Preventing Deepfakes of Intimate Images Act, H.R. 3106, would amend VAWA 2022 by creating a separate civil claim for disclosing certain “intimate digital depictions” without the written consent of the depicted individual, as well as providing criminal liability for certain actual or threatened disclosures. Deepfakes may also give rise to liability under state defamation laws where a party uses them to communicate reputation-damaging falsehoods about a person with a requisite degree of fault. Regarding the use of AI in political advertisements, some proposed legislation would prohibit deepfakes or require disclaimers for them in federal campaigns, although such proposals may raise First Amendment concerns. The Protect Elections from Deceptive AI Act, S. 2770 (118th Cong.), for instance, would ban the use of AI to generate materially deceptive content falsely depicting federal candidates in political ads to influence federal elections, while excluding news, commentary, satires, and parodies from liability. Google announced that, as of mid-November 2023, verified election advertisers on its platform “must prominently disclose when their ads contain synthetic content that inauthentically depicts real or realisticlooking people or events.” Another concern some commentators raise is that AI-generated material might be falsely attributed to real persons without their permission. One writer who focuses on the publishing industry, for instance, found that books apparently generated by AI were being sold under her name on Amazon. Although the Congressional Research Service 5 company ultimately removed these titles, the writer claimed that her “initial infringement claim with Amazon went nowhere,” since her name was not trademarked and the books did not infringe existing copyrights. As she noted, however, this scenario might give rise to claims under state ROP laws as well as the Lanham Act. In addition, the Federal Trade Commission (FTC) states that “books sold as if authored by humans but in fact reflecting the output of [AI]” violate the FTC Act and may result in civil fines. It is unclear how Section 230 of the Communications Act of 1934 might apply when ROP-infringing content from a third party, including content made with AI, is disseminated through social media and other interactive computer services. Although the law generally bars any lawsuits that would hold online service providers and users liable for third party content, there is an exception allowing lawsuits under “any law pertaining to intellectual property.” Courts differ as to whether state ROP laws and the Lanham Act’s prohibition on false endorsement are laws “pertaining to” IP within the meaning of Section 230. Another Legal Sidebar discusses the application of Section 230 to generative AI more broadly. Considerations for Congress Some commentators have called for federal ROP legislation to provide more uniform and predictable protection for the ROP in the United States. Others have argued that Congress should leave ROP protection to the states on federalism grounds. If Congress decides to craft federal ROP legislation, it might consider the scope of the ROP protections it seeks to enact, the effect of those enactments on state ROP laws, and constitutional authorities and limitations on Congress’s power to enact ROP protections. As noted below, some Members have proposed legislation that would prohibit certain unauthorized uses of digital replicas or depictions of individuals while leaving state ROP laws in place.	Respond only using the information within the provided text block. You must provide a direct answer to the question asked and format your reply in a paragraph without any bullets, headers, or other extraneous formatting. Limit your reply to 50 words. EVIDENCE: Recent advances in generative AI systems, which are trained on large volumes of data to generate new content that may mimic likenesses, voices, or other aspects of real people’s identities, have stimulated congressional interest. Like the above-noted uses of AI to imitate Tom Hanks and George Carlin, the examples below illustrate that some AI uses raise concerns under both ROP laws and myriad other laws. One example of AI’s capability to imitate voices was an AI-generated song called “Heart on My Sleeve,” which sounded like it was sung by the artist Drake and was heard by millions of listeners in 2023. Simulating an artist’s voice in this manner could make one liable under ROP laws, although these laws Congressional Research Service 4 differ as to whether they cover voice imitations or vocal styles as opposed to the artist’s actual voice. Voice imitations are not, however, prohibited by copyright laws. For example, the alleged copyright violation that caused YouTube to remove “Heart on My Sleeve”—namely, that it sampled another recording without permission—was unrelated to the Drake voice imitation. In August 2023, Google and Universal Music were in discussions to license artists’ melodies and voices for AI-generated songs. The potential for AI to replicate both voices and likenesses was also a point of contention in last year’s negotiations for a collective bargaining agreement between the Screen Actors Guild-American Federation of Television and Radio Artists (SAG-AFTRA)—a union that represents movie, television, and radio actors—and television and movie studios, including streaming services. SAG-AFTRA expressed concern that AI could be used to alter or replace actors’ performances without their permission, such as by using real film recordings to train AI to create “digital replicas” of actors and voice actors. The Memorandum of Agreement between SAG-AFTRA and studios approved in December 2023 requires studios to obtain “clear and conspicuous” consent from an actor or background actor to create or use a digital replica of the actor or to digitally alter the actor’s performance, with certain exceptions. It also requires that the actor’s consent for use of a digital replica or digital alterations be based on a “reasonably specific description” of the intended use or alteration. The agreement provides that consent continues after the actor’s death unless “explicitly limited,” while consent for additional postmortem uses must be obtained from the actor’s authorized representative or—if a representative cannot be identified or located—from the union. In January 2024, SAG-AFTRA announced it had also reached an agreement with a voice technology company regarding voice replicas for video games, while a negotiation to update SAG-AFTRA’s agreement with video game publishers is reportedly ongoing. Commentators have also raised concern with deceptive AI-generated or AI-altered content known as “deepfakes,” including some videos with sexually explicit content and others meant to denigrate public officials. To the extent this content includes real people’s NIL and is used commercially, ROP laws might provide a remedy. Where deepfakes are used to promote products or services—such as the AI replica of Tom Hanks used in a dental plan ad—they may also constitute false endorsement under the Lanham Act. In addition to these laws, some states have enacted laws prohibiting sexually explicit deepfakes, with California and New York giving victims a civil claim and Georgia and Virginia imposing criminal liability. In addition, Section 1309 of the federal Violence Against Women Act Reauthorization Act of 2022 (VAWA 2022) provides a civil claim for nonconsensual disclosure of “intimate visual depictions,” which might be interpreted to prohibit intimate deepfakes—as might some states’ “revenge porn” laws. A bill introduced in the House of Representatives in May 2023, the Preventing Deepfakes of Intimate Images Act, H.R. 3106, would amend VAWA 2022 by creating a separate civil claim for disclosing certain “intimate digital depictions” without the written consent of the depicted individual, as well as providing criminal liability for certain actual or threatened disclosures. Deepfakes may also give rise to liability under state defamation laws where a party uses them to communicate reputation-damaging falsehoods about a person with a requisite degree of fault. Regarding the use of AI in political advertisements, some proposed legislation would prohibit deepfakes or require disclaimers for them in federal campaigns, although such proposals may raise First Amendment concerns. The Protect Elections from Deceptive AI Act, S. 2770 (118th Cong.), for instance, would ban the use of AI to generate materially deceptive content falsely depicting federal candidates in political ads to influence federal elections, while excluding news, commentary, satires, and parodies from liability. Google announced that, as of mid-November 2023, verified election advertisers on its platform “must prominently disclose when their ads contain synthetic content that inauthentically depicts real or realisticlooking people or events.” Another concern some commentators raise is that AI-generated material might be falsely attributed to real persons without their permission. One writer who focuses on the publishing industry, for instance, found that books apparently generated by AI were being sold under her name on Amazon. Although the Congressional Research Service 5 company ultimately removed these titles, the writer claimed that her “initial infringement claim with Amazon went nowhere,” since her name was not trademarked and the books did not infringe existing copyrights. As she noted, however, this scenario might give rise to claims under state ROP laws as well as the Lanham Act. In addition, the Federal Trade Commission (FTC) states that “books sold as if authored by humans but in fact reflecting the output of [AI]” violate the FTC Act and may result in civil fines. It is unclear how Section 230 of the Communications Act of 1934 might apply when ROP-infringing content from a third party, including content made with AI, is disseminated through social media and other interactive computer services. Although the law generally bars any lawsuits that would hold online service providers and users liable for third party content, there is an exception allowing lawsuits under “any law pertaining to intellectual property.” Courts differ as to whether state ROP laws and the Lanham Act’s prohibition on false endorsement are laws “pertaining to” IP within the meaning of Section 230. Another Legal Sidebar discusses the application of Section 230 to generative AI more broadly. Considerations for Congress Some commentators have called for federal ROP legislation to provide more uniform and predictable protection for the ROP in the United States. Others have argued that Congress should leave ROP protection to the states on federalism grounds. If Congress decides to craft federal ROP legislation, it might consider the scope of the ROP protections it seeks to enact, the effect of those enactments on state ROP laws, and constitutional authorities and limitations on Congress’s power to enact ROP protections. As noted below, some Members have proposed legislation that would prohibit certain unauthorized uses of digital replicas or depictions of individuals while leaving state ROP laws in place. USER: Please extract all acronyms and provide the full name for any and all acronyms found in the text. You can ignore any acronyms that is not explicitly defined. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	41	28	1,129	null	294
Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here.	What are the Golden Rules of Great Customer Service?	GOLDEN RULES TO GREAT CUSTOMER SERVICE Presented by Bill Huninghake & Rich York THE GOLDEN RULE DO UNTO OTHERS AS YOU WOULD HAVE THEM DO UNTO YOU. GOLDEN RULES TO GREAT CUSTOMER SERVICE 1. A CUSTOMER IN NEED IS A CUSTOMER INDEED. 2. HIRE PEOPLE WITH GOOD CUSTOMER SKILLS 3. TRAIN YOUR EMPLOYEES ON STORE POLICIES. 4. CROSS TRAIN YOUR EMPLOYEES. 5. TRAIN YOUR EMPLOYEES HOW TO BUILD RAPPORT. 6. KNOW YOUR CUSTOMERS NAMES AND USE THEM. 7. TRAIN YOUR EMPLOYEES HOW TO ASK OPEN ENDED QUESTIONS. 8. INSTILL A SENSE OF URGENCY IN HELPING CUSTOMERS. 9. TRAIN YOUR EMPLOYEES HOW TO HANDLE ANGRY CUSTOMERS. 10. DON’T LET AN UNHAPPY CUSTOMER LEAVE YOUR STORE. WHAT IS YOUR GOLDEN EGG? 1. IMPROVE CUSTOMER RETENTION 2. COMMUNITY INVOLVEMENT 3. INCREASE NEW CUSTOMERS 4. FRIENDLIEST PLACE AROUND 5. BEST PERISHABLES IN TOWN 6. BEST MEAT DEPARTMENT AROUND SUPERCENTER AFFILIATED FOODS STORE WHY DID THE CUSTOMER CROSS THE ROAD? Why Customers Quit Shopping Your Store Die, 1% Move, 3% Other Friendship, 5% Competition, 9% Product Dissatisfaction, 14% Attitude of an Employee 68% FIRST GOLDEN RULE A CUSTOMER IN NEED IS A CUSTOMER INDEED When there is not much difference between your product and the product of your competitor, there needs to be a BIG difference in the quality of service you provide your customer. SECOND GOLDEN RULE HIRE PEOPLE WITH GOOD CUSTOMER SERVICE SKILLS A B C D E F G H I J K L M N O P Q R S T U V W X Y Z A -- 1 T -- 20 T -- 20 I -- 9 T -- 20 U -- 21 D -- 4 E -- 5 Attitude equals 100%. ATTITUDE IS A LITTLE THING THAT MAKES A BIG DIFFERENCE HOW TO HIRE GREAT EMPLOYEES: Seek out the great employees who already work for you. Interview them, find out what makes them tick. Write profiles of great employees. Find out what qualities they have in common. Then look to hire people with the same qualities. THIRD GOLDEN RULE TRAIN YOUR EMPLOYEES ON STORE POLICIES BE THE EXAMPLE FOR YOUR EMPLOYEES TO EMULATE. DON’T ASK YOUR EMPLOYEES TO DO SOMETHING YOU WOULDN’T. EXAMPLE POLICIES • Visit with customers • No whispering • Walk the customer to product • Don’t get in the customer’s way when working in the aisles • 10 ft rule – Greet the customer • 2 is company but 3 is a crowd – more than two in line call for help • 3 sacks = mandatory carry out • Thank the Customer no matter what FOURTH GOLDEN RULE CROSS TRAIN YOUR EMPLOYEES Provide opportunities for employees to learn. The kind of employees you want are the kind who want to learn. Good workers improve their skills in many areas of work and life. They can either do it on their own, and be more inclined to go elsewhere for continued challenge and learning, or they can learn under your auspices, and develop close ties to your organization while they do. • Communicate the task. Describe exactly what you want done, when you want it done, and what end results you expect. • Furnish context for the task. Explain why the task needs to be done, its importance in the overall scheme of things, and possible complications that may arise during its performance • Determine standards. Agree on the standards that you will use to measure the success of a task's completion. These standards should be realistic and attainable. FIFTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO BUILD RAPPORT WITH THE CUSTOMER Teach your employees how to create excellent customer service through human interaction • All customers are greeted politely and courteously. • Create an atmosphere of friendliness throughout each customer interaction. • Professionalism is displayed through word and deeds. • Show empathy and understanding for a customer with a problem • All customers are treated fairly in every interaction with the store • Conduct yourself with tact SIXTH GOLDEN RULE KNOW YOUR CUSTOMERS NAMES AND USE THEM Use the following to build positive relationships with your customers • KIDS NAMES • ACHIEVEMENTS • HONOR ROLL • MARRIAGE • NEW CAR • HAIR STYLE CHANGE **STAY AWAY FROM PERSONAL SENSITIVE SUBJECTS EVERYONE HAS AN INVISIBLE SIGN HANGING FROM HIS OR HER NECK THAT READS “MAKE ME FEEL IMPORTANT,” NEVER FORGET THIS WHEN WORKING WITH PEOPLE. SEVENTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO ASK OPEN ENDED QUESTIONS Open-ended questions are questions that encourage people to talk about whatever is important to them. They help to establish rapport, gather information, and increase understanding. They are the opposite of closed-ended questions that typically require a simple brief response such “yes” or “no.” Examples of open-ended questions: • How can I be of help? • · Would you tell me more about ___? • · Could you help me understand ___? • · What are the good things and the less good things about ___? • · What do you think you will lose if you give up ___? • · What have you tried before? • · What do you want to do next? Affirmations Affirmations are statements and gestures that recognize client strengths and acknowledge behaviors that lead in the direction of positive change, no matter how big or small. Affirmations build confidence in one’s ability to change. To be effective, affirmations must be genuine and congruent. Examples of affirmation statements: · Thank you for … · I really like the way you … · That was a very creative how you … · You showed a lot of self-control in the way you … · It may not seem like much, but I think it was very impressive how you … · You have a real gift for … “TO GIVE REAL SERVICE YOU MUST ADD SOMETHING WHICH CANNOT BE BOUGHT OR MEASURED WITH MONEY, AND THAT IS SINCERITY AND INTEGRITY” -Donald A. Adams EIGHTH GOLDEN RULE INSTILL A SENSE OF URGENCY IN HELPING CUSTOMERS WHAT DO THESE CUSTOMERS HAVE IN COMMON? EDUCATE YOUR EMPLOYEES ON FIVE PRINCIPLES OF A GOOD EMPLOYEE • URGENCY • OWNERSHIP • LEARN-BY-DOING • LIFELONG LEARNING • MOTIVATION Customers don’t expect you to be perfect. They do expect you to fix things when they go wrong NINTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO HANDLE ANGRY CUSTOMERS NEVER ARGUE WITH A CUSTOMER . LISTEN! CLOSE YOUR MOUTH AND LISTEN!! WHEN THAT DOESN’T WORK……. Saying I’m sorry will often times reduce anger. Apologies even if it was not your fault. Defusing Angry Customers using the LARSON approach • Listen let them vent. Empathize, take notes • Agreement find areas of agreement • Repeat/Restate use the customers words for clarification of issue • Seek Resolution Ask what can be done to resolve the problem • Offer a sincere apology We’re sorry this happened and if were responsible we will make it right • Now solve the problem immediately THE FOUR R’S • REPEAT • REVIEW • RESPOND • RESOLVE TENTH GOLDEN RULE DON’T LET AN ANGRY CUSTOMER LEAVE YOUR STORE 10 WAYS TO BUILD CUSTOMER LOYALTY 1. Take ownership of your customer’s problem. Even if you are not the cause of it. 2. Follow up with every customer who was upset or had a difficult problem. 3. Ask yourself with every customer interaction you have, “If this were me, what would I want?” 4. Thank your customers and co-workers every chance you get! 5. Fax articles or other materials to your customers if you think they can benefit from the information. 10 WAYS TO BUILD CUSTOMER LOYALTY (Continued) 6. Remember personal details about your customers such as birthdays, children’s names and accomplishments. 7. SMILE every time you are on the telephone. 8. Look for ways to bend the rules and remove service obstacles. 9. Time is a person’s most precious commodity. Respect your customer’s time and schedule. 10. Provide your customers with respect, friendliness, and knowledge, and oh, yes, the products and services you sell. COMPARING A KNIGHT IN SHINING ARMOR TO A CUSTOMER SERVICE REPRESENTATIVE WE CONTROL OUR OWN DESTINY AND WE WILL GET THE RESULTS WE WANT BY WORKING THE GOLDEN RULES THANK YOU FOR SPENDING TIME WITH ME TODAY THE END INSERT CLIP FROM PICKLE	Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here. What are the Golden Rules of Great Customer Service? GOLDEN RULES TO GREAT CUSTOMER SERVICE Presented by Bill Huninghake & Rich York THE GOLDEN RULE DO UNTO OTHERS AS YOU WOULD HAVE THEM DO UNTO YOU. GOLDEN RULES TO GREAT CUSTOMER SERVICE 1. A CUSTOMER IN NEED IS A CUSTOMER INDEED. 2. HIRE PEOPLE WITH GOOD CUSTOMER SKILLS 3. TRAIN YOUR EMPLOYEES ON STORE POLICIES. 4. CROSS TRAIN YOUR EMPLOYEES. 5. TRAIN YOUR EMPLOYEES HOW TO BUILD RAPPORT. 6. KNOW YOUR CUSTOMERS NAMES AND USE THEM. 7. TRAIN YOUR EMPLOYEES HOW TO ASK OPEN ENDED QUESTIONS. 8. INSTILL A SENSE OF URGENCY IN HELPING CUSTOMERS. 9. TRAIN YOUR EMPLOYEES HOW TO HANDLE ANGRY CUSTOMERS. 10. DON’T LET AN UNHAPPY CUSTOMER LEAVE YOUR STORE. WHAT IS YOUR GOLDEN EGG? 1. IMPROVE CUSTOMER RETENTION 2. COMMUNITY INVOLVEMENT 3. INCREASE NEW CUSTOMERS 4. FRIENDLIEST PLACE AROUND 5. BEST PERISHABLES IN TOWN 6. BEST MEAT DEPARTMENT AROUND SUPERCENTER AFFILIATED FOODS STORE WHY DID THE CUSTOMER CROSS THE ROAD? Why Customers Quit Shopping Your Store Die, 1% Move, 3% Other Friendship, 5% Competition, 9% Product Dissatisfaction, 14% Attitude of an Employee 68% FIRST GOLDEN RULE A CUSTOMER IN NEED IS A CUSTOMER INDEED When there is not much difference between your product and the product of your competitor, there needs to be a BIG difference in the quality of service you provide your customer. SECOND GOLDEN RULE HIRE PEOPLE WITH GOOD CUSTOMER SERVICE SKILLS A B C D E F G H I J K L M N O P Q R S T U V W X Y Z A -- 1 T -- 20 T -- 20 I -- 9 T -- 20 U -- 21 D -- 4 E -- 5 Attitude equals 100%. ATTITUDE IS A LITTLE THING THAT MAKES A BIG DIFFERENCE HOW TO HIRE GREAT EMPLOYEES: Seek out the great employees who already work for you. Interview them, find out what makes them tick. Write profiles of great employees. Find out what qualities they have in common. Then look to hire people with the same qualities. THIRD GOLDEN RULE TRAIN YOUR EMPLOYEES ON STORE POLICIES BE THE EXAMPLE FOR YOUR EMPLOYEES TO EMULATE. DON’T ASK YOUR EMPLOYEES TO DO SOMETHING YOU WOULDN’T. EXAMPLE POLICIES • Visit with customers • No whispering • Walk the customer to product • Don’t get in the customer’s way when working in the aisles • 10 ft rule – Greet the customer • 2 is company but 3 is a crowd – more than two in line call for help • 3 sacks = mandatory carry out • Thank the Customer no matter what FOURTH GOLDEN RULE CROSS TRAIN YOUR EMPLOYEES Provide opportunities for employees to learn. The kind of employees you want are the kind who want to learn. Good workers improve their skills in many areas of work and life. They can either do it on their own, and be more inclined to go elsewhere for continued challenge and learning, or they can learn under your auspices, and develop close ties to your organization while they do. • Communicate the task. Describe exactly what you want done, when you want it done, and what end results you expect. • Furnish context for the task. Explain why the task needs to be done, its importance in the overall scheme of things, and possible complications that may arise during its performance • Determine standards. Agree on the standards that you will use to measure the success of a task's completion. These standards should be realistic and attainable. FIFTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO BUILD RAPPORT WITH THE CUSTOMER Teach your employees how to create excellent customer service through human interaction • All customers are greeted politely and courteously. • Create an atmosphere of friendliness throughout each customer interaction. • Professionalism is displayed through word and deeds. • Show empathy and understanding for a customer with a problem • All customers are treated fairly in every interaction with the store • Conduct yourself with tact SIXTH GOLDEN RULE KNOW YOUR CUSTOMERS NAMES AND USE THEM Use the following to build positive relationships with your customers • KIDS NAMES • ACHIEVEMENTS • HONOR ROLL • MARRIAGE • NEW CAR • HAIR STYLE CHANGE **STAY AWAY FROM PERSONAL SENSITIVE SUBJECTS EVERYONE HAS AN INVISIBLE SIGN HANGING FROM HIS OR HER NECK THAT READS “MAKE ME FEEL IMPORTANT,” NEVER FORGET THIS WHEN WORKING WITH PEOPLE. SEVENTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO ASK OPEN ENDED QUESTIONS Open-ended questions are questions that encourage people to talk about whatever is important to them. They help to establish rapport, gather information, and increase understanding. They are the opposite of closed-ended questions that typically require a simple brief response such “yes” or “no.” Examples of open-ended questions: • How can I be of help? • · Would you tell me more about ___? • · Could you help me understand ___? • · What are the good things and the less good things about ___? • · What do you think you will lose if you give up ___? • · What have you tried before? • · What do you want to do next? Affirmations Affirmations are statements and gestures that recognize client strengths and acknowledge behaviors that lead in the direction of positive change, no matter how big or small. Affirmations build confidence in one’s ability to change. To be effective, affirmations must be genuine and congruent. Examples of affirmation statements: · Thank you for … · I really like the way you … · That was a very creative how you … · You showed a lot of self-control in the way you … · It may not seem like much, but I think it was very impressive how you … · You have a real gift for … “TO GIVE REAL SERVICE YOU MUST ADD SOMETHING WHICH CANNOT BE BOUGHT OR MEASURED WITH MONEY, AND THAT IS SINCERITY AND INTEGRITY” -Donald A. Adams EIGHTH GOLDEN RULE INSTILL A SENSE OF URGENCY IN HELPING CUSTOMERS WHAT DO THESE CUSTOMERS HAVE IN COMMON? EDUCATE YOUR EMPLOYEES ON FIVE PRINCIPLES OF A GOOD EMPLOYEE • URGENCY • OWNERSHIP • LEARN-BY-DOING • LIFELONG LEARNING • MOTIVATION Customers don’t expect you to be perfect. They do expect you to fix things when they go wrong NINTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO HANDLE ANGRY CUSTOMERS NEVER ARGUE WITH A CUSTOMER . LISTEN! CLOSE YOUR MOUTH AND LISTEN!! WHEN THAT DOESN’T WORK……. Saying I’m sorry will often times reduce anger. Apologies even if it was not your fault. Defusing Angry Customers using the LARSON approach • Listen let them vent. Empathize, take notes • Agreement find areas of agreement • Repeat/Restate use the customers words for clarification of issue • Seek Resolution Ask what can be done to resolve the problem • Offer a sincere apology We’re sorry this happened and if were responsible we will make it right • Now solve the problem immediately THE FOUR R’S • REPEAT • REVIEW • RESPOND • RESOLVE TENTH GOLDEN RULE DON’T LET AN ANGRY CUSTOMER LEAVE YOUR STORE 10 WAYS TO BUILD CUSTOMER LOYALTY 1. Take ownership of your customer’s problem. Even if you are not the cause of it. 2. Follow up with every customer who was upset or had a difficult problem. 3. Ask yourself with every customer interaction you have, “If this were me, what would I want?” 4. Thank your customers and co-workers every chance you get! 5. Fax articles or other materials to your customers if you think they can benefit from the information. 10 WAYS TO BUILD CUSTOMER LOYALTY (Continued) 6. Remember personal details about your customers such as birthdays, children’s names and accomplishments. 7. SMILE every time you are on the telephone. 8. Look for ways to bend the rules and remove service obstacles. 9. Time is a person’s most precious commodity. Respect your customer’s time and schedule. 10. Provide your customers with respect, friendliness, and knowledge, and oh, yes, the products and services you sell. COMPARING A KNIGHT IN SHINING ARMOR TO A CUSTOMER SERVICE REPRESENTATIVE WE CONTROL OUR OWN DESTINY AND WE WILL GET THE RESULTS WE WANT BY WORKING THE GOLDEN RULES THANK YOU FOR SPENDING TIME WITH ME TODAY THE END INSERT CLIP FROM PICKLE	Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here. EVIDENCE: GOLDEN RULES TO GREAT CUSTOMER SERVICE Presented by Bill Huninghake & Rich York THE GOLDEN RULE DO UNTO OTHERS AS YOU WOULD HAVE THEM DO UNTO YOU. GOLDEN RULES TO GREAT CUSTOMER SERVICE 1. A CUSTOMER IN NEED IS A CUSTOMER INDEED. 2. HIRE PEOPLE WITH GOOD CUSTOMER SKILLS 3. TRAIN YOUR EMPLOYEES ON STORE POLICIES. 4. CROSS TRAIN YOUR EMPLOYEES. 5. TRAIN YOUR EMPLOYEES HOW TO BUILD RAPPORT. 6. KNOW YOUR CUSTOMERS NAMES AND USE THEM. 7. TRAIN YOUR EMPLOYEES HOW TO ASK OPEN ENDED QUESTIONS. 8. INSTILL A SENSE OF URGENCY IN HELPING CUSTOMERS. 9. TRAIN YOUR EMPLOYEES HOW TO HANDLE ANGRY CUSTOMERS. 10. DON’T LET AN UNHAPPY CUSTOMER LEAVE YOUR STORE. WHAT IS YOUR GOLDEN EGG? 1. IMPROVE CUSTOMER RETENTION 2. COMMUNITY INVOLVEMENT 3. INCREASE NEW CUSTOMERS 4. FRIENDLIEST PLACE AROUND 5. BEST PERISHABLES IN TOWN 6. BEST MEAT DEPARTMENT AROUND SUPERCENTER AFFILIATED FOODS STORE WHY DID THE CUSTOMER CROSS THE ROAD? Why Customers Quit Shopping Your Store Die, 1% Move, 3% Other Friendship, 5% Competition, 9% Product Dissatisfaction, 14% Attitude of an Employee 68% FIRST GOLDEN RULE A CUSTOMER IN NEED IS A CUSTOMER INDEED When there is not much difference between your product and the product of your competitor, there needs to be a BIG difference in the quality of service you provide your customer. SECOND GOLDEN RULE HIRE PEOPLE WITH GOOD CUSTOMER SERVICE SKILLS A B C D E F G H I J K L M N O P Q R S T U V W X Y Z A -- 1 T -- 20 T -- 20 I -- 9 T -- 20 U -- 21 D -- 4 E -- 5 Attitude equals 100%. ATTITUDE IS A LITTLE THING THAT MAKES A BIG DIFFERENCE HOW TO HIRE GREAT EMPLOYEES: Seek out the great employees who already work for you. Interview them, find out what makes them tick. Write profiles of great employees. Find out what qualities they have in common. Then look to hire people with the same qualities. THIRD GOLDEN RULE TRAIN YOUR EMPLOYEES ON STORE POLICIES BE THE EXAMPLE FOR YOUR EMPLOYEES TO EMULATE. DON’T ASK YOUR EMPLOYEES TO DO SOMETHING YOU WOULDN’T. EXAMPLE POLICIES • Visit with customers • No whispering • Walk the customer to product • Don’t get in the customer’s way when working in the aisles • 10 ft rule – Greet the customer • 2 is company but 3 is a crowd – more than two in line call for help • 3 sacks = mandatory carry out • Thank the Customer no matter what FOURTH GOLDEN RULE CROSS TRAIN YOUR EMPLOYEES Provide opportunities for employees to learn. The kind of employees you want are the kind who want to learn. Good workers improve their skills in many areas of work and life. They can either do it on their own, and be more inclined to go elsewhere for continued challenge and learning, or they can learn under your auspices, and develop close ties to your organization while they do. • Communicate the task. Describe exactly what you want done, when you want it done, and what end results you expect. • Furnish context for the task. Explain why the task needs to be done, its importance in the overall scheme of things, and possible complications that may arise during its performance • Determine standards. Agree on the standards that you will use to measure the success of a task's completion. These standards should be realistic and attainable. FIFTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO BUILD RAPPORT WITH THE CUSTOMER Teach your employees how to create excellent customer service through human interaction • All customers are greeted politely and courteously. • Create an atmosphere of friendliness throughout each customer interaction. • Professionalism is displayed through word and deeds. • Show empathy and understanding for a customer with a problem • All customers are treated fairly in every interaction with the store • Conduct yourself with tact SIXTH GOLDEN RULE KNOW YOUR CUSTOMERS NAMES AND USE THEM Use the following to build positive relationships with your customers • KIDS NAMES • ACHIEVEMENTS • HONOR ROLL • MARRIAGE • NEW CAR • HAIR STYLE CHANGE *STAY AWAY FROM PERSONAL SENSITIVE SUBJECTS EVERYONE HAS AN INVISIBLE SIGN HANGING FROM HIS OR HER NECK THAT READS “MAKE ME FEEL IMPORTANT,” NEVER FORGET THIS WHEN WORKING WITH PEOPLE. SEVENTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO ASK OPEN ENDED QUESTIONS Open-ended questions are questions that encourage people to talk about whatever is important to them. They help to establish rapport, gather information, and increase understanding. They are the opposite of closed-ended questions that typically require a simple brief response such “yes” or “no.” Examples of open-ended questions: • How can I be of help? • · Would you tell me more about ___? • · Could you help me understand ___? • · What are the good things and the less good things about ___? • · What do you think you will lose if you give up ___? • · What have you tried before? • · What do you want to do next? Affirmations Affirmations are statements and gestures that recognize client strengths and acknowledge behaviors that lead in the direction of positive change, no matter how big or small. Affirmations build confidence in one’s ability to change. To be effective, affirmations must be genuine and congruent. Examples of affirmation statements: · Thank you for … · I really like the way you … · That was a very creative how you … · You showed a lot of self-control in the way you … · It may not seem like much, but I think it was very impressive how you … · You have a real gift for … “TO GIVE REAL SERVICE YOU MUST ADD SOMETHING WHICH CANNOT BE BOUGHT OR MEASURED WITH MONEY, AND THAT IS SINCERITY AND INTEGRITY” -Donald A. Adams EIGHTH GOLDEN RULE INSTILL A SENSE OF URGENCY IN HELPING CUSTOMERS WHAT DO THESE CUSTOMERS HAVE IN COMMON? EDUCATE YOUR EMPLOYEES ON FIVE PRINCIPLES OF A GOOD EMPLOYEE • URGENCY • OWNERSHIP • LEARN-BY-DOING • LIFELONG LEARNING • MOTIVATION Customers don’t expect you to be perfect. They do expect you to fix things when they go wrong NINTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO HANDLE ANGRY CUSTOMERS NEVER ARGUE WITH A CUSTOMER . LISTEN! CLOSE YOUR MOUTH AND LISTEN!! WHEN THAT DOESN’T WORK……. Saying I’m sorry will often times reduce anger. Apologies even if it was not your fault. Defusing Angry Customers using the LARSON approach • Listen let them vent. Empathize, take notes • Agreement find areas of agreement • Repeat/Restate use the customers words for clarification of issue • Seek Resolution Ask what can be done to resolve the problem • Offer a sincere apology We’re sorry this happened and if were responsible we will make it right • Now solve the problem immediately THE FOUR R’S • REPEAT • REVIEW • RESPOND • RESOLVE TENTH GOLDEN RULE DON’T LET AN ANGRY CUSTOMER LEAVE YOUR STORE 10 WAYS TO BUILD CUSTOMER LOYALTY 1. Take ownership of your customer’s problem. Even if you are not the cause of it. 2. Follow up with every customer who was upset or had a difficult problem. 3. Ask yourself with every customer interaction you have, “If this were me, what would I want?” 4. Thank your customers and co-workers every chance you get! 5. Fax articles or other materials to your customers if you think they can benefit from the information. 10 WAYS TO BUILD CUSTOMER LOYALTY (Continued) 6. Remember personal details about your customers such as birthdays, children’s names and accomplishments. 7. SMILE every time you are on the telephone. 8. Look for ways to bend the rules and remove service obstacles. 9. Time is a person’s most precious commodity. Respect your customer’s time and schedule. 10. Provide your customers with respect, friendliness, and knowledge, and oh, yes, the products and services you sell. COMPARING A KNIGHT IN SHINING ARMOR TO A CUSTOMER SERVICE REPRESENTATIVE WE CONTROL OUR OWN DESTINY AND WE WILL GET THE RESULTS WE WANT BY WORKING THE GOLDEN RULES THANK YOU FOR SPENDING TIME WITH ME TODAY THE END INSERT CLIP FROM PICKLE USER: What are the Golden Rules of Great Customer Service? Assistant: Answer only* using the evidence. If unknown, say you cannot answer. Cite sources.	false	24	9	1,376	null	22
Answer questions using ONLY the provided context. Do NOT use the internet or any internal knowledge. Use markdown seldomly, and only use bold or italic, nothing else.	What are the requirements of OPM?	As part of the assessment, S. 4043 would require OPM to explain whether each agency met its telework goals and, if not, the actions being taken to identify and eliminate barriers to meeting them. The annual report would also discuss additional steps that are planned by agencies to ensure telework oversight and quality control and increase the utilization rates of office building space owned or leased by the agencies. S. 4043 also requires the Office of Management and Budget (OMB), in consultation with GSA and the Federal Real Property Council, to develop benchmarks and guidance for executive agencies to use when calculating building utilization rates. S. 4043 would then require each executive agency head to establish (1) a system to track office building space utilization rates consistent with that OMB guidance and (2) indicators that measure the effects of telework policy on the management of real and personal property, among other things. S. 4043 would also require OPM to establish data standards to aid telework reporting requirements and for automated telework tracking within payroll systems used by agencies. S. 4043 would require OPM, in turn, to create an online tool that makes the standardized and reported data publicly available and would allow OPM to use the online tool to fulfill its annual reporting requirements. For a more detailed discussion of the bill’s provisions on telework data standards, including office building utilization data, see CRS Insight IN12352, Establishing Data Standards and Measuring Building Use: Select Provisions of the Telework Transparency Act of 2024 (S. 4043).	What are the requirements of OPM? As part of the assessment, S. 4043 would require OPM to explain whether each agency met its telework goals and, if not, the actions being taken to identify and eliminate barriers to meeting them. The annual report would also discuss additional steps that are planned by agencies to ensure telework oversight and quality control and increase the utilization rates of office building space owned or leased by the agencies. S. 4043 also requires the Office of Management and Budget (OMB), in consultation with GSA and the Federal Real Property Council, to develop benchmarks and guidance for executive agencies to use when calculating building utilization rates. S. 4043 would then require each executive agency head to establish (1) a system to track office building space utilization rates consistent with that OMB guidance and (2) indicators that measure the effects of telework policy on the management of real and personal property, among other things. S. 4043 would also require OPM to establish data standards to aid telework reporting requirements and for automated telework tracking within payroll systems used by agencies. S. 4043 would require OPM, in turn, to create an online tool that makes the standardized and reported data publicly available and would allow OPM to use the online tool to fulfill its annual reporting requirements. For a more detailed discussion of the bill’s provisions on telework data standards, including office building utilization data, see CRS Insight IN12352, Establishing Data Standards and Measuring Building Use: Select Provisions of the Telework Transparency Act of 2024 (S. 4043). Answer questions using ONLY the provided context. Do NOT use the internet or any internal knowledge. Use markdown seldomly, and only use bold or italic, nothing else.	Answer questions using ONLY the provided context. Do NOT use the internet or any internal knowledge. Use markdown seldomly, and only use bold or italic, nothing else. EVIDENCE: As part of the assessment, S. 4043 would require OPM to explain whether each agency met its telework goals and, if not, the actions being taken to identify and eliminate barriers to meeting them. The annual report would also discuss additional steps that are planned by agencies to ensure telework oversight and quality control and increase the utilization rates of office building space owned or leased by the agencies. S. 4043 also requires the Office of Management and Budget (OMB), in consultation with GSA and the Federal Real Property Council, to develop benchmarks and guidance for executive agencies to use when calculating building utilization rates. S. 4043 would then require each executive agency head to establish (1) a system to track office building space utilization rates consistent with that OMB guidance and (2) indicators that measure the effects of telework policy on the management of real and personal property, among other things. S. 4043 would also require OPM to establish data standards to aid telework reporting requirements and for automated telework tracking within payroll systems used by agencies. S. 4043 would require OPM, in turn, to create an online tool that makes the standardized and reported data publicly available and would allow OPM to use the online tool to fulfill its annual reporting requirements. For a more detailed discussion of the bill’s provisions on telework data standards, including office building utilization data, see CRS Insight IN12352, Establishing Data Standards and Measuring Building Use: Select Provisions of the Telework Transparency Act of 2024 (S. 4043). USER: What are the requirements of OPM? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	27	6	254	null	210
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.	What are the benefits of racetrack layouts as stated in the provided context?	Merchandising Gude Module 1: The Importance of Merchandising Merchandising, or how products are displayed in the store, plays a critical role in the overall success of your business. After all, when customers come into your store, you want them to buy. Effective merchandising is a tool that gets them closer to that purchase decision. But having effective merchandising demands discipline and planning. It’s hard work. You must pay attention to detail on a daily basis. You also must realize that many of your competitors have effective merchandising. That means your customers are used to seeing it, so they expect it from you, too. In this course, we’ll discuss the techniques and best practices that make up an effective merchandising strategy. We’ll begin by talking about why merchandising is so important. Merchandising makes several important contributions to your store. It increases sales by making a store appealing to your customers. It improves profitability by generating more margin dollars. It controls costs by improving the productivity of the salesfloor as well as each employee. Appeals to Customers • Good merchandising makes shopping easier for customers and gives them reasons to come back often and spend more money. Remember that many consumers may not consider shopping fun. A merchandiser’s goal is to take the hassle out of shopping and make it easier. • Good merchandising can also create customer loyalty. Consumers shop where they feel certain they can find the merchandise they want. They will be loyal to your store if you can create a pleasing shopping experience and provide what they need. • Finally, good merchandising can promote repeat shopping. One of the best opportunities for growth comes from building on the business of existing shoppers. When customers know your store is easy to shop, they will return again and again. Improves Profitability • One way good merchandising can improve your store’s profitability is by enhancing your price image. Many consumers may think that independent home improvement retailers have high prices. The challenge for those retailers, then, is not to have the lowest prices, but to convince consumers that they are priced competitively for the value and service they offer. Pallet displays in the power aisle are a good example of how to promote a value-priced image. • Merchandising also allows retailers to make strategic pricing decisions. Through promotional merchandising techniques, such as dump bins, it’s possible to increase item sales while at the same time lowering prices. • Merchandising can increase your sales per customer if it’s arranged to promote add-on sales, for example, through impulse displays at the checkout counter. • Merchandising also promotes self-service shopping. While you can only wait on one customer at a time, good displays help customers shop on their own. This means you have more time to spend with customers who need extra help. Module 1: The Importance of Merchandising (continued) Increases Salesfloor Productivity • Merchandising can help control costs by helping retailers improve the productivity of the salesfloor. Productivity improves when retailers can increase sales using their existing salesfloor square footage and number of employees. Merchandising affects virtually all of the measurements of retail productivity, such as gross margin and sales per square foot. • Merchandising also makes the salesfloor more productive by suggesting add-on sales and impulse purchases. It helps organize the store, suggest project ideas, remind customers of items they may have forgotten and promote special buys. • Merchandising also complements advertising by helping customers find sale items. Increases Employee Productivity • Good merchandising can help increase your productivity by helping you provide better customer service. As an employee, you want to spend your time giving customers the product knowledge they need to solve their home improvement problems. You want to minimize the time you spend simply directing customers to the aisles where they can find what they need. That’s why you have signage and merchandising. • Good merchandising makes selling more rewarding. The more customers are able to shop for themselves, the more time you have to develop new retailing skills. This will help you advance and gain new responsibilities in the company Module 2: The Elements of Merchandising There’s more to merchandising than just having attractive displays. It incorporates the design of the salesfloor, the placement of the signage and the presentation of the products. When you learn how to merchandise, you learn how to effectively use space, color and lighting to encourage customers to buy. A well-merchandised store is also a well-organized store. Customers like organized stores because they can find merchandise quickly and easily on their own. All of the elements of merchandising contribute to making a store more organized. In this module, we’ll discuss eight elements of merchandising: salesfloor layout, interior signage, cross merchandising, the use of space, color, lighting, mass displays and interactive technology. Racetrack Layout The racetrack layout, also called a loop layout, has the main traffic aisle circling the salesfloor. It gives every major department exposure on the main aisle. It moves customers through the store and lets them see merchandise in more departments. It also provides more locations for endcaps, which helps create a value-priced image. Diagonal Layout The diagonal layout is a modification of the racetrack layout and can be effective in smaller stores. It creates several triangular areas in the store and pulls customers to corners they might otherwise miss. Grid Layout The grid layout is the simple, traditional layout for a home improvement store. It has straight cross aisles leading off one or more main aisles into departments. This layout is neat and makes good use of space. Its main drawback is that is does not put the maximum amount of product in front of customers. Power Aisle The power aisle design works well for smaller salesfloors where a racetrack is not practical. It is a double-width aisle that runs the full length of the store. This design often includes departmental cross aisles that feed off of the power aisle. The power aisle gives exposure to most major departments through the use of feature endcaps or promotional mass displays in the center of the aisle. It makes maximum use of the display area. Module 2: The Elements of Merchandising Salesfloor Layout Most stores are organized into departments, and customers are accustomed to shopping this way. Here are five ways the salesfloor can be laid out in a typical store. Project Centers Project centers and demonstration areas can be developed with any salesfloor layout. They can be used for classes, workshops or product demonstrations. They are also useful areas for collection points for how-to information, such as books and product information. These areas should present products related to projects and focus attention on promoted merchandise. Signage should suggest projects, explain product features and benefits, talk about prices and highlight the value of home improvement projects. Cube Displays Cube displays are another way smaller stores can get the maximum amount of merchandise on the salesfloor. These displays use higher fixtures with careful attention to the kinds of merchandise displayed on higher shelves. An effective way to use cube displays is to put the higher fixtures in the back of the store to make more merchandise visible from the front and lead customers through the store. Module 2: The Elements of Merchandising (continued) Brought to you by the North American Retail Hardware Association • www.nrha.org Interior Signing • Signage is an important part of merchandising because it makes shopping easier for customers and gives them the information to make informed buying decisions. • Signs keep customers in the store longer, move them from department to department and suggest more items to purchase. In addition to department and aisle signs, shelf and product signs can convey shopping information. • Some signs provide information about specific products. Signs may also be used to describe the product’s features, benefits and uses. They should always be neat, easy to read, informative and compelling. • Signs are also used to provide information about price. They can create urgency if they are used to identify items as bargains or closeouts. They can also identify advertised items and help establish a value price image for the store. • Department signs are used to help identify the location of departments in the store, such as paint or tools. These signs should be visible from the front of the store so customers can quickly find what they need. Store Design and Product Presentation In addition to the layout of the salesfloor, here are some elements of merchandising you may encounter in the store. Cross Merchandising • Cross merchandising is a term used to describe the placement of products together that are used together in projects. It is an effective way to show related items that are normally stocked in different departments. For example, you might show garden gloves next to the shovels. You can merchandise these items next to each other on the same shelf or across the aisle. Cross-aisle merchandising is the practice of displaying related merchandise on facing shelves. • Cross merchandising is an effective technique because it makes shopping easier and more convenient when customers can see several items they need in one location. • This appeals to a customer’s desire to save time because they don’t have to go to multiple areas of the store to get what they need. • It’s also an effective tool suggesting add-on sales, since related items are together. • Cross merchandising organizes products in the way they are used. In this way, it gives customers project information. It can also suggest better-quality items. • Here are some ways you can effectively use cross merchandising: • Combine products from different departments. • Promote seasonal projects. • Promote common household repair and maintenance projects. • Display the pairs in the department where customers are most likely to go first. • Look for vendor planograms that utilize cross-merchandising. • Incorporate signage to compare benefits of good-better-best quality. Use of Space • Merchandising should organize products in the most productive use of the space. Shelves should be far enough apart that the merchandise fits comfortably, but not waste space. In the same way, hooks and bins should fit the size of the item. Long- and short-handled items should go together. • The use of space in merchandising also involves placement in the store. Reserve the prime display areas in the store for items customers are most likely to want. Keep the best display area for high-demand, fast-moving products. Putting slow movers in prime display spaces won’t make them sell faster. It may only suggest to customers that they may have to go somewhere else to find what they need.	[Query] ================== What are the benefits of racetrack layouts as stated in the provided context? ================ [Context] ================== Merchandising Gude Module 1: The Importance of Merchandising Merchandising, or how products are displayed in the store, plays a critical role in the overall success of your business. After all, when customers come into your store, you want them to buy. Effective merchandising is a tool that gets them closer to that purchase decision. But having effective merchandising demands discipline and planning. It’s hard work. You must pay attention to detail on a daily basis. You also must realize that many of your competitors have effective merchandising. That means your customers are used to seeing it, so they expect it from you, too. In this course, we’ll discuss the techniques and best practices that make up an effective merchandising strategy. We’ll begin by talking about why merchandising is so important. Merchandising makes several important contributions to your store. It increases sales by making a store appealing to your customers. It improves profitability by generating more margin dollars. It controls costs by improving the productivity of the salesfloor as well as each employee. Appeals to Customers • Good merchandising makes shopping easier for customers and gives them reasons to come back often and spend more money. Remember that many consumers may not consider shopping fun. A merchandiser’s goal is to take the hassle out of shopping and make it easier. • Good merchandising can also create customer loyalty. Consumers shop where they feel certain they can find the merchandise they want. They will be loyal to your store if you can create a pleasing shopping experience and provide what they need. • Finally, good merchandising can promote repeat shopping. One of the best opportunities for growth comes from building on the business of existing shoppers. When customers know your store is easy to shop, they will return again and again. Improves Profitability • One way good merchandising can improve your store’s profitability is by enhancing your price image. Many consumers may think that independent home improvement retailers have high prices. The challenge for those retailers, then, is not to have the lowest prices, but to convince consumers that they are priced competitively for the value and service they offer. Pallet displays in the power aisle are a good example of how to promote a value-priced image. • Merchandising also allows retailers to make strategic pricing decisions. Through promotional merchandising techniques, such as dump bins, it’s possible to increase item sales while at the same time lowering prices. • Merchandising can increase your sales per customer if it’s arranged to promote add-on sales, for example, through impulse displays at the checkout counter. • Merchandising also promotes self-service shopping. While you can only wait on one customer at a time, good displays help customers shop on their own. This means you have more time to spend with customers who need extra help. Module 1: The Importance of Merchandising (continued) Increases Salesfloor Productivity • Merchandising can help control costs by helping retailers improve the productivity of the salesfloor. Productivity improves when retailers can increase sales using their existing salesfloor square footage and number of employees. Merchandising affects virtually all of the measurements of retail productivity, such as gross margin and sales per square foot. • Merchandising also makes the salesfloor more productive by suggesting add-on sales and impulse purchases. It helps organize the store, suggest project ideas, remind customers of items they may have forgotten and promote special buys. • Merchandising also complements advertising by helping customers find sale items. Increases Employee Productivity • Good merchandising can help increase your productivity by helping you provide better customer service. As an employee, you want to spend your time giving customers the product knowledge they need to solve their home improvement problems. You want to minimize the time you spend simply directing customers to the aisles where they can find what they need. That’s why you have signage and merchandising. • Good merchandising makes selling more rewarding. The more customers are able to shop for themselves, the more time you have to develop new retailing skills. This will help you advance and gain new responsibilities in the company Module 2: The Elements of Merchandising There’s more to merchandising than just having attractive displays. It incorporates the design of the salesfloor, the placement of the signage and the presentation of the products. When you learn how to merchandise, you learn how to effectively use space, color and lighting to encourage customers to buy. A well-merchandised store is also a well-organized store. Customers like organized stores because they can find merchandise quickly and easily on their own. All of the elements of merchandising contribute to making a store more organized. In this module, we’ll discuss eight elements of merchandising: salesfloor layout, interior signage, cross merchandising, the use of space, color, lighting, mass displays and interactive technology. Racetrack Layout The racetrack layout, also called a loop layout, has the main traffic aisle circling the salesfloor. It gives every major department exposure on the main aisle. It moves customers through the store and lets them see merchandise in more departments. It also provides more locations for endcaps, which helps create a value-priced image. Diagonal Layout The diagonal layout is a modification of the racetrack layout and can be effective in smaller stores. It creates several triangular areas in the store and pulls customers to corners they might otherwise miss. Grid Layout The grid layout is the simple, traditional layout for a home improvement store. It has straight cross aisles leading off one or more main aisles into departments. This layout is neat and makes good use of space. Its main drawback is that is does not put the maximum amount of product in front of customers. Power Aisle The power aisle design works well for smaller salesfloors where a racetrack is not practical. It is a double-width aisle that runs the full length of the store. This design often includes departmental cross aisles that feed off of the power aisle. The power aisle gives exposure to most major departments through the use of feature endcaps or promotional mass displays in the center of the aisle. It makes maximum use of the display area. Module 2: The Elements of Merchandising Salesfloor Layout Most stores are organized into departments, and customers are accustomed to shopping this way. Here are five ways the salesfloor can be laid out in a typical store. Project Centers Project centers and demonstration areas can be developed with any salesfloor layout. They can be used for classes, workshops or product demonstrations. They are also useful areas for collection points for how-to information, such as books and product information. These areas should present products related to projects and focus attention on promoted merchandise. Signage should suggest projects, explain product features and benefits, talk about prices and highlight the value of home improvement projects. Cube Displays Cube displays are another way smaller stores can get the maximum amount of merchandise on the salesfloor. These displays use higher fixtures with careful attention to the kinds of merchandise displayed on higher shelves. An effective way to use cube displays is to put the higher fixtures in the back of the store to make more merchandise visible from the front and lead customers through the store. Module 2: The Elements of Merchandising (continued) Brought to you by the North American Retail Hardware Association • www.nrha.org Interior Signing • Signage is an important part of merchandising because it makes shopping easier for customers and gives them the information to make informed buying decisions. • Signs keep customers in the store longer, move them from department to department and suggest more items to purchase. In addition to department and aisle signs, shelf and product signs can convey shopping information. • Some signs provide information about specific products. Signs may also be used to describe the product’s features, benefits and uses. They should always be neat, easy to read, informative and compelling. • Signs are also used to provide information about price. They can create urgency if they are used to identify items as bargains or closeouts. They can also identify advertised items and help establish a value price image for the store. • Department signs are used to help identify the location of departments in the store, such as paint or tools. These signs should be visible from the front of the store so customers can quickly find what they need. Store Design and Product Presentation In addition to the layout of the salesfloor, here are some elements of merchandising you may encounter in the store. Cross Merchandising • Cross merchandising is a term used to describe the placement of products together that are used together in projects. It is an effective way to show related items that are normally stocked in different departments. For example, you might show garden gloves next to the shovels. You can merchandise these items next to each other on the same shelf or across the aisle. Cross-aisle merchandising is the practice of displaying related merchandise on facing shelves. • Cross merchandising is an effective technique because it makes shopping easier and more convenient when customers can see several items they need in one location. • This appeals to a customer’s desire to save time because they don’t have to go to multiple areas of the store to get what they need. • It’s also an effective tool suggesting add-on sales, since related items are together. • Cross merchandising organizes products in the way they are used. In this way, it gives customers project information. It can also suggest better-quality items. • Here are some ways you can effectively use cross merchandising: • Combine products from different departments. • Promote seasonal projects. • Promote common household repair and maintenance projects. • Display the pairs in the department where customers are most likely to go first. • Look for vendor planograms that utilize cross-merchandising. • Incorporate signage to compare benefits of good-better-best quality. Use of Space • Merchandising should organize products in the most productive use of the space. Shelves should be far enough apart that the merchandise fits comfortably, but not waste space. In the same way, hooks and bins should fit the size of the item. Long- and short-handled items should go together. • The use of space in merchandising also involves placement in the store. Reserve the prime display areas in the store for items customers are most likely to want. Keep the best display area for high-demand, fast-moving products. Putting slow movers in prime display spaces won’t make them sell faster. It may only suggest to customers that they may have to go somewhere else to find what they need. ================ [Task Instructions] ================== 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.	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: Merchandising Gude Module 1: The Importance of Merchandising Merchandising, or how products are displayed in the store, plays a critical role in the overall success of your business. After all, when customers come into your store, you want them to buy. Effective merchandising is a tool that gets them closer to that purchase decision. But having effective merchandising demands discipline and planning. It’s hard work. You must pay attention to detail on a daily basis. You also must realize that many of your competitors have effective merchandising. That means your customers are used to seeing it, so they expect it from you, too. In this course, we’ll discuss the techniques and best practices that make up an effective merchandising strategy. We’ll begin by talking about why merchandising is so important. Merchandising makes several important contributions to your store. It increases sales by making a store appealing to your customers. It improves profitability by generating more margin dollars. It controls costs by improving the productivity of the salesfloor as well as each employee. Appeals to Customers • Good merchandising makes shopping easier for customers and gives them reasons to come back often and spend more money. Remember that many consumers may not consider shopping fun. A merchandiser’s goal is to take the hassle out of shopping and make it easier. • Good merchandising can also create customer loyalty. Consumers shop where they feel certain they can find the merchandise they want. They will be loyal to your store if you can create a pleasing shopping experience and provide what they need. • Finally, good merchandising can promote repeat shopping. One of the best opportunities for growth comes from building on the business of existing shoppers. When customers know your store is easy to shop, they will return again and again. Improves Profitability • One way good merchandising can improve your store’s profitability is by enhancing your price image. Many consumers may think that independent home improvement retailers have high prices. The challenge for those retailers, then, is not to have the lowest prices, but to convince consumers that they are priced competitively for the value and service they offer. Pallet displays in the power aisle are a good example of how to promote a value-priced image. • Merchandising also allows retailers to make strategic pricing decisions. Through promotional merchandising techniques, such as dump bins, it’s possible to increase item sales while at the same time lowering prices. • Merchandising can increase your sales per customer if it’s arranged to promote add-on sales, for example, through impulse displays at the checkout counter. • Merchandising also promotes self-service shopping. While you can only wait on one customer at a time, good displays help customers shop on their own. This means you have more time to spend with customers who need extra help. Module 1: The Importance of Merchandising (continued) Increases Salesfloor Productivity • Merchandising can help control costs by helping retailers improve the productivity of the salesfloor. Productivity improves when retailers can increase sales using their existing salesfloor square footage and number of employees. Merchandising affects virtually all of the measurements of retail productivity, such as gross margin and sales per square foot. • Merchandising also makes the salesfloor more productive by suggesting add-on sales and impulse purchases. It helps organize the store, suggest project ideas, remind customers of items they may have forgotten and promote special buys. • Merchandising also complements advertising by helping customers find sale items. Increases Employee Productivity • Good merchandising can help increase your productivity by helping you provide better customer service. As an employee, you want to spend your time giving customers the product knowledge they need to solve their home improvement problems. You want to minimize the time you spend simply directing customers to the aisles where they can find what they need. That’s why you have signage and merchandising. • Good merchandising makes selling more rewarding. The more customers are able to shop for themselves, the more time you have to develop new retailing skills. This will help you advance and gain new responsibilities in the company Module 2: The Elements of Merchandising There’s more to merchandising than just having attractive displays. It incorporates the design of the salesfloor, the placement of the signage and the presentation of the products. When you learn how to merchandise, you learn how to effectively use space, color and lighting to encourage customers to buy. A well-merchandised store is also a well-organized store. Customers like organized stores because they can find merchandise quickly and easily on their own. All of the elements of merchandising contribute to making a store more organized. In this module, we’ll discuss eight elements of merchandising: salesfloor layout, interior signage, cross merchandising, the use of space, color, lighting, mass displays and interactive technology. Racetrack Layout The racetrack layout, also called a loop layout, has the main traffic aisle circling the salesfloor. It gives every major department exposure on the main aisle. It moves customers through the store and lets them see merchandise in more departments. It also provides more locations for endcaps, which helps create a value-priced image. Diagonal Layout The diagonal layout is a modification of the racetrack layout and can be effective in smaller stores. It creates several triangular areas in the store and pulls customers to corners they might otherwise miss. Grid Layout The grid layout is the simple, traditional layout for a home improvement store. It has straight cross aisles leading off one or more main aisles into departments. This layout is neat and makes good use of space. Its main drawback is that is does not put the maximum amount of product in front of customers. Power Aisle The power aisle design works well for smaller salesfloors where a racetrack is not practical. It is a double-width aisle that runs the full length of the store. This design often includes departmental cross aisles that feed off of the power aisle. The power aisle gives exposure to most major departments through the use of feature endcaps or promotional mass displays in the center of the aisle. It makes maximum use of the display area. Module 2: The Elements of Merchandising Salesfloor Layout Most stores are organized into departments, and customers are accustomed to shopping this way. Here are five ways the salesfloor can be laid out in a typical store. Project Centers Project centers and demonstration areas can be developed with any salesfloor layout. They can be used for classes, workshops or product demonstrations. They are also useful areas for collection points for how-to information, such as books and product information. These areas should present products related to projects and focus attention on promoted merchandise. Signage should suggest projects, explain product features and benefits, talk about prices and highlight the value of home improvement projects. Cube Displays Cube displays are another way smaller stores can get the maximum amount of merchandise on the salesfloor. These displays use higher fixtures with careful attention to the kinds of merchandise displayed on higher shelves. An effective way to use cube displays is to put the higher fixtures in the back of the store to make more merchandise visible from the front and lead customers through the store. Module 2: The Elements of Merchandising (continued) Brought to you by the North American Retail Hardware Association • www.nrha.org Interior Signing • Signage is an important part of merchandising because it makes shopping easier for customers and gives them the information to make informed buying decisions. • Signs keep customers in the store longer, move them from department to department and suggest more items to purchase. In addition to department and aisle signs, shelf and product signs can convey shopping information. • Some signs provide information about specific products. Signs may also be used to describe the product’s features, benefits and uses. They should always be neat, easy to read, informative and compelling. • Signs are also used to provide information about price. They can create urgency if they are used to identify items as bargains or closeouts. They can also identify advertised items and help establish a value price image for the store. • Department signs are used to help identify the location of departments in the store, such as paint or tools. These signs should be visible from the front of the store so customers can quickly find what they need. Store Design and Product Presentation In addition to the layout of the salesfloor, here are some elements of merchandising you may encounter in the store. Cross Merchandising • Cross merchandising is a term used to describe the placement of products together that are used together in projects. It is an effective way to show related items that are normally stocked in different departments. For example, you might show garden gloves next to the shovels. You can merchandise these items next to each other on the same shelf or across the aisle. Cross-aisle merchandising is the practice of displaying related merchandise on facing shelves. • Cross merchandising is an effective technique because it makes shopping easier and more convenient when customers can see several items they need in one location. • This appeals to a customer’s desire to save time because they don’t have to go to multiple areas of the store to get what they need. • It’s also an effective tool suggesting add-on sales, since related items are together. • Cross merchandising organizes products in the way they are used. In this way, it gives customers project information. It can also suggest better-quality items. • Here are some ways you can effectively use cross merchandising: • Combine products from different departments. • Promote seasonal projects. • Promote common household repair and maintenance projects. • Display the pairs in the department where customers are most likely to go first. • Look for vendor planograms that utilize cross-merchandising. • Incorporate signage to compare benefits of good-better-best quality. Use of Space • Merchandising should organize products in the most productive use of the space. Shelves should be far enough apart that the merchandise fits comfortably, but not waste space. In the same way, hooks and bins should fit the size of the item. Long- and short-handled items should go together. • The use of space in merchandising also involves placement in the store. Reserve the prime display areas in the store for items customers are most likely to want. Keep the best display area for high-demand, fast-moving products. Putting slow movers in prime display spaces won’t make them sell faster. It may only suggest to customers that they may have to go somewhere else to find what they need. USER: What are the benefits of racetrack layouts as stated in the provided context? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	25	13	1,773	null	89
Answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. If the answer contains more than one piece of information, utilize a numbered list.	If I need permission to use a work, where can I find the copyright owner?	In general, for works created on or after January 1, 1978, the term of copyright is the life of the author plus seventy years after the author’s death. If the work is a joint work with multiple authors, the term lasts for seventy years after the last surviving author’s death. For works made for hire and anonymous or pseudonymous works, the duration of copyright is 95 years from publication or 120 years from creation, whichever is shorter. For works created before January 1, 1978, that were not published or registered as of that date, the term of copyright is generally the same as for works created on or after January 1, 1978. The law, however, provides that in no case would the term have expired before December 31, 2002, and if the work was published on or before that date, the term will not expire before December 31, 2047. For works created before January 1, 1978, that were published or registered before that date, the initial term of copyright was twenty-eight years from the date of publication with notice or from the date of registration. At the end of the initial term, the copyright could be renewed for another sixtyseven years for a total term of protection of up to ninety-five years. To extend copyright into the renewal term, two registrations had to be made before the original term expired: one for the original term and the other for the renewal term. This requirement was eliminated on June 26, 1992, and renewal term registration is now optional. For more information on the term of copyright protection, see Duration of Copyright (Circular 15A) and Renewal of Copyright (Circular 6A). How Can I Protect My Work? Copyright exists automatically in an original work of authorship once it is fixed in a tangible medium, but a copyright owner can take steps to enhance the protections of copyright, the most important of which is registering the work. Although registering a work is not mandatory, for U.S. works, registration (or refusal) is necessary to enforce the exclusive rights of copyright through litigation. Applying a copyright notice to a work has not been required since March 1, 1989, but may still provide practical and legal benefits. Notice typically consists of the copyright symbol or the word “Copyright,” the name of the copyright owner, and the year of first publication. Placing a copyright notice on a work is not a substitute for registration. Copyright Basics 5 Benefits of Registration Registration establishes a claim to copyright with the Copyright Office. An application for copyright registration can be filed by the author or owner of an exclusive right in a work, the owner of all exclusive rights, or an agent on behalf of an author or owner. An application contains three essential elements: a completed application form, a nonrefundable filing fee, and a nonreturnable deposit— that is, a copy or copies of the work being registered and “deposited” with the Copyright Office. A certificate of registration creates a public record of key facts relating to the authorship and ownership of the claimed work, including the title of the work, the author of the work, the name and address of the claimant or copyright owner, the year of creation, and information about whether the work is published, has been previously registered, or includes preexisting material. You can submit an application online through www.copyright.gov or on a paper application. For more information on registering a work with the Copyright Office, see Copyright Registration (Circular 2). In addition to establishing a public record of a copyright claim, registration offers several other statutory advantages: • Before an infringement suit may be filed in court, registration (or refusal) is necessary for U.S. works.2 • Registration establishes prima facie evidence of the validity of the copyright and facts stated in the certificate when registration is made before or within five years of publication. • When registration is made prior to infringement or within three months after publication of a work, a copyright owner is eligible for statutory damages, attorneys’ fees, and costs. • Registration permits a copyright owner to establish a record with the U.S. Customs and Border Protection (CBP)4 for protection against the importation of infringing copies. Registration can be made at any time within the life of the copyright. If you register before publication, you do not have to re-register when the work is published, although you can register the published edition, if desired. Effective Date of Registration When the Copyright Office registers a work it assigns an effective date of registration to the certificate of registration. The effective date of registration is the day that the Office receives in proper form all required elements—an acceptable application, an acceptable deposit, and a nonrefundable filing fee. The date is not set until all the required elements are in the Office’s possession. If the Office receives incomplete materials, an unacceptable deposit, or an insufficient fee, the effective date of registration will be set on the date that the Office receives all the required materials in acceptable form. The date is not based on how long it takes the Office to examine the materials or mail the certificate of registration. You do not have to receive your certificate of registration before you publish or produce your work. Nor do you need permission from the Copyright Office to place a copyright notice on your work. But the Copyright Office must approve or refuse your application before you can file a lawsuit for copyright infringement, except in cases involving a non-U.S. work.5 You may seek statutory damages and attorneys’ fees in an infringement action provided that the infringement began after the effective date of registration. The law, however, provides a grace period of three months after publication during which full remedies can be recovered for any infringement begun during the three months after publication if registration is made before this period ends. Copyright Basics 6 Copyright Notice A copyright notice is a statement placed on copies or phonorecords of a work to inform the public that a copyright owner is claiming ownership of the work. A copyright notice consists of three elements: • The copyright symbol © or (p) for phonorecords, the word “Copyright,” or the abbreviation “Copr.”; • The year of first publication of the work (or of creation if the work is unpublished); and • The name of the copyright owner, an abbreviation by which the name can be recognized, or a generally known alternative designation. A notice should be affixed to copies or phonorecords of a work in a way that gives reasonable notice of the claim of copyright. Using a copyright notice is optional for unpublished works, non-U.S. works, and works published on or after March 1, 1989. However, notice conveys the following benefits: • It puts potential users on notice that copyright is claimed in the work. • For published works, notice may prevent a defendant from attempting to limit liability for damages or injunctive relief based on an “innocent infringement” defense. • It identifies the copyright owner at the time of first publication for parties seeking permission to use the work. • It identifies the year of first publication, which can be used to determine the term of copyright for anonymous or pseudonymous works or works made for hire. • It may prevent the work from becoming an “orphan” by identifying the copyright owner or specifying the term of copyright. Orphan works are original works of authorship for which prospective users cannot identify or locate copyright owners to request permission. Notice was required for works published in the United States before March 1, 1989. Works published without notice before that date may have entered the public domain in this country. For more information, see Copyright Notice (Circular 3	Answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. If the answer contains more than one piece of information, utilize a numbered list. If I need permission to use a work, where can I find the copyright owner? In general, for works created on or after January 1, 1978, the term of copyright is the life of the author plus seventy years after the author’s death. If the work is a joint work with multiple authors, the term lasts for seventy years after the last surviving author’s death. For works made for hire and anonymous or pseudonymous works, the duration of copyright is 95 years from publication or 120 years from creation, whichever is shorter. For works created before January 1, 1978, that were not published or registered as of that date, the term of copyright is generally the same as for works created on or after January 1, 1978. The law, however, provides that in no case would the term have expired before December 31, 2002, and if the work was published on or before that date, the term will not expire before December 31, 2047. For works created before January 1, 1978, that were published or registered before that date, the initial term of copyright was twenty-eight years from the date of publication with notice or from the date of registration. At the end of the initial term, the copyright could be renewed for another sixtyseven years for a total term of protection of up to ninety-five years. To extend copyright into the renewal term, two registrations had to be made before the original term expired: one for the original term and the other for the renewal term. This requirement was eliminated on June 26, 1992, and renewal term registration is now optional. For more information on the term of copyright protection, see Duration of Copyright (Circular 15A) and Renewal of Copyright (Circular 6A). How Can I Protect My Work? Copyright exists automatically in an original work of authorship once it is fixed in a tangible medium, but a copyright owner can take steps to enhance the protections of copyright, the most important of which is registering the work. Although registering a work is not mandatory, for U.S. works, registration (or refusal) is necessary to enforce the exclusive rights of copyright through litigation. Applying a copyright notice to a work has not been required since March 1, 1989, but may still provide practical and legal benefits. Notice typically consists of the copyright symbol or the word “Copyright,” the name of the copyright owner, and the year of first publication. Placing a copyright notice on a work is not a substitute for registration. Copyright Basics 5 Benefits of Registration Registration establishes a claim to copyright with the Copyright Office. An application for copyright registration can be filed by the author or owner of an exclusive right in a work, the owner of all exclusive rights, or an agent on behalf of an author or owner. An application contains three essential elements: a completed application form, a nonrefundable filing fee, and a nonreturnable deposit— that is, a copy or copies of the work being registered and “deposited” with the Copyright Office. A certificate of registration creates a public record of key facts relating to the authorship and ownership of the claimed work, including the title of the work, the author of the work, the name and address of the claimant or copyright owner, the year of creation, and information about whether the work is published, has been previously registered, or includes preexisting material. You can submit an application online through www.copyright.gov or on a paper application. For more information on registering a work with the Copyright Office, see Copyright Registration (Circular 2). In addition to establishing a public record of a copyright claim, registration offers several other statutory advantages: • Before an infringement suit may be filed in court, registration (or refusal) is necessary for U.S. works.2 • Registration establishes prima facie evidence of the validity of the copyright and facts stated in the certificate when registration is made before or within five years of publication. • When registration is made prior to infringement or within three months after publication of a work, a copyright owner is eligible for statutory damages, attorneys’ fees, and costs. • Registration permits a copyright owner to establish a record with the U.S. Customs and Border Protection (CBP)4 for protection against the importation of infringing copies. Registration can be made at any time within the life of the copyright. If you register before publication, you do not have to re-register when the work is published, although you can register the published edition, if desired. Effective Date of Registration When the Copyright Office registers a work it assigns an effective date of registration to the certificate of registration. The effective date of registration is the day that the Office receives in proper form all required elements—an acceptable application, an acceptable deposit, and a nonrefundable filing fee. The date is not set until all the required elements are in the Office’s possession. If the Office receives incomplete materials, an unacceptable deposit, or an insufficient fee, the effective date of registration will be set on the date that the Office receives all the required materials in acceptable form. The date is not based on how long it takes the Office to examine the materials or mail the certificate of registration. You do not have to receive your certificate of registration before you publish or produce your work. Nor do you need permission from the Copyright Office to place a copyright notice on your work. But the Copyright Office must approve or refuse your application before you can file a lawsuit for copyright infringement, except in cases involving a non-U.S. work.5 You may seek statutory damages and attorneys’ fees in an infringement action provided that the infringement began after the effective date of registration. The law, however, provides a grace period of three months after publication during which full remedies can be recovered for any infringement begun during the three months after publication if registration is made before this period ends. Copyright Basics 6 Copyright Notice A copyright notice is a statement placed on copies or phonorecords of a work to inform the public that a copyright owner is claiming ownership of the work. A copyright notice consists of three elements: • The copyright symbol © or (p) for phonorecords, the word “Copyright,” or the abbreviation “Copr.”; • The year of first publication of the work (or of creation if the work is unpublished); and • The name of the copyright owner, an abbreviation by which the name can be recognized, or a generally known alternative designation. A notice should be affixed to copies or phonorecords of a work in a way that gives reasonable notice of the claim of copyright. Using a copyright notice is optional for unpublished works, non-U.S. works, and works published on or after March 1, 1989. However, notice conveys the following benefits: • It puts potential users on notice that copyright is claimed in the work. • For published works, notice may prevent a defendant from attempting to limit liability for damages or injunctive relief based on an “innocent infringement” defense. • It identifies the copyright owner at the time of first publication for parties seeking permission to use the work. • It identifies the year of first publication, which can be used to determine the term of copyright for anonymous or pseudonymous works or works made for hire. • It may prevent the work from becoming an “orphan” by identifying the copyright owner or specifying the term of copyright. Orphan works are original works of authorship for which prospective users cannot identify or locate copyright owners to request permission. Notice was required for works published in the United States before March 1, 1989. Works published without notice before that date may have entered the public domain in this country. For more information, see Copyright Notice (Circular 3	Answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. If the answer contains more than one piece of information, utilize a numbered list. EVIDENCE: In general, for works created on or after January 1, 1978, the term of copyright is the life of the author plus seventy years after the author’s death. If the work is a joint work with multiple authors, the term lasts for seventy years after the last surviving author’s death. For works made for hire and anonymous or pseudonymous works, the duration of copyright is 95 years from publication or 120 years from creation, whichever is shorter. For works created before January 1, 1978, that were not published or registered as of that date, the term of copyright is generally the same as for works created on or after January 1, 1978. The law, however, provides that in no case would the term have expired before December 31, 2002, and if the work was published on or before that date, the term will not expire before December 31, 2047. For works created before January 1, 1978, that were published or registered before that date, the initial term of copyright was twenty-eight years from the date of publication with notice or from the date of registration. At the end of the initial term, the copyright could be renewed for another sixtyseven years for a total term of protection of up to ninety-five years. To extend copyright into the renewal term, two registrations had to be made before the original term expired: one for the original term and the other for the renewal term. This requirement was eliminated on June 26, 1992, and renewal term registration is now optional. For more information on the term of copyright protection, see Duration of Copyright (Circular 15A) and Renewal of Copyright (Circular 6A). How Can I Protect My Work? Copyright exists automatically in an original work of authorship once it is fixed in a tangible medium, but a copyright owner can take steps to enhance the protections of copyright, the most important of which is registering the work. Although registering a work is not mandatory, for U.S. works, registration (or refusal) is necessary to enforce the exclusive rights of copyright through litigation. Applying a copyright notice to a work has not been required since March 1, 1989, but may still provide practical and legal benefits. Notice typically consists of the copyright symbol or the word “Copyright,” the name of the copyright owner, and the year of first publication. Placing a copyright notice on a work is not a substitute for registration. Copyright Basics 5 Benefits of Registration Registration establishes a claim to copyright with the Copyright Office. An application for copyright registration can be filed by the author or owner of an exclusive right in a work, the owner of all exclusive rights, or an agent on behalf of an author or owner. An application contains three essential elements: a completed application form, a nonrefundable filing fee, and a nonreturnable deposit— that is, a copy or copies of the work being registered and “deposited” with the Copyright Office. A certificate of registration creates a public record of key facts relating to the authorship and ownership of the claimed work, including the title of the work, the author of the work, the name and address of the claimant or copyright owner, the year of creation, and information about whether the work is published, has been previously registered, or includes preexisting material. You can submit an application online through www.copyright.gov or on a paper application. For more information on registering a work with the Copyright Office, see Copyright Registration (Circular 2). In addition to establishing a public record of a copyright claim, registration offers several other statutory advantages: • Before an infringement suit may be filed in court, registration (or refusal) is necessary for U.S. works.2 • Registration establishes prima facie evidence of the validity of the copyright and facts stated in the certificate when registration is made before or within five years of publication. • When registration is made prior to infringement or within three months after publication of a work, a copyright owner is eligible for statutory damages, attorneys’ fees, and costs. • Registration permits a copyright owner to establish a record with the U.S. Customs and Border Protection (CBP)4 for protection against the importation of infringing copies. Registration can be made at any time within the life of the copyright. If you register before publication, you do not have to re-register when the work is published, although you can register the published edition, if desired. Effective Date of Registration When the Copyright Office registers a work it assigns an effective date of registration to the certificate of registration. The effective date of registration is the day that the Office receives in proper form all required elements—an acceptable application, an acceptable deposit, and a nonrefundable filing fee. The date is not set until all the required elements are in the Office’s possession. If the Office receives incomplete materials, an unacceptable deposit, or an insufficient fee, the effective date of registration will be set on the date that the Office receives all the required materials in acceptable form. The date is not based on how long it takes the Office to examine the materials or mail the certificate of registration. You do not have to receive your certificate of registration before you publish or produce your work. Nor do you need permission from the Copyright Office to place a copyright notice on your work. But the Copyright Office must approve or refuse your application before you can file a lawsuit for copyright infringement, except in cases involving a non-U.S. work.5 You may seek statutory damages and attorneys’ fees in an infringement action provided that the infringement began after the effective date of registration. The law, however, provides a grace period of three months after publication during which full remedies can be recovered for any infringement begun during the three months after publication if registration is made before this period ends. Copyright Basics 6 Copyright Notice A copyright notice is a statement placed on copies or phonorecords of a work to inform the public that a copyright owner is claiming ownership of the work. A copyright notice consists of three elements: • The copyright symbol © or (p) for phonorecords, the word “Copyright,” or the abbreviation “Copr.”; • The year of first publication of the work (or of creation if the work is unpublished); and • The name of the copyright owner, an abbreviation by which the name can be recognized, or a generally known alternative designation. A notice should be affixed to copies or phonorecords of a work in a way that gives reasonable notice of the claim of copyright. Using a copyright notice is optional for unpublished works, non-U.S. works, and works published on or after March 1, 1989. However, notice conveys the following benefits: • It puts potential users on notice that copyright is claimed in the work. • For published works, notice may prevent a defendant from attempting to limit liability for damages or injunctive relief based on an “innocent infringement” defense. • It identifies the copyright owner at the time of first publication for parties seeking permission to use the work. • It identifies the year of first publication, which can be used to determine the term of copyright for anonymous or pseudonymous works or works made for hire. • It may prevent the work from becoming an “orphan” by identifying the copyright owner or specifying the term of copyright. Orphan works are original works of authorship for which prospective users cannot identify or locate copyright owners to request permission. Notice was required for works published in the United States before March 1, 1989. Works published without notice before that date may have entered the public domain in this country. For more information, see Copyright Notice (Circular 3 USER: If I need permission to use a work, where can I find the copyright owner? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	37	15	1,296	null	148
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. Respond in a bulleted list with additional information for each point.	How can I distinguish different forms of seizures or epilepsy?	Generalized seizures are produced by electrical impulses from throughout the entire brain, whereas partial seizures are produced (at least initially) by a relatively small part of the brain. The part of the brain generating the seizures is sometimes called the focus. Generalized Seizures • The most common and most dramatic is the generalized convulsion, also called the generalized tonic clonic (“grand mal”) seizure. The patient loses consciousness and usually collapses. There is generalized body stiffening (called the “tonic” phase) for 30 to 60 seconds, followed by violent jerking (the “clonic” phase) for 30 to 60 seconds, after which the patient goes into a deep sleep (the “postictal” or after-seizure phase). During these seizures, injuries and accidents may occur, such as tongue biting and urinary incontinence. • Absence seizures cause a short loss of consciousness (just a few seconds) with few or no other symptoms. The patient, most often a child, typically interrupts an activity and stares blankly. These seizures begin and end abruptly and may occur several times a day. Patients are usually not aware that they are having a seizure, except that they may be aware of “losing time.” • Myoclonic seizures consist of sporadic jerks, usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent, these seizures may result in dropping or involuntarily throwing objects. • Clonic seizures are repetitive, rhythmic jerks that involve both sides of the body at the same time. • Tonic seizures are characterized by stiffening of the muscles. • Atonic seizures consist of a sudden and general loss of muscle tone, particularly in the arms and legs, which often result in a fall. Partial Seizures Partial seizures are divided into simple, complex, and those that evolve into (secondary) generalized seizures. The difference between simple and complex partial seizures is that during simple partial seizures, patients retain awareness; during complex partial seizures, they lose awareness. • Simple partial seizures are further subdivided into four categories according to the nature of their symptoms: motor, sensory, autonomic or psychological. o Motor symptoms include movements such as jerking and stiffening. o Sensory symptoms caused by seizures involve unusual sensations affecting any of the five senses (vision, hearing, smell, taste or touch). o When simple partial seizures cause sensory symptoms only (and no motor symptoms), they are called “auras.” o The only common autonomic symptom is a peculiar sensation in the stomach that is experienced by many patients with temporal lobe epilepsy. o Finally, simple partial seizures with psychological symptoms are characterized by various experiences involving memory (the sensation of deja-vu), emotions (such as fear or pleasure), or other complex psychological phenomena. • Complex partial seizures, by definition, include impairment of awareness. Patients seem to be “out of touch,” “out of it” or “staring into space” or “in a trance” during these seizures. There are often odd movements called automatisms, which are involuntary but coordinated movements that tend to be purposeless and repetitive. Common automatisms include lip smacking, chewing, fidgeting and walking. • The third kind of partial seizure is one that begins as a focal seizure and evolves into a generalized convulsive (“tonic clonic”) seizure. Most types of seizures occur in different types of epilepsy, and most patients with epilepsy experience more than one seizure type. This is because seizures are only symptoms. Therefore, it is essential that your neurologist diagnose your type of EPILEPSY, not just the type(s) of SEIZURE you are having. Epilepsy can be divided into two broad categories: idiopathic and symptomatic. Idiopathic epilepsy is caused by genetic factors, as opposed to brain damage. Symptomatic epilepsy is caused by physical defects in the brain. Based on the type of seizure affecting the patient, idiopathic and symptomatic epilepsies can be further categorized. Type 1: Idiopathic Generalized Epilepsy • This is a genetic and inherited group of disorders, so there is often, but not always, a family history of epilepsy. • Idiopathic generalized epilepsy tends to appear during childhood or adolescence, although it may not be diagnosed until adulthood. • In this type of epilepsy, there are no nervous system abnormalities other than the seizures; the brain is structurally normal. • People with idiopathic generalized epilepsy have normal intelligence, and the results of the neurological examination and brain scan are normal. • The results of the electroencephalogram (EEG - a test which measures electrical impulses in the brain) are also normal, except for the discharges associated with epilepsy. • The types of seizures affecting patients with idiopathic generalized epilepsy may include myoclonic, absence, and generalized tonic-clonic seizures, with one type predominating. Idiopathic generalized epilepsy is usually treated with medications and is a condition that is commonly outgrown, as in childhood absence epilepsy. Type 2: Idiopathic Partial Epilepsies • Idiopathic partial epilepsy begins in childhood (between ages 5 and 8) and runs in families. • Also known as benign focal epilepsy of childhood or benign Rolandic epilepsy, this is one of the mildest types of epilepsy. • It is almost always outgrown by puberty and is never diagnosed in adults. • Seizures tend to occur during sleep and are most often simple partial motor seizures that involve the face and secondarily generalized (grand mal) seizures. Type 3: Symptomatic Generalized Epilepsy • This is caused by widespread brain damage, and injury during birth is the most common cause. • When the cause of symptomatic general epilepsy cannot be identified, the disorder may be referred to as cryptogenic epilepsy. • Specific, inherited brain diseases, such as adrenoleukodystrophy (ADL, which was featured in the movie “Lorenzo’s Oil”), or brain infections (such as meningitis and encephalitis) can also cause symptomatic generalized epilepsy. • In addition to seizures, these patients often have other neurological problems, such as developmental delay, mental retardation or cerebral palsy. • These epilepsies include different subtypes—the most typical is the Lennox-Gastaut syndrome. Multiple types of seizures (generalized tonic-clonic, tonic, myoclonic, tonic, atonic and absence seizures) are common and can be difficult to control. Type 4: Symptomatic Partial Epilepsy • This is the most common type of epilepsy to begin in adulthood. • It is caused by a localized abnormality of the brain, which can result from strokes, tumors, trauma, scarring or “sclerosis” of brain tissue (common in the temporal lobe), cysts or infections. • Sometimes these brain abnormalities can be seen on magnetic resonance imaging (MRI) scans, but often they cannot be identified, despite repeated attempts, because they are microscopic. • When the cause of symptomatic partial epilepsy cannot be identified, the disorder may be referred to as cryptogenic epilepsy. The diagnosis is based on: • The patient’s medical history, including any family history of seizures, associated medical conditions and current medications. Some important questions you will be asked include: o At what age did the seizures begin? o What circumstances surrounded your first seizure? o What factors seem to bring on the seizures? o What do you feel before, during and after the seizures? o How long do the seizures last? o Have you been treated for epilepsy before? What medications were prescribed and in what dosages? Was the treatment effective? o Others who have often seen you before, during and after seizures, such as family and close friends, should be present to provide details of your seizures if they involve loss of consciousness. • A complete physical and neurological examination —your muscle strength, reflexes, eye sight, hearing and ability to detect various sensations are tested so your doctors can better understand the cause of your seizures • An electroencephalogram (EEG), which measures electrical impulses in the brain. o This is the only test that directly detects electrical activity in the brain, and seizures are defined by abnormal electrical activity in the brain. During an EEG, electrodes (small metal disks) are attached to specific locations on your head. The electrodes are attached to a monitor to record the brain’s electrical activity. The EEG is useful not only to confirm a diagnosis of epilepsy, but also to determine the type of epilepsy. o A routine EEG only records about 20 minutes of brain waves (however, the routine EEG procedure takes about 90 minutes). Because 20 minutes is such a short amount of time, the results of routine EEG studies are often normal, even in people known to have epilepsy. Therefore, prolonged EEG monitoring may be necessary. Prolonged o EEG-video monitoring is an even better diagnostic method. During this type of monitoring, an EEG monitors the brain’s activity and cameras videotape body movements and behavior during a seizure. Prolonged monitoring often requires the patient to spend time in a special facility for several days. Prolonged EEG-video monitoring is the only definitive way to diagnose epilepsy. • Imaging studies of the brain, such as those provided by magnetic resonance imaging (MRI). This can identify the cause of the seizures, but the vast majority of patients with epilepsy have normal MRIs.	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. Respond in a bulleted list with additional information for each point. How can I distinguish different forms of seizures or epilepsy? Generalized seizures are produced by electrical impulses from throughout the entire brain, whereas partial seizures are produced (at least initially) by a relatively small part of the brain. The part of the brain generating the seizures is sometimes called the focus. Generalized Seizures • The most common and most dramatic is the generalized convulsion, also called the generalized tonic clonic (“grand mal”) seizure. The patient loses consciousness and usually collapses. There is generalized body stiffening (called the “tonic” phase) for 30 to 60 seconds, followed by violent jerking (the “clonic” phase) for 30 to 60 seconds, after which the patient goes into a deep sleep (the “postictal” or after-seizure phase). During these seizures, injuries and accidents may occur, such as tongue biting and urinary incontinence. • Absence seizures cause a short loss of consciousness (just a few seconds) with few or no other symptoms. The patient, most often a child, typically interrupts an activity and stares blankly. These seizures begin and end abruptly and may occur several times a day. Patients are usually not aware that they are having a seizure, except that they may be aware of “losing time.” • Myoclonic seizures consist of sporadic jerks, usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent, these seizures may result in dropping or involuntarily throwing objects. • Clonic seizures are repetitive, rhythmic jerks that involve both sides of the body at the same time. • Tonic seizures are characterized by stiffening of the muscles. • Atonic seizures consist of a sudden and general loss of muscle tone, particularly in the arms and legs, which often result in a fall. Partial Seizures Partial seizures are divided into simple, complex, and those that evolve into (secondary) generalized seizures. The difference between simple and complex partial seizures is that during simple partial seizures, patients retain awareness; during complex partial seizures, they lose awareness. • Simple partial seizures are further subdivided into four categories according to the nature of their symptoms: motor, sensory, autonomic or psychological. o Motor symptoms include movements such as jerking and stiffening. o Sensory symptoms caused by seizures involve unusual sensations affecting any of the five senses (vision, hearing, smell, taste or touch). o When simple partial seizures cause sensory symptoms only (and no motor symptoms), they are called “auras.” o The only common autonomic symptom is a peculiar sensation in the stomach that is experienced by many patients with temporal lobe epilepsy. o Finally, simple partial seizures with psychological symptoms are characterized by various experiences involving memory (the sensation of deja-vu), emotions (such as fear or pleasure), or other complex psychological phenomena. • Complex partial seizures, by definition, include impairment of awareness. Patients seem to be “out of touch,” “out of it” or “staring into space” or “in a trance” during these seizures. There are often odd movements called automatisms, which are involuntary but coordinated movements that tend to be purposeless and repetitive. Common automatisms include lip smacking, chewing, fidgeting and walking. • The third kind of partial seizure is one that begins as a focal seizure and evolves into a generalized convulsive (“tonic clonic”) seizure. Most types of seizures occur in different types of epilepsy, and most patients with epilepsy experience more than one seizure type. This is because seizures are only symptoms. Therefore, it is essential that your neurologist diagnose your type of EPILEPSY, not just the type(s) of SEIZURE you are having. Epilepsy can be divided into two broad categories: idiopathic and symptomatic. Idiopathic epilepsy is caused by genetic factors, as opposed to brain damage. Symptomatic epilepsy is caused by physical defects in the brain. Based on the type of seizure affecting the patient, idiopathic and symptomatic epilepsies can be further categorized. Type 1: Idiopathic Generalized Epilepsy • This is a genetic and inherited group of disorders, so there is often, but not always, a family history of epilepsy. • Idiopathic generalized epilepsy tends to appear during childhood or adolescence, although it may not be diagnosed until adulthood. • In this type of epilepsy, there are no nervous system abnormalities other than the seizures; the brain is structurally normal. • People with idiopathic generalized epilepsy have normal intelligence, and the results of the neurological examination and brain scan are normal. • The results of the electroencephalogram (EEG - a test which measures electrical impulses in the brain) are also normal, except for the discharges associated with epilepsy. • The types of seizures affecting patients with idiopathic generalized epilepsy may include myoclonic, absence, and generalized tonic-clonic seizures, with one type predominating. Idiopathic generalized epilepsy is usually treated with medications and is a condition that is commonly outgrown, as in childhood absence epilepsy. Type 2: Idiopathic Partial Epilepsies • Idiopathic partial epilepsy begins in childhood (between ages 5 and 8) and runs in families. • Also known as benign focal epilepsy of childhood or benign Rolandic epilepsy, this is one of the mildest types of epilepsy. • It is almost always outgrown by puberty and is never diagnosed in adults. • Seizures tend to occur during sleep and are most often simple partial motor seizures that involve the face and secondarily generalized (grand mal) seizures. Type 3: Symptomatic Generalized Epilepsy • This is caused by widespread brain damage, and injury during birth is the most common cause. • When the cause of symptomatic general epilepsy cannot be identified, the disorder may be referred to as cryptogenic epilepsy. • Specific, inherited brain diseases, such as adrenoleukodystrophy (ADL, which was featured in the movie “Lorenzo’s Oil”), or brain infections (such as meningitis and encephalitis) can also cause symptomatic generalized epilepsy. • In addition to seizures, these patients often have other neurological problems, such as developmental delay, mental retardation or cerebral palsy. • These epilepsies include different subtypes—the most typical is the Lennox-Gastaut syndrome. Multiple types of seizures (generalized tonic-clonic, tonic, myoclonic, tonic, atonic and absence seizures) are common and can be difficult to control. Type 4: Symptomatic Partial Epilepsy • This is the most common type of epilepsy to begin in adulthood. • It is caused by a localized abnormality of the brain, which can result from strokes, tumors, trauma, scarring or “sclerosis” of brain tissue (common in the temporal lobe), cysts or infections. • Sometimes these brain abnormalities can be seen on magnetic resonance imaging (MRI) scans, but often they cannot be identified, despite repeated attempts, because they are microscopic. • When the cause of symptomatic partial epilepsy cannot be identified, the disorder may be referred to as cryptogenic epilepsy. The diagnosis is based on: • The patient’s medical history, including any family history of seizures, associated medical conditions and current medications. Some important questions you will be asked include: o At what age did the seizures begin? o What circumstances surrounded your first seizure? o What factors seem to bring on the seizures? o What do you feel before, during and after the seizures? o How long do the seizures last? o Have you been treated for epilepsy before? What medications were prescribed and in what dosages? Was the treatment effective? o Others who have often seen you before, during and after seizures, such as family and close friends, should be present to provide details of your seizures if they involve loss of consciousness. • A complete physical and neurological examination —your muscle strength, reflexes, eye sight, hearing and ability to detect various sensations are tested so your doctors can better understand the cause of your seizures • An electroencephalogram (EEG), which measures electrical impulses in the brain. o This is the only test that directly detects electrical activity in the brain, and seizures are defined by abnormal electrical activity in the brain. During an EEG, electrodes (small metal disks) are attached to specific locations on your head. The electrodes are attached to a monitor to record the brain’s electrical activity. The EEG is useful not only to confirm a diagnosis of epilepsy, but also to determine the type of epilepsy.	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. Respond in a bulleted list with additional information for each point. EVIDENCE: Generalized seizures are produced by electrical impulses from throughout the entire brain, whereas partial seizures are produced (at least initially) by a relatively small part of the brain. The part of the brain generating the seizures is sometimes called the focus. Generalized Seizures • The most common and most dramatic is the generalized convulsion, also called the generalized tonic clonic (“grand mal”) seizure. The patient loses consciousness and usually collapses. There is generalized body stiffening (called the “tonic” phase) for 30 to 60 seconds, followed by violent jerking (the “clonic” phase) for 30 to 60 seconds, after which the patient goes into a deep sleep (the “postictal” or after-seizure phase). During these seizures, injuries and accidents may occur, such as tongue biting and urinary incontinence. • Absence seizures cause a short loss of consciousness (just a few seconds) with few or no other symptoms. The patient, most often a child, typically interrupts an activity and stares blankly. These seizures begin and end abruptly and may occur several times a day. Patients are usually not aware that they are having a seizure, except that they may be aware of “losing time.” • Myoclonic seizures consist of sporadic jerks, usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent, these seizures may result in dropping or involuntarily throwing objects. • Clonic seizures are repetitive, rhythmic jerks that involve both sides of the body at the same time. • Tonic seizures are characterized by stiffening of the muscles. • Atonic seizures consist of a sudden and general loss of muscle tone, particularly in the arms and legs, which often result in a fall. Partial Seizures Partial seizures are divided into simple, complex, and those that evolve into (secondary) generalized seizures. The difference between simple and complex partial seizures is that during simple partial seizures, patients retain awareness; during complex partial seizures, they lose awareness. • Simple partial seizures are further subdivided into four categories according to the nature of their symptoms: motor, sensory, autonomic or psychological. o Motor symptoms include movements such as jerking and stiffening. o Sensory symptoms caused by seizures involve unusual sensations affecting any of the five senses (vision, hearing, smell, taste or touch). o When simple partial seizures cause sensory symptoms only (and no motor symptoms), they are called “auras.” o The only common autonomic symptom is a peculiar sensation in the stomach that is experienced by many patients with temporal lobe epilepsy. o Finally, simple partial seizures with psychological symptoms are characterized by various experiences involving memory (the sensation of deja-vu), emotions (such as fear or pleasure), or other complex psychological phenomena. • Complex partial seizures, by definition, include impairment of awareness. Patients seem to be “out of touch,” “out of it” or “staring into space” or “in a trance” during these seizures. There are often odd movements called automatisms, which are involuntary but coordinated movements that tend to be purposeless and repetitive. Common automatisms include lip smacking, chewing, fidgeting and walking. • The third kind of partial seizure is one that begins as a focal seizure and evolves into a generalized convulsive (“tonic clonic”) seizure. Most types of seizures occur in different types of epilepsy, and most patients with epilepsy experience more than one seizure type. This is because seizures are only symptoms. Therefore, it is essential that your neurologist diagnose your type of EPILEPSY, not just the type(s) of SEIZURE you are having. Epilepsy can be divided into two broad categories: idiopathic and symptomatic. Idiopathic epilepsy is caused by genetic factors, as opposed to brain damage. Symptomatic epilepsy is caused by physical defects in the brain. Based on the type of seizure affecting the patient, idiopathic and symptomatic epilepsies can be further categorized. Type 1: Idiopathic Generalized Epilepsy • This is a genetic and inherited group of disorders, so there is often, but not always, a family history of epilepsy. • Idiopathic generalized epilepsy tends to appear during childhood or adolescence, although it may not be diagnosed until adulthood. • In this type of epilepsy, there are no nervous system abnormalities other than the seizures; the brain is structurally normal. • People with idiopathic generalized epilepsy have normal intelligence, and the results of the neurological examination and brain scan are normal. • The results of the electroencephalogram (EEG - a test which measures electrical impulses in the brain) are also normal, except for the discharges associated with epilepsy. • The types of seizures affecting patients with idiopathic generalized epilepsy may include myoclonic, absence, and generalized tonic-clonic seizures, with one type predominating. Idiopathic generalized epilepsy is usually treated with medications and is a condition that is commonly outgrown, as in childhood absence epilepsy. Type 2: Idiopathic Partial Epilepsies • Idiopathic partial epilepsy begins in childhood (between ages 5 and 8) and runs in families. • Also known as benign focal epilepsy of childhood or benign Rolandic epilepsy, this is one of the mildest types of epilepsy. • It is almost always outgrown by puberty and is never diagnosed in adults. • Seizures tend to occur during sleep and are most often simple partial motor seizures that involve the face and secondarily generalized (grand mal) seizures. Type 3: Symptomatic Generalized Epilepsy • This is caused by widespread brain damage, and injury during birth is the most common cause. • When the cause of symptomatic general epilepsy cannot be identified, the disorder may be referred to as cryptogenic epilepsy. • Specific, inherited brain diseases, such as adrenoleukodystrophy (ADL, which was featured in the movie “Lorenzo’s Oil”), or brain infections (such as meningitis and encephalitis) can also cause symptomatic generalized epilepsy. • In addition to seizures, these patients often have other neurological problems, such as developmental delay, mental retardation or cerebral palsy. • These epilepsies include different subtypes—the most typical is the Lennox-Gastaut syndrome. Multiple types of seizures (generalized tonic-clonic, tonic, myoclonic, tonic, atonic and absence seizures) are common and can be difficult to control. Type 4: Symptomatic Partial Epilepsy • This is the most common type of epilepsy to begin in adulthood. • It is caused by a localized abnormality of the brain, which can result from strokes, tumors, trauma, scarring or “sclerosis” of brain tissue (common in the temporal lobe), cysts or infections. • Sometimes these brain abnormalities can be seen on magnetic resonance imaging (MRI) scans, but often they cannot be identified, despite repeated attempts, because they are microscopic. • When the cause of symptomatic partial epilepsy cannot be identified, the disorder may be referred to as cryptogenic epilepsy. The diagnosis is based on: • The patient’s medical history, including any family history of seizures, associated medical conditions and current medications. Some important questions you will be asked include: o At what age did the seizures begin? o What circumstances surrounded your first seizure? o What factors seem to bring on the seizures? o What do you feel before, during and after the seizures? o How long do the seizures last? o Have you been treated for epilepsy before? What medications were prescribed and in what dosages? Was the treatment effective? o Others who have often seen you before, during and after seizures, such as family and close friends, should be present to provide details of your seizures if they involve loss of consciousness. • A complete physical and neurological examination —your muscle strength, reflexes, eye sight, hearing and ability to detect various sensations are tested so your doctors can better understand the cause of your seizures • An electroencephalogram (EEG), which measures electrical impulses in the brain. o This is the only test that directly detects electrical activity in the brain, and seizures are defined by abnormal electrical activity in the brain. During an EEG, electrodes (small metal disks) are attached to specific locations on your head. The electrodes are attached to a monitor to record the brain’s electrical activity. The EEG is useful not only to confirm a diagnosis of epilepsy, but also to determine the type of epilepsy. o A routine EEG only records about 20 minutes of brain waves (however, the routine EEG procedure takes about 90 minutes). Because 20 minutes is such a short amount of time, the results of routine EEG studies are often normal, even in people known to have epilepsy. Therefore, prolonged EEG monitoring may be necessary. Prolonged o EEG-video monitoring is an even better diagnostic method. During this type of monitoring, an EEG monitors the brain’s activity and cameras videotape body movements and behavior during a seizure. Prolonged monitoring often requires the patient to spend time in a special facility for several days. Prolonged EEG-video monitoring is the only definitive way to diagnose epilepsy. • Imaging studies of the brain, such as those provided by magnetic resonance imaging (MRI). This can identify the cause of the seizures, but the vast majority of patients with epilepsy have normal MRIs. USER: How can I distinguish different forms of seizures or epilepsy? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	39	10	1,478	null	485
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. Draw your answer from the above text only. Lists should be presented in bullet point. Summaries should be a single paragraph of no more than 6 sentences.	According to the text provided, excluding Authentic, how many additional flavors has Celestial Seasonings created for their green teas?	The mature tea leaves with which regular green teas are made naturally contain high levels of tannins, which can sometimes cause bitterness. Celestial Seasonings created its smoother green teas by adding Bai Mu Dan white tea, whose delicate, silky flavor profile comes from selecting only the tender buds and low-tannin young leaves of the camellia sinensis plant. The white tea infusion creates a balanced and satisfying taste with the healthful antioxidants for which green and white tea are both known. New Celestial Seasonings Green Tea is available on store shelves in nine varieties, including Authentic, Honey Lemon Ginseng and Goji Berry Pomegranate.	[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. Draw your answer from the above text only. Lists should be presented in bullet point. Summaries should be a single paragraph of no more than 6 sentences.] [The mature tea leaves with which regular green teas are made naturally contain high levels of tannins, which can sometimes cause bitterness. Celestial Seasonings created its smoother green teas by adding Bai Mu Dan white tea, whose delicate, silky flavor profile comes from selecting only the tender buds and low-tannin young leaves of the camellia sinensis plant. The white tea infusion creates a balanced and satisfying taste with the healthful antioxidants for which green and white tea are both known. New Celestial Seasonings Green Tea is available on store shelves in nine varieties, including Authentic, Honey Lemon Ginseng and Goji Berry Pomegranate.] [According to the text provided, excluding Authentic, how many flavors has Celestial Seasonings created for their green teas?	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. Draw your answer from the above text only. Lists should be presented in bullet point. Summaries should be a single paragraph of no more than 6 sentences. EVIDENCE: The mature tea leaves with which regular green teas are made naturally contain high levels of tannins, which can sometimes cause bitterness. Celestial Seasonings created its smoother green teas by adding Bai Mu Dan white tea, whose delicate, silky flavor profile comes from selecting only the tender buds and low-tannin young leaves of the camellia sinensis plant. The white tea infusion creates a balanced and satisfying taste with the healthful antioxidants for which green and white tea are both known. New Celestial Seasonings Green Tea is available on store shelves in nine varieties, including Authentic, Honey Lemon Ginseng and Goji Berry Pomegranate. USER: According to the text provided, excluding Authentic, how many additional flavors has Celestial Seasonings created for their green teas? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	55	19	102	null	196
Please only respond using information contained in the context block below. Bullet points must have 4 sentences each.	Explain in detail the disadvantages of global freight-forwarding's legacy system.	Slide 19 - Competitive strength across three axes For the next 8 slides, I am going to take you on a deep dive into the how and the why of WiseTech and CargoWise’s core competitive strengths, differentiators and efficiencies. Firstly, our product’s competitive strength has three distinct axes. As a product-led innovator, we have a long-term strategy of building breakthrough products to revolutionize, not to simply replace. We look to find fundamental flaws, operating problems, inefficient models and incomplete or ineffective processes, and to embed and automate improvements so that we revolutionize the industry’s established model. We have done this very effectively with CargoWise’s international freight forwarding capabilities and the competitive result is clearly visible on slide 26. Similarly, with Global Customs, the Warehouse Suite and soon with the planned release of Container Transport Optimization and ComplianceWise, we are not simply offering a me-too product or a simple upgrade from an aging legacy system, we are providing a dramatically better business model embedded in the CargoWise application suite. In the appendix we outline some of the key business model and product differentiators provided to customers by CargoWise. 15 Secondly, because of the many cost and management efficiencies achieved through CargoWise, we are driving value for our customers across their entire cost base, which I will talk to more in detail on the next slide. Finally, the operating model delivered by CargoWise creates substantial cost efficiencies and global management simplicity. This enables industry consolidation through M&A and the rapid, successful and profitable integration of acquired businesses, whilst also driving competitive advantage and profitable organic growth. Slide 20 - Driving efficiencies across our customers’ entire cost base leading to optimized operations CargoWise delivers cost efficiencies in four distinct layers. About 30% of our customers’ total costs sit within operating expenses from legacy IT systems costs and operational labor costs. The remaining 70% of our customers’ cost base is from the direct costs of air, sea, rail and road transport and from surcharges, fines and penalties related to the management of these transport services. Starting with IT cost efficiency, many freight forwarders still have outdated, in-house legacy IT systems built 20 to 30 years ago. They are inflexible, complex and expensive to maintain, and are supplemented at great cost with hundreds of smaller satellite systems, many of which are also legacy systems with their own costs and risks including cyber security. 16 CargoWise customers replace these myriad legacy systems with a single, global, modern, efficient and fully integrated platform that dramatically reduces IT costs and risks. The second cost efficiency involves tackling the labor cost required to deliver the planning, execution and management of the movement of goods from point of origin to final destination. International freight forwarders are asset light services providers. They have large global workforces in each locale, often with a full management hierarchy, managing the local business and processing the local requirements. Many of these procedures are manually executed, often requiring the rekeying of critical data multiple times into many separate, satellite systems. CargoWise provides a single, comprehensive, global system that streamlines and automates many of these procedures, removing much of the original data entry and avoiding rekeying data multiple times. With CargoWise, it is also simple to visualize, plan, manage and control globally from a single location and to move low value work to lower cost locations. Export offices or shared services centers can perform most of the critical tasks including data entry, leaving the often-higher cost import location a much smaller set of tasks. All this allows our customers to extract much greater value by substantially improving operational yield. The third cost efficiency addresses fines, penalties and unwanted surcharges on the movement of cargo. Aging legacy systems have many costs, complexities and risks and can't keep up with the rapidly changing compliance obligations that govern 17 global trade. Because they’re unable to comply or optimize effectively, many logistics providers build in margins or substantial budgets to cover fines and penalties or attempt to pass incidental surcharges on to their customers. The fourth cost efficiency is freight cost efficiency. Given the global scale of CargoWise, and its integration with electronic schedules, rates, booking, tracking, job costing and account settlement, CargoWise customers are able to acquire and optimize transport services much more efficiently than ever before, improving freight utilization, negotiating better rates with carriers, optimizing packing and movement, and allowing economies of scale, to become more price competitive, and improve unit economics and the value delivered to their customers. By creating substantial cost benefits over time, through these four layers of cost improvements, customers also consume more CargoWise services, which drives ongoing long-term revenue growth for WiseTech.	Please only respond using information contained in the context block below. Bullet points must have 4 sentences each. Slide 19 - Competitive strength across three axes For the next 8 slides, I am going to take you on a deep dive into the how and the why of WiseTech and CargoWise’s core competitive strengths, differentiators and efficiencies. Firstly, our product’s competitive strength has three distinct axes. As a product-led innovator, we have a long-term strategy of building breakthrough products to revolutionize, not to simply replace. We look to find fundamental flaws, operating problems, inefficient models and incomplete or ineffective processes, and to embed and automate improvements so that we revolutionize the industry’s established model. We have done this very effectively with CargoWise’s international freight forwarding capabilities and the competitive result is clearly visible on slide 26. Similarly, with Global Customs, the Warehouse Suite and soon with the planned release of Container Transport Optimization and ComplianceWise, we are not simply offering a me-too product or a simple upgrade from an aging legacy system, we are providing a dramatically better business model embedded in the CargoWise application suite. In the appendix we outline some of the key business model and product differentiators provided to customers by CargoWise. 15 Secondly, because of the many cost and management efficiencies achieved through CargoWise, we are driving value for our customers across their entire cost base, which I will talk to more in detail on the next slide. Finally, the operating model delivered by CargoWise creates substantial cost efficiencies and global management simplicity. This enables industry consolidation through M&A and the rapid, successful and profitable integration of acquired businesses, whilst also driving competitive advantage and profitable organic growth. Slide 20 - Driving efficiencies across our customers’ entire cost base leading to optimized operations CargoWise delivers cost efficiencies in four distinct layers. About 30% of our customers’ total costs sit within operating expenses from legacy IT systems costs and operational labor costs. The remaining 70% of our customers’ cost base is from the direct costs of air, sea, rail and road transport and from surcharges, fines and penalties related to the management of these transport services. Starting with IT cost efficiency, many freight forwarders still have outdated, in-house legacy IT systems built 20 to 30 years ago. They are inflexible, complex and expensive to maintain, and are supplemented at great cost with hundreds of smaller satellite systems, many of which are also legacy systems with their own costs and risks including cyber security. 16 CargoWise customers replace these myriad legacy systems with a single, global, modern, efficient and fully integrated platform that dramatically reduces IT costs and risks. The second cost efficiency involves tackling the labor cost required to deliver the planning, execution and management of the movement of goods from point of origin to final destination. International freight forwarders are asset light services providers. They have large global workforces in each locale, often with a full management hierarchy, managing the local business and processing the local requirements. Many of these procedures are manually executed, often requiring the rekeying of critical data multiple times into many separate, satellite systems. CargoWise provides a single, comprehensive, global system that streamlines and automates many of these procedures, removing much of the original data entry and avoiding rekeying data multiple times. With CargoWise, it is also simple to visualize, plan, manage and control globally from a single location and to move low value work to lower cost locations. Export offices or shared services centers can perform most of the critical tasks including data entry, leaving the often-higher cost import location a much smaller set of tasks. All this allows our customers to extract much greater value by substantially improving operational yield. The third cost efficiency addresses fines, penalties and unwanted surcharges on the movement of cargo. Aging legacy systems have many costs, complexities and risks and can't keep up with the rapidly changing compliance obligations that govern 17 global trade. Because they’re unable to comply or optimize effectively, many logistics providers build in margins or substantial budgets to cover fines and penalties or attempt to pass incidental surcharges on to their customers. The fourth cost efficiency is freight cost efficiency. Given the global scale of CargoWise, and its integration with electronic schedules, rates, booking, tracking, job costing and account settlement, CargoWise customers are able to acquire and optimize transport services much more efficiently than ever before, improving freight utilization, negotiating better rates with carriers, optimizing packing and movement, and allowing economies of scale, to become more price competitive, and improve unit economics and the value delivered to their customers. By creating substantial cost benefits over time, through these four layers of cost improvements, customers also consume more CargoWise services, which drives ongoing long-term revenue growth for WiseTech. Explain in detail the disadvantages of global freight-forwarding's legacy system.	Please only respond using information contained in the context block below. Bullet points must have 4 sentences each. EVIDENCE: Slide 19 - Competitive strength across three axes For the next 8 slides, I am going to take you on a deep dive into the how and the why of WiseTech and CargoWise’s core competitive strengths, differentiators and efficiencies. Firstly, our product’s competitive strength has three distinct axes. As a product-led innovator, we have a long-term strategy of building breakthrough products to revolutionize, not to simply replace. We look to find fundamental flaws, operating problems, inefficient models and incomplete or ineffective processes, and to embed and automate improvements so that we revolutionize the industry’s established model. We have done this very effectively with CargoWise’s international freight forwarding capabilities and the competitive result is clearly visible on slide 26. Similarly, with Global Customs, the Warehouse Suite and soon with the planned release of Container Transport Optimization and ComplianceWise, we are not simply offering a me-too product or a simple upgrade from an aging legacy system, we are providing a dramatically better business model embedded in the CargoWise application suite. In the appendix we outline some of the key business model and product differentiators provided to customers by CargoWise. 15 Secondly, because of the many cost and management efficiencies achieved through CargoWise, we are driving value for our customers across their entire cost base, which I will talk to more in detail on the next slide. Finally, the operating model delivered by CargoWise creates substantial cost efficiencies and global management simplicity. This enables industry consolidation through M&A and the rapid, successful and profitable integration of acquired businesses, whilst also driving competitive advantage and profitable organic growth. Slide 20 - Driving efficiencies across our customers’ entire cost base leading to optimized operations CargoWise delivers cost efficiencies in four distinct layers. About 30% of our customers’ total costs sit within operating expenses from legacy IT systems costs and operational labor costs. The remaining 70% of our customers’ cost base is from the direct costs of air, sea, rail and road transport and from surcharges, fines and penalties related to the management of these transport services. Starting with IT cost efficiency, many freight forwarders still have outdated, in-house legacy IT systems built 20 to 30 years ago. They are inflexible, complex and expensive to maintain, and are supplemented at great cost with hundreds of smaller satellite systems, many of which are also legacy systems with their own costs and risks including cyber security. 16 CargoWise customers replace these myriad legacy systems with a single, global, modern, efficient and fully integrated platform that dramatically reduces IT costs and risks. The second cost efficiency involves tackling the labor cost required to deliver the planning, execution and management of the movement of goods from point of origin to final destination. International freight forwarders are asset light services providers. They have large global workforces in each locale, often with a full management hierarchy, managing the local business and processing the local requirements. Many of these procedures are manually executed, often requiring the rekeying of critical data multiple times into many separate, satellite systems. CargoWise provides a single, comprehensive, global system that streamlines and automates many of these procedures, removing much of the original data entry and avoiding rekeying data multiple times. With CargoWise, it is also simple to visualize, plan, manage and control globally from a single location and to move low value work to lower cost locations. Export offices or shared services centers can perform most of the critical tasks including data entry, leaving the often-higher cost import location a much smaller set of tasks. All this allows our customers to extract much greater value by substantially improving operational yield. The third cost efficiency addresses fines, penalties and unwanted surcharges on the movement of cargo. Aging legacy systems have many costs, complexities and risks and can't keep up with the rapidly changing compliance obligations that govern 17 global trade. Because they’re unable to comply or optimize effectively, many logistics providers build in margins or substantial budgets to cover fines and penalties or attempt to pass incidental surcharges on to their customers. The fourth cost efficiency is freight cost efficiency. Given the global scale of CargoWise, and its integration with electronic schedules, rates, booking, tracking, job costing and account settlement, CargoWise customers are able to acquire and optimize transport services much more efficiently than ever before, improving freight utilization, negotiating better rates with carriers, optimizing packing and movement, and allowing economies of scale, to become more price competitive, and improve unit economics and the value delivered to their customers. By creating substantial cost benefits over time, through these four layers of cost improvements, customers also consume more CargoWise services, which drives ongoing long-term revenue growth for WiseTech. USER: Explain in detail the disadvantages of global freight-forwarding's legacy system. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	18	10	778	null	134
Simplify the language used so it's easier to understand. Only pull information from the provided document.	What is the short title of the act?	1ST SESSION, 43RD LEGISLATURE, ONTARIO 2 CHARLES III, 2023 Bill 152 An Act to amend the Highway Traffic Act to prohibit passing on a highway painted with double solid yellow lines Mr. G. Bourgouin Private Member’s Bill 1st Reading November 21, 2023 2nd Reading 3rd Reading Royal Assent Bill 152 2023 An Act to amend the Highway Traffic Act to prohibit passing on a highway painted with double solid yellow lines His Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows: 1 Section 148 of the Highway Traffic Act is amended by adding the following subsection: Double solid yellow lines (9) No person in charge of a vehicle shall pass or attempt to pass another vehicle going in the same direction on a highway if doing so would require the crossing of double solid yellow lines painted on the roadway. Offence (10) Every person who contravenes subsection (9) is guilty of an offence and on conviction is liable to, (a) a fine of $400; and (b) three or more demerit points under Ontario Regulation 339/94 (Demerit Point System) made under this Act. Commencement 2 This Act comes into force on the day it receives Royal Assent. Short title 3 The short title of this Act is the Chad’s Law (Enforcing Safer Passing), 2023. ______________ EXPLANATORY NOTE Section 148 of the Highway Traffic Act is amended to prohibit passing or attempting to pass another vehicle going in the same direction on a highway if doing so would require the crossing of double solid yellow lines painted on the roadway. Every person who contravenes this prohibition is guilty of an offence and on conviction is liable to a fine of $400 and three or more demerit points.	Simplify the language used so it's easier to understand. Only pull information from the provided document. What is the short title of the act? 1ST SESSION, 43RD LEGISLATURE, ONTARIO 2 CHARLES III, 2023 Bill 152 An Act to amend the Highway Traffic Act to prohibit passing on a highway painted with double solid yellow lines Mr. G. Bourgouin Private Member’s Bill 1st Reading November 21, 2023 2nd Reading 3rd Reading Royal Assent Bill 152 2023 An Act to amend the Highway Traffic Act to prohibit passing on a highway painted with double solid yellow lines His Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows: 1 Section 148 of the Highway Traffic Act is amended by adding the following subsection: Double solid yellow lines (9) No person in charge of a vehicle shall pass or attempt to pass another vehicle going in the same direction on a highway if doing so would require the crossing of double solid yellow lines painted on the roadway. Offence (10) Every person who contravenes subsection (9) is guilty of an offence and on conviction is liable to, (a) a fine of $400; and (b) three or more demerit points under Ontario Regulation 339/94 (Demerit Point System) made under this Act. Commencement 2 This Act comes into force on the day it receives Royal Assent. Short title 3 The short title of this Act is the Chad’s Law (Enforcing Safer Passing), 2023. ______________ EXPLANATORY NOTE Section 148 of the Highway Traffic Act is amended to prohibit passing or attempting to pass another vehicle going in the same direction on a highway if doing so would require the crossing of double solid yellow lines painted on the roadway. Every person who contravenes this prohibition is guilty of an offence and on conviction is liable to a fine of $400 and three or more demerit points.	Simplify the language used so it's easier to understand. Only pull information from the provided document. EVIDENCE: 1ST SESSION, 43RD LEGISLATURE, ONTARIO 2 CHARLES III, 2023 Bill 152 An Act to amend the Highway Traffic Act to prohibit passing on a highway painted with double solid yellow lines Mr. G. Bourgouin Private Member’s Bill 1st Reading November 21, 2023 2nd Reading 3rd Reading Royal Assent Bill 152 2023 An Act to amend the Highway Traffic Act to prohibit passing on a highway painted with double solid yellow lines His Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows: 1 Section 148 of the Highway Traffic Act is amended by adding the following subsection: Double solid yellow lines (9) No person in charge of a vehicle shall pass or attempt to pass another vehicle going in the same direction on a highway if doing so would require the crossing of double solid yellow lines painted on the roadway. Offence (10) Every person who contravenes subsection (9) is guilty of an offence and on conviction is liable to, (a) a fine of $400; and (b) three or more demerit points under Ontario Regulation 339/94 (Demerit Point System) made under this Act. Commencement 2 This Act comes into force on the day it receives Royal Assent. Short title 3 The short title of this Act is the Chad’s Law (Enforcing Safer Passing), 2023. ______________ EXPLANATORY NOTE Section 148 of the Highway Traffic Act is amended to prohibit passing or attempting to pass another vehicle going in the same direction on a highway if doing so would require the crossing of double solid yellow lines painted on the roadway. Every person who contravenes this prohibition is guilty of an offence and on conviction is liable to a fine of $400 and three or more demerit points. USER: What is the short title of the act? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	16	8	296	null	524
You must respond to the prompt using only the information provided in the context block.Here is the question you are to answer:	How does the Government of Alberta's Ministry of Health plan to meet the three outcomes identified in their 2022-2023 Annual Health Report?	Outcome One: An effective, accessible and coordinated health care system built around the needs of individuals, families, caregivers and communities, and supported by competent, accountable health professionals and secure digital information systems Key Objectives 1.1 Increase health system capacity and reduce wait times, particularly for publicly funded surgical procedures and diagnostic MRI and CT scans, emergency medical services, and intensive care units. As the province emerges from the pandemic, Alberta Health continues to prioritize health system capacity, including building surgical and Intensive Care Unit (ICU) capacity, as well as the health workforce. Several initiatives are underway to minimize disruptions to patient care and expand the capacity of Alberta’s publicly funded health care system permanently. This also includes preparing to respond more effectively to any future health crises and reducing wait times across the health care system. A resilient, sustainable health system will allow the system to operate at full capacity for longer periods before needing to adjust health care resources. The policy has overall goals of improving access to scheduled health services, improving wait time measurement and reporting, and ensuring timely communication for patients. In November 2022, Alberta released the Health Care Action Plan (HCAP). The HCAP identifies immediate government actions to build a better health care system for Albertans. In order to meet the growing demands of Alberta’s health care system, an Official Administrator was appointed to Alberta Health Services (AHS) to provide leadership to address the four goals of the HCAP: • decrease emergency department wait times; • improve emergency medical services response times; • reduce wait times for surgeries; and, • empower frontline workers to deliver health care. Since 2019, government has been committed to increasing surgical capacity to keep pace with demand and reduce the length of time Albertans are waiting for scheduled surgeries. Efforts are geared towards improving patient navigation of the health care system through enhanced care coordination and surgical pathways and resources; improving specialist advice and collaboration with family physicians before consultation; and, centralizing referrals for distribution to the most appropriate surgeon with a shorter wait list. Through the Alberta Surgical Initiative (ASI), Alberta Health continues to work with AHS to improve and standardize the entire surgical journey through: • prioritizing surgeries and allocating operating room time according to the greatest need; • streamlining referrals from primary care to specialists; • increasing surgeries at underutilized operating rooms, mainly in rural areas; and, • providing less complex surgeries through accredited chartered surgical facilities (CSFs) to provide publicly funded insured services and extend existing capacity in hospitals. Through these dedicated efforts, the total number of surgeries completed in 2022-23 was 292,500, which is over 13,900 more surgeries than the year before. Further, approximately 22,100 cancer surgeries were completed in 2022-23, which represents a 10 per cent increase compared to the pre-pandemic amount. Nearly 65 per cent of the cancer surgeries were completed within clinically recommended wait times. By the end of 2022-23, AHS had cleared all postponed surgeries due to COVID-19, and continues to work on reducing wait times. The main focus remains on those patients that are waiting the longest out of clinically recommended targets, and the most acute cases. As of March 31, 2023, AHS reduced the adult surgical waitlist by more than 7,000 patients, and the total number of cases on the adult surgical waitlist is 67,186 which is less than before the pandemic. In 2022-23, there were 38 existing CSFs and three new CSF contracts were implemented to expand publicly funded surgical capacity in these facilities. CSFs are an extension of existing capacity in hospitals and used in many other Canadian health systems. Under the Health Facilities Act, CSFs providing publicly funded insured services must be accredited by the College of Physicians and Surgeons of Alberta, and have a signed service contract with AHS. In 2022-23, accredited CSFs in Alberta provided approximately 47,400 surgeries, which is equivalent to 16.2 per cent of publicly funded scheduled surgeries. In Alberta and other provinces, wait times for three common surgical procedures (hip replacement, knee replacement and cataract surgeries) continue to be impacted by delays due to the COVID-19 pandemic and workforce shortages. The 2022-23 results for hip, knee and cataract surgical procedures showed a decline, meaning that fewer Albertans received these surgical procedures within national benchmark wait times when compared to 2021-22 results. The chart below shows quarterly trends for the three common surgical procedures completed within national benchmarks in 2022-23. There were improvements in the number of cases completed for hip and knee replacements over the course of 2022-23, showing increases of 13 per cent and 15 per cent (respectively), and demonstrating significant improvements with the appointment of the Official Administrator and the implementation of the HCAP in November 2022. While the quarterly results for cataract surgery declined in the second quarter, the number has stabilized in the third quarter since the implementation of HCAP and is beginning an upward trend in the fourth quarter, although it is slightly below the first quarter result. Since 2019-20, there has been a 20 per cent improvement in cases completed within national benchmarks for cataract surgeries, ranking Alberta as a top performer nationally. As part of ASI, Alberta Health has worked with AHS to implement additional measures aimed at improving access and wait times for surgery. Work is ongoing to increase the use of Rapid Access Clinics to reduce wait times for the assessment of orthopedic issues, reducing unnecessary consultations and decreasing wait times for consultations. The Facilitated Access to Specialized Treatment (FAST) program accelerates implementation of central intake for orthopedic and urology surgery to allow patients to see the first available surgeon. Work has begun on the implementation of the Electronic Referral System (ERS), which will expedite referrals for Albertans requiring assessment by surgical specialists. In addition, consultants have been contracted to enhance surgical capacity by improving inpatient surgeries scheduling, monitoring operating room capacity, and reducing patient flow variation. With the added capacity of additional CSFs offering surgeries and implementation of FAST and ERS, Albertans will experience a streamlined surgical journey from referral to consultation to surgery. More Albertans will get their surgery within the clinically recommended wait time targets, thereby reducing the amount of time they must live with pain and other inconveniences. Reducing wait times for medically necessary diagnostic tests is also a top priority for government. Each year, Alberta spends about $1 billion on diagnostic imaging, which includes ultrasounds, Xrays, mammography, MRI and CT scans. About 46 per cent of the $1 billion is allocated to AHS, while 54 per cent is allocated to community diagnostic imaging providers. Approximately one-third of all CT and MRI scans are emergency scans and are completed within clinically appropriate timelines (under 24 hours). In 2022-23, a total of 520,504 CT scans and 231,030 MRI scans were completed across the province. The wait time for both types of scans increased due to a sharp increase in demand and staffing issues. Alberta Health and AHS continue to implement the Diagnostic Imaging Action Plan developed in 2019 to facilitate timely access to CT and MRI scans. As part of the plan, there is a significant focus on triaging patients to ensure that those who need urgent scans can get one as soon as possible. In addition, the Clinical Decision Support (CDS) within Connect Care aims to improve appropriateness of referrals and triage decisions. AHS has reached a five-year agreement with radiologist groups in Edmonton and Calgary to reduce wait times, and signed a memorandum of understanding with the remaining three largest radiology providers in Alberta North, Central, and South Zones. In total, 83 per cent of provincial radiologists have signed agreements with AHS. As part of the HCAP, the Government of Alberta is working with AHS to improve emergency medical services (EMS) response times. Improved ambulance times means that Albertans are receiving the urgent care they need from highly skilled paramedics more quickly. The Alberta Emergency Medical Services Provincial Advisory Committee (AEPAC) was established and tasked with providing immediate and long-term recommendations that will better support staff and ensure a strengthened and sustainable EMS system for Albertans needing services now and into the future. AEPAC focused on the issues facing EMS, such as system pressures that may cause service gaps, staffing issues, and hours of work. This included issues related to ground ambulance, air ambulance, and dispatch. Furthermore, Alberta conducted an independent review of EMS dispatch (the Dispatch Review) to inform improvements that can be made to dispatch services overall. The Dispatch Review and full report from AEPAC were submitted to the Minister of Health in the fall of 2022 and released to the public in January 2023. The Government of Alberta accepted the final AEPAC report and Dispatch Review recommendations in full. The recommendations were focused on accountability, capacity, efficiencies, operations, performance, and workforce support. Adjustments are being made to improve EMS response times and get paramedics out of hospital waiting rooms and back into their communities. Implementation of recommendations on a priority basis has supported ongoing reduction in EMS response times and red alerts, and improvements in community coverage. In 2022-23, Alberta Health initiated several actions to address these recommendations and strengthen the EMS system across the province. Examples of projects include: • Implemented measures to improve the central dispatch system to better deal with lowacuity calls and prioritize emergent/urgent 911 calls for EMS and made workforcescheduling changes as part of the Fatigue Management Strategy. • Initiated pilot projects using an integrated Fire-EMS model to maximize the use of paramedics and increase ambulance capacity to the health care system. Examples of the projects included: using inbound EMS resources only when they are clinically required; staffing spare ambulances to support the EMS system during times of stress; and, expanding single member advanced care paramedic response units that provide immediate advanced life support care in anticipation of, or in the absence of, an available ambulance. • Introduced new provincial guidelines, including a 45-minute EMS emergency department (ED) wait time target for 911, to get ambulances back on the road more quickly. The new provincial guidelines enable fast-tracking ambulance transfers at EDs by moving less urgent patients to hospital waiting areas. • Put procedures in place to contract appropriately trained resources for non-emergency transfers between facilities in Calgary and Edmonton, freeing up paramedics. Instead of using highly trained paramedics for non-medical patient transfers to patients’ homes from a facility or acute care, alternative resources are now arranged by hospitals, also freeing up paramedics. • Granted an exemption to the minimum staffing requirements defined in the Ground Ambulance Regulation, significantly expanding the instances where an emergency medical responder can meet the staffing requirements for all classes of ambulance, to alleviate staffing challenges across the province. • Empowered paramedics to assess a patient's condition at the scene to decide if they need ambulance transport to the hospital. In 2022-23, a total of $590 million was spent on EMS. Capacity increases were laid out in the AHS’ EMS 10-Point Plan and recommendations by AEPAC, including increases in paramedic workforce and adding ambulances to the system. As of March 31, 2023, there are 8,417 regulated members in the province registered with the Alberta College of Paramedics, including 1,383 emergency medical responders, 4,050 primary care paramedics, and 2,984 advanced care paramedics. AHS added 19 new ambulances in Calgary and Edmonton and more ambulance coverage in Chestermere and Okotoks, and hired 457 new staff members, including 341 paramedics. Increased capacity helps reduce EMS response times and red alerts and improves working conditions for frontline practitioners and community coverage, especially for life-threatening conditions. Measures to address staffing issues include AHS’ Fatigue Management Strategy, a recruitment campaign aimed at other provinces and Australia, development of a Provincial Service Plan, and interim AEPAC recommendations brought forward in June 2022, granting an exemption to expand use of emergency medical responders and pilot projects to give greater autonomy to ambulance operators using an integrated fire-EMS model. In addition, keeping paramedics out of hospital waiting rooms and in communities has contributed to decreased EMS response times and red alerts, improved community coverage, and quicker access to EMS. The HCAP 90-day Report released in February 2023 (https://www.albertahealthservices.ca/assets/about/aop/ahs-aop-90-report.pdf ) shows an early reduction in response times and red alerts, and greater focus on urgent/emergent 911 calls through low-acuity diversion measures and non-clinical patient transport programs across Alberta, particularly in Calgary and Edmonton. Comparing November 2022 to March 2023, EMS response time for the most urgent calls in metro and urban areas was reduced from 21.8 minutes to 15 minutes. Improving access to EMS enables timely patient care and entry into the health care system. The government also launched the EMS/811 Shared Response program to ensure patients receive the level of care they need and reduce unnecessary ambulance responses. Calls that have been assessed as not experiencing a medical emergency that requires an ambulance are transferred to Health Link 811, where registered nurses provide further triage, assessment and care. Since the launch in January 2023, more than 2000 911-callers with non-urgent conditions were transferred and helped by Health Link 811, keeping more ambulances available for emergency calls. In October 2022, government appointed a Parliamentary Secretary of EMS Reform to work with health partners to set priorities for service improvement based on AEPAC and Dispatch Review report recommendations. Remaining AEPAC and Dispatch Review recommendations have been incorporated into the AHS Operations Plan and are being prioritized and monitored by the EMS Reform Parliamentary Secretary. There are almost two million visits to Alberta EDs every year. Alberta Health together with AHS is working to improve patient flow within the health system, in particular to reduce ED wait times. AHS is committed to improving the experience of patients and families from the time they seek emergency care until the time the patient is discharged or admitted. There are 780 more staff in EDs today than in December 2018. AHS is working diligently on several initiatives to improve access to emergency care including improving access to continuing care living options, expanding hospital capacity, and implementing initiatives in hospitals to streamline patient treatment and discharge. In 2022-23, alternate level of care days were reduced by enhancing social work supports in acute care to address barriers for discharge. This included adding a fast-track area at the Alberta Children’s Hospital in Calgary, and deploying additional units of EMS mobile Integrated Health Units in Calgary and Edmonton to provide care for unscheduled needs within the community (i.e., IV antibiotics, rehydration, and transfusions at home). In January 2023, the Bridge Healing Transitional Accommodation Program was launched in Edmonton to support transitioning of patients experiencing homelessness as they are discharged from emergency departments. The initiative aims to reduce hospital readmission rates for Albertans experiencing homelessness by providing wrap-around health and social services. This program provides 36 beds to support this vulnerable population. Over the next three years, $305 million will be provided for additional health care capacity on a permanent basis under the HCAP. This includes approximately $268.6 million in operating funds and $36.4 million for capital projects to increase ICU capacity on a permanent basis. Approximately $61 million was spent in 2022-23 to create 50 permanent new fully equipped and staffed adult ICU beds across the province, which brings the number of ICU beds up to 223 from 173 before the pandemic. The pandemic has shown that more permanent capacity and staff are needed, particularly in rural and remote areas. The ministry continues to address ICU staffing shortages across health care facilities in Alberta. As vacancies are filled, ICU beds are reopened. Temporary bed closures are implemented only as a last resort, and patients continue to receive safe, high-quality care. AHS filled 392 positions, as of the end of fiscal year 2022-23, to support the new beds. These positions included nurses, allied health professionals, pharmacists, and clinical support service positions for diagnostic imaging and service workers. The latest data available at the end of fiscal year 2022-23 indicated that the provincial ICU baseline occupancy rate was 82 per cent, a 29 per cent improvement from being at over capacity (115 per cent) in 2021-22. Increasing ICU capacity ensures that Albertans receive care when they need it most. However, unplanned temporary service disruptions, including bed reductions, are not unusual in any health system, as services and beds are managed based on patient need, staffing levels, acuity of patient health, and other factors. Government works to ensure patients continue to receive safe, high-quality care. Occasionally, however, temporary bed closures are implemented as a last resort. Government is committed to ensuring that any Albertan who needs acute care will receive it. Workforce challenges remain a significant barrier to improving wait times for surgery given the high demand for anesthesiologists in Canada and international jurisdictions. Alberta Health is reviewing and developing options to support continued implementation of the Anesthesia Care Team Model in AHS and CSFs. The implementation of the Anesthesia Care Team Model aims to use anesthesiologists more resourcefully for some ophthalmology and orthopedic surgeries by employing a multidisciplinary team that works under supervision of the anesthesiologist to support anesthesia services in the operating room. Recruitment efforts are underway through AHS to attract more anesthesiologists to Alberta, including in rural areas. In March 2023, government released MAPS Strategy, which sets out a framework for supporting the province’s current health care workers and building the future workforce that can support Albertans getting the health care they need when and where they need it. Alberta has various initiatives underway to attract and retain nurses and increase system capacity. Alberta Health worked with the College of Registered Nurses of Alberta to streamline registration processes for Internationally Educated Nurses (IEN) and developed a grant agreement with the Alberta Association of Nurses for nurse navigators to support IENs going through the assessment, education, and registration processes. Announced in September 2022, the Modernizing Alberta’s Primary Health Care System (MAPS) initiative formed three panels to provide advice to the Minister on ways to improve the primary health care system, thereby improving the overall efficiency of the health care system. On February 21, 2023, the Minister announced an investment into primary health care of $243 million over three years; of this, $125 million is allocated for MAPS recommendations. In addition, the Minister accepted, in principle, early opportunities for investment that could be implemented to enhance Albertans’ access to primary health care immediately. On March 31, 2023, the MAPS Strategic Advisory Panel and Indigenous Primary Health Care Advisory Panel submitted parallel final reports to the Minister, outlining transformative strategic roadmaps for the next 10 years of primary health care in Alberta. These reports address both Indigenous access to primary health care and advice on improving primary health care for all Albertans. The intent of the MAPS initiative will be to reorient the health system around primary health care, thereby improving patient outcomes and reducing costs and decreasing pressures on the acute care system in the long-term. Partnerships and collaboration between primary care providers and specialists will improve patient wait times and health outcomes. The ASI Care Pathways and Specialty Advice, which includes the Provincial Pathways Unit and provincially aligned non-urgent telephone advice service programs, support consistency and quality to ensure continuity of care across the patient journey. The Provincial Primary Care Network provided these projects with conditional endorsement to begin transition to operational shared service programs. Primary Care Networks (PCNs) are also working with other stakeholders on the ASI to improve primary care and specialist linkages and patient navigation of the health care system by building and leveraging PCN specialist linkage programs. Some initiatives include Strong Partnerships and Transitions of Care for the Central Zone; Patient’s Medical Home, including referral navigators; Specialist LINK Tool for the Calgary Zone; Connect MD for the Edmonton and North Zones; FAST General Surgery for the Edmonton Zone; and, Specialist Integration Task Group for the Calgary Zone. Modernize Alberta’s continuing care system, based on Alberta’s facility‐based continuing care and palliative and end‐of‐life care reviews, to improve continuing care services for Albertans living with disabilities and chronic conditions (including people living with dementia). Government continues to be committed to addressing gaps in the continuing care system, and meeting the needs of Albertans by implementing transformative changes within the system. Alberta Health worked with partners to develop a new legislative framework for the continuing care system. The Continuing Care Act (Act), which received Royal Assent on May 31, 2022, will increase clarity regarding services, address gaps and inconsistencies across services and settings, enable improved service delivery for Albertans, and support health system accountability and sustainability. Multiple pieces of legislation will be consolidated into the Act, which establishes clear and consistent oversight and authority over the delivery of continuing care services and settings. The new legislation was proclaimed to be in effect April 1, 2024, except for sections regarding administrative penalties, which will be proclaimed on April 1, 2025. Implementation of the legislative framework will better support Albertans transitioning between care types and settings, including home and community care, supportive living accommodations, and continuing care homes. The continuing care system in Alberta provides a range of services for health, personal care, and housing to ensure the safety, independence, and quality of life for people in Alberta, regardless of age, based on their evaluated need for continuing care assistance. Publicly funded care options include home and community care; continuing care homes, which includes Designated Supportive Living and Long-Term Care; and, Palliative and End-of-Life Care services (PEOLC). In addition, Albertans have the option to access housing support in supportive living settings, such as lodges, group homes, and seniors' complexes. In 2022-23, 871 new continuing care beds/spaces were created at AHS-operated or contracted facilities to meet Albertans’ needs. The government continues to be committed to expanding the number of available continuing care spaces throughout the province and enhancing the continuing care system to effectively meet the needs of Albertans by incorporating recommendations from the Facility-Based Continuing Care (FBCC) Review Final Report, which was released on May 31, 2021. Alberta Health has acted on several recommendations from the FBCC review, including the introduction of self-managed care as a way to provide greater choice regarding locations, types and providers of services. Further, Alberta Health has enhanced client choice by supporting more continuing care clients in the community rather than at FBCC sites. Alberta Health worked with Alberta Blue Cross and AHS to successfully implement the ClientDirected Home Care Invoicing model. This model was implemented in the Edmonton Zone in April 2022, and in the Calgary Zone in the fall of 2022. Expansion to rural areas of the province will move forward over the course of 2023 to provide Albertans with increased choice and flexibility in selecting their home care service provider and the ability to better direct how their care is provided. In June 2022, Alberta Health worked with AHS to initiate a Request for Expression of Interest and Qualification (RFEOIQ) procurement process to explore opportunities to optimize the provision of home care services in Alberta, as well as identify innovative service delivery solutions to support specialized needs and populations. Albertans will begin to see the outcomes and impacts of the RFEOIQ process during fiscal year 2023-24, as the successful proposals are implemented. Another recommendation from the FBCC report was to streamline inspections. Transition of continuing care facility audits from AHS to Alberta Health began in March 2022. A coordinated monitoring approach has reduced duplications of both reviews and site visits. In 2022-23, over 1,100 inspections were completed on accommodation and care in continuing care facilities across the province. Alberta Health also followed up on over 940 reportable incidents of resident safety or care concerns and conducted 103 complaint investigations. These activities continue to provide assurance that residents and clients are receiving safe and quality care and services. Budget 2022 allocated $204 million in capital grant funding over three years to expand capacity for continuing care. The inaugural Indigenous Stream was launched in 2021 to support continuing care facilities on and off reserves/settlements. As of June 2022, seven projects were approved for $67 million to develop 147 continuing care spaces. The inaugural Modernization Stream was launched on September 20, 2022, and concluded on January 6, 2023. This stream focused on refurbishing and/or replacing existing aging continuing care infrastructure at non-AHS owned facilities. The Government of Alberta continues to prioritize quality PEOLC by investing $20 million in over 30 projects since 2019. Progress to date on projects commenced in 2020 include: • Covenant Health continued to work to increase general awareness of PEOLC, increase uptake of advance care planning and develop standardized, competency-based education to support the provision of high-quality PEOLC. • In October 2022, Covenant Health’s Palliative Institute launched the Compassionate Alberta website, (compassionatealberta.ca) which is a resource aimed at increasing awareness around palliative care and to help Albertans have open and honest conversations about death. • Between April 2022 and March 2023, the Alberta Hospice Palliative Care Association successfully launched two programs that addresses the needs of caregivers and those with a life-limiting illness (the Living Every Season Program) as well as grief and bereavement needs for Albertans (the You’re Not Alone Grief Connection Program). In November 2021, Alberta Health released the PEOLC call for grant proposals. The grant program focused on projects that address the four PEOLC priority areas identified in the Advancing Palliative and End‐of‐Life Care in Alberta Report. As a result of this grant call, a total of 25 new PEOLC grants were initiated in April 2022, totaling $11.3 million. The funding and project breakdown is as follows: • Nearly $4.2 million for eight projects to expand community supports and services. • More than $4.1 million for 10 projects to improve health-care provider and caregiver education and training. • More than $1.9 million to support four projects that advance earlier access to palliative and end-of-life care. • More than $1.1 million for three projects for research and innovation. In June 2022, the Pilgrims Hospice Society completed a one-year, grant-funded project that supported care navigation services, which provided Albertans with information on residential support programming and provided staff training on hospice care. Pilgrims Hospice Society also received $2.5 million in October 2022 to support residential hospice care at the Roozen Family Hospice Centre in Edmonton. This demonstration project will provide important information on the standalone hospice model used at the centre, including usage data and service quality, to identify longer-term options for funding and expanding residential hospice services in Alberta. Government continued to invest in supporting the nearly one million Albertans who are caregivers for family and friends. This included approximately $2 million in grant funding since 2022 to Caregivers Alberta to enhance their programs and services; to Norquest College for the Skills Training for caregivers with a focus on rural areas; to the University of Alberta to reduce caregiver distress and support family and friend caregivers to maintain their health and well-being; and, to the Alzheimer Society of Alberta and the Northwest Territories to focus on delivering communitybased programming for persons living with dementia and their caregivers. In 2022-23, the Government of Alberta continued to support innovations in dementia care through the Community-based Innovations for Dementia Care initiative, which supported 15 communitylevel projects, and through multiple projects delivered by the Alzheimer Society of Alberta and the Northwest Territories: • The Alberta Employers Dementia Awareness Project identified the needs of employers to develop best practices to create inclusive workplaces. This included piloting and launch of the Dementia Alberta website (https://www.dementiaalberta.ca) to ensure dementia in the workplace awareness materials are available to Alberta employers. The project also helps to ensure that employers have access to materials describing the importance of brain health and dementia risk reductions, and that employers have access to sample guidance, facts, tips and scenarios applicable to Alberta employers and employees. • The expansion of the First Link® early intervention program by enhancing outreach to and in rural communities. During the project, 113 rural communities received outreach and 91 small cities, specialized municipalities, municipal districts, towns, villages or summer villages received outreach services. • The Community Dementia Ambassador Project, which created a program delivered by volunteers (Ambassadors) who live in or are familiar with the cultural and social values of Alberta communities. This project identified 22 Ambassadors from 16 communities, including Cardston, St. Paul and Peace River. Ambassadors reached more than 1,325 Albertans. To support the continuing care sector and its staffing needs, the government is exploring ways to increase the number of students enrolled in Health Care Aide (HCA) programs at various postsecondary institutions. Government is funding an additional 1,090 seats in HCA programs over three years, and invested $12.8 million to provide bursaries for HCA students to assist with education costs and encourage them to become HCAs. The HCA bursary program, administered by NorQuest College, went live July 1, 2022, and included three streams of funding: the Financial Incentive program, the HCA Tuition Bursary program, and the Workplace Tutor program. Under the Financial Incentive program, students who were enrolled in a licensed HCA program between January 1 and June 30, 2022, are eligible for up to $4,000 if they agree to work a minimum of 1,000 hours with an identified continuing care operator within one year of starting employment. Eligible HCA students may receive up to $9,000 through the HCA Tuition Bursary program. The Workplace Tutor program provides funding for identified continuing care operators to educate and train HCAs at their workplace. Demand for the bursaries is steady with over 600 students applying for the regular bursary and approximately 350 HCA students approved to receive the bursary. These bursaries will remove barriers for students, and pay for schooling and other expenses while they are completing their program. From July 2022 to March 31, 2023, government provided $20.6 million to continuing care operators to partially offset inflationary increases to accommodation charges for continuing care residents. This support made accommodation charges more affordable for residents and shielded them from the full cost of living pressures associated with higher-than-average inflation. The government provided $1 million to improve access to non-medical supports in the community. This included initiatives with United Way Calgary and the Edmonton Seniors Coordinating Council to provide more community supports and navigation assistance for clients seeking this help, expanding caregiver supports. In 2022-23, the percentage of medical patients with an unplanned hospital readmission within 30 days of discharge from hospital was 12.8 per cent. This was one per cent lower compared to last year (2021-22). A lower percentage means fewer patients have been readmitted to hospital within one month of discharge. A high rate of readmissions increases costs and may mean the health system is not performing as well as it could be. Although readmission may involve many factors, lower readmission rates show that Albertans are supported by discharge planning and continuity of services after discharge. Rates may also be impacted by the nature of the population served by a hospital facility, such as elderly patients or patients with complex health needs, or by the accessibility of post-discharge health care services in the community. Coordination of care is also improving with increased access to virtual care services and supports as well as recent enhancements to health information systems that enable electronic notification of primary care doctors when their patient is admitted or discharged from hospital. 1.3 Use digital technology to enable new models of care and reduce manual and paperbased processes. Government continues to enhance the digital health environment to provide Albertans with digital access to their health information and give health care providers more complete digital patient information at the point of care to enhance quality of care for Albertans. Collecting health system data helps support evidence-informed decisions to address changing circumstances and to keep Albertans informed. The digital modernization of the health care system involves several key elements. The MyHealth Records (MHR) portal allows Albertans to access their health information. In 2022-23, over $7.9 million was spent on MHR. Alberta Netcare, the province's Electronic Health Record, is available to health care professionals in the community and AHS. In addition, Connect Care, an integrated system with Alberta Netcare, serves as a common platform for clinical information and stores all medical records, prescriptions, and care history collected from AHS facilities, including doctor's notes. Giving Albertans digital access to their health information via the MHR portal reduces the need for them to manually request that information separately from each health provider. Albertans registered on MHR has grown from 1.25 million users in March of 2022 to just under 1.5 million users at the end of March 2023. MHR portal capabilities have been expanded with the addition of immediate release diagnostic imaging reports including CT and MRI scans. The Apple MHR App is now integrated with Apple Health Kit, allowing Albertans to connect health information from their Apple Health App account to MHR. These information technology components facilitate the shift from paper-based processes to digital processes and support the expansion of virtual care options. In 2022-23, new services to support electronic referral as part of the ASI were planned and developed. A data feed is being tested, paving the way for future referral notifications in MHR and in the Electronic Medical Records (EMR) systems of referring providers. Other improvements also included continuity of care services: • Patient data from the Central Patient Attachment Registry is now integrated with Alberta Netcare, enabling health care providers across Alberta to access information on the patient’s medical home, and who their primary provider is. Design work on Alberta’s version of the International Patient Summary is nearing completion and development work will begin shortly with EMR vendors. A patient summary is a collection of clinical and contextual information about a patient’s health details. The Alberta version of the national standard is being coordinated with Ontario and Canada Health Infoway (a not-for profit funded by the Government of Canada) and includes necessary minimum amount of information to inform patient treatment at point of care. Alberta is hoping to have at least one EMR vendor conformed to Alberta’s Patient Summary in 2023, with additional vendors onboarded in 2024. • The Community Information Integration (CII) project improves Albertans’ access to primary care and community health information by collecting patient data from physician offices and other community-based clinics and making it available to other health care providers through Alberta Netcare. Over $6.5 million was spent on CII in 2022-23. In January 2023, there were 1,764 providers live on CII, taken from 430 clinics across 40 PCNs, and nearly 1.2 million Albertans in the Central Patient Attachment Registry database. More than seven million patient encounters and over 500,000 consult reports have been submitted to Netcare as of March 31, 2023. As the province emerges from the pandemic, the expectations of Albertans have shifted and there is a greater reliance on accessing on-demand virtual government services. In alignment with the Government of Alberta Digital Strategy and Alberta Health’s eHealth Strategy, developed in 202122, Alberta Health will modernize digital service delivery, increase productivity, save tax dollars, and improve user experience by better integrating technologies into the delivery of government services. In 2022-23, $5.7 million was spent through the Health Canada Bilateral Agreement for PanCanadian Virtual Care to address secure messaging, secure video-conferencing technology, remote patient monitoring technologies, patient access to COVID-19 and other lab results, and back-end supports for integration of new platforms. This investment supported Alberta Health’s ongoing initiatives foundational to expanding the virtual health care system. Alberta Health has identified four strategic priorities for virtual care delivery in the province, which are reflected in Alberta’s Virtual Care Action Plan: • establishment of an eHealth Strategy that includes a strategy for virtual care; • expansion of the MyHealth Records patient portal capabilities, including expansion of lab results and addition of diagnostic imaging results; • development of secure messaging services for Alberta, including advanced services for twoway integration between community EMRs and Alberta Netcare; and, • development of a privacy and security framework for virtual care. Access to the MHR portal is free at https://myhealth.alberta.ca/myhealthrecords. Currently, Albertans can view parts of their Netcare record, including their medications dispensed through community pharmacies, lab results and immunization history through MHR. In 2022-23, discussions and approval processes for MHR and Alberta Netcare were underway for implementation. This enables Albertans to be active participants in their own health management. The ministry continues to make progress on a phased roll out of Connect Care within all AHS facilities to support digital modernization of the health system. In 2022-23, five of the nine planned launches for this multi-year project had been completed. Connect Care provides a single source of information in AHS to support team-based, integrated care with a focus on the patient and the efficient and effective provision of services. In 2022-23, over $260 million was spent on Connect Care. The total cost of Connect Care when completed is expected to be $1.45 billion. Although progress was slowed by the pandemic, work continues on the remaining four launches of deployment. All launches are expected to be completed by fall 2024 and approximately 145,400 users are expected with full roll out of the program. The application of modern technologies will support the delivery of innovative care models that empower patients, families and their health care teams to improve quality of care. In 2022-23, eight digital health projects were funded at the Universities of Alberta and Calgary for a total investment of $9.6 million from AHS and Alberta Innovates. These academic-clinical collaborations will help AHS identify and advance solutions that improve health care quality, health outcomes, and overall value for Albertans. Projects include the integration of prevention into Connect Care to improve the health of Albertans; digital tools such as clinical decision support and remote monitoring for people with kidney issues to reduce acute care use; tele monitoring to reduce adverse events for hospitalized patients; and, an integrated digital health approach to diabetes with First Nations in Alberta. Digital technology is also being leveraged to modernize critical capabilities to administer the Alberta Health Care Insurance Plan (AHCIP) and support core business, such as claims processing and payment to health care providers. To better meet the needs of Albertans and care providers, work continued on future models of care and emerging digital technology to replace and redesign mainframe systems to increase functionality and reduce maintenance costs. In 2022-23, over $6.5 million was spent on this initiative and the work towards the replacement and redesign of nine applications used to administer the AHCIP is ongoing. 1.4 Ensure processes for resolving patient concerns are effective, streamlined, and consistent across the province. It is important that Albertans are aware of what resources are available to help them resolve patient concerns, and how their valuable feedback can help improve the quality and safety of health services. The Office of the Alberta Health Advocates empowers Albertans to advocate for their health needs; resolves their concerns and refers individuals to programs and services to address their complaints; educates Albertans about the province’s Health Charter; and, provides health selfadvocacy skills and health literacy education to promote early resolution of issues and remove barriers and gaps in care. In February 2023, government appointed a new Health and Mental Health Advocate to be a strong voice for Albertans when it comes to their health care and to ensure the health system operates effectively for all Albertans. From April 1, 2022, to March 31, 2023, there were 2,589 Albertans served by the Office of the Alberta Health Advocates. More specifically, there were 1,565 under the Health Advocate’s jurisdiction, 742 under the Mental Health Advocate’s jurisdiction, and 175 files that were under both jurisdictions. The Office of the Alberta Health Advocates hears the patient perspective on care experiences and provides feedback to entities in the health system through effective partnership and collaboration to encourage system improvement/change and effective legislative development. The ministry is committed to ensuring the patient complaints process is fair, responsive, and accessible and has processes in place to review and respond to feedback from patients and families. Recommendations to improve the current processes for resolving patient concerns and complaints have been developed, informed by consultation and research led by the Health Quality Council of Alberta. These recommendations were approved by government in the summer of 2022; Alberta Health is working on their implementation which is to expand the role and mandate of the Health Advocate; centralize intake, triage, navigation and standardize follow up with Albertans for all patient complaints; and, require mandatory information exchange between stakeholders to support improved public reporting for health care complaints. Once the recommendations are fully implemented, Albertans will have a simplified process to raise concerns and complaints about health care, and the Health Advocate will help them find the appropriate body to review and investigate the complaints. The Health Advocate will help improve accountability by monitoring the status of the resolution processes for completion and closure. Concerns and complaints will continue to be reviewed and investigated by AHS, health professions and other bodies created under statute to hear concerns. Alberta Health continues working with First Nations and Métis health leaders to better understand their experiences with the current complaints management systems in Alberta, involve them in identifying ways to build Indigenous patient trust in the health care they receive, and to ensure their concerns are addressed appropriately. The outcome of this work will improve the current complaints management system by removing existing red tape and making the system easier to navigate for patients and families. Outcome Two: A modernized, safe, person-centred, high quality and resilient health system that provides the most effective care now and in the future for each tax dollar spent Key Objectives 2.1 Continue to implement strategies to bring Alberta’s health spending and health outcomes more in line with comparator provinces and national norms, including implementation of AHS review recommendations and working with the Alberta Medical Association to reach a fiscally sustainable agreement. Albertans want and deserve a health care system that meets their needs, while also understanding the system needs to be sustainable. Government’s focus on ensuring value for money spent on health care supports this vision through actions and initiatives that make the most of taxpayer dollars. Budget 2022 invested $22.5 billion in Health’s operating budget to keep Albertans safe and healthy. In 2022-23, Alberta received $5.8 billion in Government of Canada transfers, of which $5.5 billion was the Canada Health Transfer (CHT). The CHT included a $232 million one-time funding to address surgery backlog resulting from the COVID-19 pandemic. In February 2023, Alberta reached an agreement with the Government of Canada to invest more than $24 billion in Alberta's health care system over the next 10 years through the CHT. This funding aims to respond to the immediate needs of Albertans under the Health Care Action Plan, as well as improve access to family health services, including in rural and remote areas and in underserved communities; foster a resilient and supported health workforce; improve mental health care and addictions services; and, allow Albertans access to their own electronic health information. The ministry continues to closely monitor provincial per capita spending on health care to quantify progress on government’s broader commitment to get the most value for each dollar and improve access, and make the health system work better for Albertans, while managing cost growth in health care. The Government of Alberta continues to collaborate with health system partners to manage the biggest cost drivers in the health system – namely hospital services, labour and physician compensation, and publicly funded drug benefit programs. In 2022-23, the Government of Alberta spent $4.3 billion on hospital services (i.e., acute care), $6.0 billion on physician compensation and development, and $2.5 billion on drugs and supplemental health benefits. The pandemic caused per capita health care spending for all provinces to increase significantly. The national average increased from $4,835 in 2019-20 to $5,628 in 2021-22. The Alberta provincial per capita spending on health care in 2021-22 is estimated to be $5,384, on par with the Canadian average. Improving efficiency and ensuring more value for tax dollars will improve health outcomes and support fiscal sustainability of the health system. The Alberta Health Services (AHS) Performance Review identified opportunities for AHS to reduce costs and improve health outcomes by using resources more efficiently. The ministry will continue to pursue opportunities to align spending with British Columbia, Ontario and Quebec by implementing efficiencies and reducing drug costs through the work of the pan-Canadian Pharmaceutical Alliance. AHS continues to find ways to improve the health system and access to services to Albertans. Actions implemented as a result of the 2019 AHS Performance Review have had substantial impacts on the health care system and savings have been used to improve front-line care and system sustainability (https://open.alberta.ca/publications/alberta-health-services-performance-reviewsummary-report). Implementation of the AHS Review initiatives was concurrent with a global pandemic, labour negotiations and development of a new agreement between the government and the Alberta Medical Association (AMA). Operating expenditures (excluding COVID-19 costs) increased by 6.1 per cent in 2022-23 when compared to 2021-22. Alberta’s population growth and aging population has resulted in increased demand for healthcare services. The overall increase also reflected implementation of the new agreement with the AMA and recent settlements with various health labour unions. Despite these cost pressures, health spending growth is lower than the combined population growth and inflation increase. Protecting and improving the quality of health care in Alberta also requires capital investments. In 2022-23, a total of $841 million was invested in health-related capital projects across the province, including technology and information systems maintenance and renewal of existing facilities. Alberta continues to expand and modernize hospitals and other facilities to protect quality health care and grow system capacity. Investments in health system infrastructure is fundamental to improving efficiency in the health care system, reducing wait-times, providing additional surgical capacity, and to generally improve patient outcomes. Budget 2022 invested $193 million over three years for the redevelopment and expansion of the Red Deer Regional Hospital Centre to increase critical services and add capacity to one of the busiest hospitals in the province. The Red Deer Regional Hospital Centre redevelopment project functional program was completed in late April. The functional program develops and validates the scope of services and projected workload, staffing, and space to meet current and emerging acute health care needs of all residents of the Red Deer Regional Hospital’s catchment area. The functional program also addresses capacity and quality of space to improve patient and staff safety, support quality of care, manage utilization efficiently and sustainably, and ensure timely access to care. When completed this project will expand inpatient capacity from 370 beds to 570 beds and add three surgical suites, plus space to add three more suites when required in the future. There will be a new cardiac catheterization laboratory, a new medical device reprocessing space, expanded ambulatory care capacity, and expansion of many other clinical programs throughout the hospital. In 2022-23, over $133 million was allocated over three years for Alberta Surgical Initiative capital projects at AHS-owned facilities. This includes the renovation of the Medicine Hat Regional Hospital, the Edson Health Centre, and the Royal Alexandra Hospital in Edmonton. Construction also progressed on the University of Alberta Hospital in Edmonton, which will include a postanesthetic recovery unit and medical device reprocessing area when completed, and the Rocky Mountain House Health Centre, which is undergoing renovations for a new procedure room and the development of a new medical device reprocessing area. Design was completed for redevelopment at the Chinook Regional Hospital that will modernize and increase surgical procedure capacity. Other work also included designing 11 operating suites at the Calgary Foothills Medical Centre. As part of Budget 2022, $2.2 billion was allocated over three years to move forward with a number of capital projects, for example: • The University of Alberta Hospital Brain Centre received $50 million over three years for a Neurosciences Intensive Care Unit. The design development report is nearing completion. • Provincial Pharmacy Central Drug Production and Distribution Centre ($49 million over three years). The design development report is complete. • The Norwood Tower at the Gene Zwozdesky Centre ($142 million over two years) received an occupancy permit in March 2023 and was turned over to AHS for operational commissioning. In 2022-23, $116 million was spent to complete the Calgary Cancer Centre. The Calgary Cancer Centre Construction is complete and AHS is preparing the hospital to open in 2024. The hospital will have 160 new inpatient cancer beds, 100 patient exam rooms, 100 chemotherapy chairs, increased space for clinical trials, 12 radiation vaults, outpatient cancer clinics, and designated areas for clinical and operational support services and research laboratories. The completed project will increase cancer care capacity in Calgary by consolidating and expanding existing services to support integrated and comprehensive cancer care. On October 6, 2022, the government executed a four-year agreement with the AMA to address common interests such as quality of care, health care system sustainability, and stability of physician practices. Implementation of the AMA Agreement is underway and includes over $250 million in new spending over four years on initiatives targeted at communities and physician specialties facing recruitment and retention issues. The agreement included concrete solutions and the financial resources to support Albertans’ health care needs by promoting system stability through competitive compensation and providing targeted funding to address pressures that require immediate and longer-term stabilization. The agreement also allows physicians to provide greater input into longer-term approaches on improving patient care and physician compensation reform initiatives. Physicians received a one per cent lump sum COVID-19 recognition payment in 2022-23. Alberta physicians were at the forefront of the pandemic and the one-time payment for eligible practicing physicians is in recognition of that work during the 2021-22 fiscal year. The lump sum payment is approximately $45 million and was provided to the AMA in December 2022 to distribute to their members. Physicians will receive an average one per cent rate increase to compensation for each of the next three years. As part of implementation of the AMA Agreement, the Business Costs Program premium rate was increased by about 22 per cent. This increase will help physicians deal with inflation and keep practices open. The increase is estimated to cost $20 million annually, providing on average an extra $2,300 annually for each physician. This is in addition to about $80 million the government currently invests in the program each year. Following the ratification of the AMA Agreement, a commitment for collaboration between Alberta Health and the AMA regarding primary health care, including one-time investments of $20 million in Primary Care Networks (PCNs) for two fiscal years, was established. The Provincial PCN Committee provided significant contributions to the work of the Modernizing Alberta’s Primary Health Care System (MAPS) initiative to improve access and quality of primary and community health services. The MAPS initiative goal is to provide recommendations on ways to strengthen primary health care and achieve a primary health care-oriented health system. MAPS is engaging leaders and experts with hands-on experience in primary health care and health systems improvement to examine the current landscape and propose improvements. By March 31, 2023, a final report was delivered proposing a strategic direction for primary health care over the next 10 years, with a parallel report providing strategic directions to improve the delivery of primary health care for Indigenous peoples in Alberta. The $20 million investment in primary health care provides significant relief across the primary health care system, particularly for PCNs that have experienced a decline in their per capita payments from declining numbers of patients. This funding provides stabilization while work is undertaken to review and improve the overall funding model for PCNs, which will consider recommendations from the MAPS initiative. For many Albertans, prescription drugs have tremendous benefits in terms of improving quality of life, managing illnesses, and in some cases, precluding the need for more extensive treatments. Alberta continued to work with the pan-Canadian Pharmaceutical Alliance (pCPA) to reduce prescription drug costs and increase access to clinically effective and cost-effective drug treatment options, including cell and gene therapy. All new drugs and/or new indications for use undergo price negotiations between the pCPA and drug manufacturers. In 2022-23, rebates have increased to an estimated $327 million from $275 million in 2021-22. This is a successful trend that shows the importance of the pCPA and Alberta’s involvement as a member to push health jurisdictions for more value and budgetary protection. In 2022-23, the province spent $2.5 billion on drugs and supplemental health benefits and continued to improve existing drug benefit programs and add innovative and effective therapies through the addition of 320 new products in 2022-23. Of the 320 products added, 48 were brand name drug products and 272 were generic products. Alberta’s Biosimilars Initiative will expand the use of biosimilars by replacing the use of biologic drugs with their biosimilar versions whenever possible. This means patients will continue receiving safe and effective treatment, but at a lower cost. In 2022-23, savings from this initiative increased to an estimated $65.7 million from $48.9 million in 2021-22. 2.2 Increase regulations and oversight to improve safety, while reducing red tape within the health system by restructuring and modernizing health legislation, streamlining processes, and reducing duplication. As of March 31, 2023, the ministry, including AHS, achieved a 36.1 per cent reduction of its regulatory and administrative requirements, exceeding the government target of 33 per cent. AHS will continue to see reductions with the ongoing launches of Connect Care across the organization, continuing through 2024. Connect Care supports digital modernization of more complete central access to patient information related to AHS services. It provides resources, including medication alerts; evidencebased order sets; test and treatment suggestions; and, care paths and best practice advisories, which result in fewer repeated tests and consistent information across the province wherever care is being provided at AHS facilities. This system also reduces the number of forms used by AHS and helps to eliminate data entry duplication. Connect Care also facilitates direct communication between patients and providers through a patient portal, MyAHS Connect, which helps patients better manage their health with online access to their health information, including reports and test results. It also allows for online interaction with their care team, an ability to review and manage appointments and after visit care summaries, and less repeating of their health histories or need to remember complex histories or medication lists. The ministry continues to monitor Alberta’s health system to ensure standards are maintained and to improve safety and quality of health care. As of March 31, 2023, amendments to the Health Professions Act have been proclaimed into force that modernize Alberta’s professional regulatory structure. This included changes to 29 regulatory college regulations and one regulation that enhance professional regulation by health profession regulatory bodies and will make it easier for regulatory colleges to be more agile and adapt faster to changing best practices. The PCN Nurse Practitioner (NP) Support Program was created to enable NPs to work to the full scope of their skills. In 2022-23, $7.6 million was provided and the program facilitated the incorporation of NPs working more than 57 full-time equivalent positions as of March 2023. The program increases access to primary health care, including after hours, weekends, and in rural and remote areas and underserved populations; supports chronic disease management; and, helps meet unmet demand for primary health care services. Challenges for the program include NP compensation, recruitment and retention, and the desire of NPs for an independent practice model. Alberta Health is currently consulting with key stakeholders on a draft NP Compensation Model to address the challenges of the program. Amendments to the Pharmacy and Drug Act and the Pharmacy and Drug Regulation came into effect June 1, 2022. These amendments allow the Alberta College of Pharmacy and pharmacies to better respond to changes in the provision of pharmacy services to Albertans and reduce significant government red tape faced by pharmacy operators. To address the current challenges in continuing care legislation and help to initiate transformative change within continuing care, Alberta Health worked with partners to develop a new legislative framework for the continuing care system to increase clarity regarding services, address gaps and inconsistencies across settings, enable improved service delivery for Albertans, and support health system accountability and sustainability. On May 31, 2022, the Continuing Care Act (Act) received Royal Assent. The Act will come into force on April 1, 2024, after the development and approval of regulations and standards. The ministry is currently working with partners on the development of those regulations and standards. When proclaimed, the Act will regulate the full spectrum of continuing care services and settings in Alberta, including continuing care homes, supportive living accommodations, and home and community care. Consequential amendments to the Act are included in The Red Tape Reduction Statutes Amendment Act, 2023. These amendments ensure alignment of terminology in existing legislation with the Act while maintaining the policies and intent of the current legislation. In May 2022, the Food Regulation under the Public Health Act was amended to eliminate the requirement for food establishments to request an approval from a public health inspector to allow dogs into outdoor eating areas. The amendment reduced red tape for operators and provided them greater flexibility in meeting the needs of their customers. The Food Regulation provides clear requirements to support the change so dogs can stay with their owners on outdoor patios, while maintaining a high degree of food safety. 2.3 Improve measuring, monitoring and reporting of health system performance to drive health care improvements. Measuring performance is the clearest way to show investments in the health care system are leading to better outcomes for Albertans. Alberta Health worked with the Health Quality Council of Alberta (HQCA) to ensure alignment of their plans and priorities with government key priorities and achieve improvements through various initiatives. On July 26, 2022, Alberta Health executed a $23 million operating grant agreement with the HQCA over three years (April 1, 2022 to March 31, 2025) to keep the organization working with patients, families, and partners from across health care and academia to inspire improvement in patient safety, person-centred care, and health service quality. As an example, Alberta Health worked with the HQCA to develop a Primary Care Patient Experience survey to engage Albertans on their experiences within the health care system. Work continued towards transitioning manual surveys to a digital, computer-adaptive testing methodologies format to use digital technology to enable new models of care and reduce manual and paper-based processes. Digital formats for surveys and reports across primary and continuing care increased Albertans’ engagement within the health system and allowed more timely feedback to service providers about care concerns, including patients’ opinions. Alberta Health worked with HQCA to create primary health care panel reports to support planning, quality improvement, health system management for overall purpose of improving primary health care delivery. The panel reports provide family physicians with information on their patients’ continuity, as well as valuable data on screening and vaccination rates, chronic conditions, pharmaceutical use, and emergency and hospital visits. Alberta Health worked with AHS and the HQCA to develop a value-based assessment tool for objectively assessing value from the Government of Alberta annual investment into health outcomes of Albertans and benchmark against other jurisdictions, particularly the comparator provinces of British Columbia, Ontario and Quebec. Alberta Health also worked with the HQCA to complete priority work on identifying emergency medical services key performance indicators. Performance measures were developed and are under ministry review, with a shift in focus to reducing response times measured at the 90th percentile, rather than the 50th percentile. Releasing the results and performance information improves quality and patient safety and assures Albertans of the government’s commitment to increase accountability and transparency in Alberta’s health care system. The adoption of best practices and monitoring of performance measures help to improve health outcomes. Work continued with the HQCA on developing the Patient Experience Awards and Quality Exchange to support excellence in care and sharing of best practices. This included continuing to develop resources and information to support and inform program planning, panel management, quality improvement and policy development in primary health care, as well as patient experience information for designated supportive living and continuing care. Information is published for Albertans in FOCUS, a dynamic online reporting tool which collects information about what patients experience in the provincial health care system, including: emergency departments, primary health care, long-term care, designated supportive living and home care. Outcome Three: The health and well-being of all Albertans is protected, supported and improved, and health inequities among population groups are reduced Key Objectives 3.1 Ensure a continued, effective response to the COVID‐19 pandemic by optimizing access to treatments and vaccine, and reducing vaccine hesitancy. The Government of Alberta remains committed to supporting Albertans as we shift to managing COVID-19 similar to how other endemic respiratory viruses are managed. Alberta’s capacity to treat and clinically manage cases of COVID-19 continues to improve. Immunization, including receiving a booster dose of COVID-19 vaccine, is one of the best choices Albertans can make to protect themselves from severe illness due to COVID-19 infection. In 2022-23, $1.2 billion was spent on COVID-19 response to ensure the health care system had the resources required to address health care pressures resulting from the pandemic. By the end of June 2022, all mandatory public health measures related to COVID-19 were lifted. This was due to increased immunization coverage, attenuation of severity of new circulating variants, and the ability to treat and clinically manage cases of COVID-19. This signaled the beginning of a shift in Alberta’s handling of COVID-19 from an emergency pandemic response to an endemic state. Government supported this transition by working across multiple facets of health care (e.g., primary care, continuing care, workplace health and safety, public health, provincial laboratory, etc.) to align public health recommendations, such as testing and isolation, across all common respiratory viral illnesses. The ministry continued to monitor the impacts and transmission of COVID-19 and other respiratory viruses in the community by working with partners on the implementation of ongoing and new COVID-19 immunization programs, including the introduction of bivalent booster vaccines, and implementing treatment protocols for COVID-19. Alberta Health and the Health Quality Council of Alberta established a COVID-19 Data Task Force, comprised of health professionals, to conduct a data review of the last several years of health information with a view to offering recommendations to the Government of Alberta on how to better manage a future pandemic. The purpose of the review is an opportunity to reflect on Alberta’s pandemic response from a data quality and validity lens to identify opportunities for improvements to manage future pandemics. To minimize the impact of COVID-19 and protect public health, COVID-19 Rapid Antigen Tests were made available across the province to all Albertans free of charge through participating community pharmacies. Initially, supply was limited and this distribution model enabled an equitable distribution of tests across the province. Between March 2021 to March 31, 2023, Alberta distributed 48.5 million rapid antigen tests to acute and continuing care sites, primary care clinics, businesses, K-12 schools, municipalities, First Nations and Métis communities, and the general public. Government developed COVID-19 vaccine strategies to help reduce the spread, minimize severe outcomes and protect vulnerable Albertans. Work continued to support the review of ongoing evidence and recommendations for immunization against COVID-19, including guidance for immunization post-infection (or hybrid immunity), as well as for fall/spring booster programs. In 2022, Alberta continuously achieved key milestones on COVID-19 vaccine administration and roll out for different age groups and populations. In April 2022, 40 per cent of Albertans 12 and older had received their third vaccine dose. In June 2022, 35 per cent of Albertans aged five to 11 had received two doses of COVID-19 vaccine. On November 14, 2022, the Pfizer vaccine was made available for individuals six months to four years of age, and on March 20, 2023, a second bivalent vaccine (spring booster) was made available for residents living in senior congregate living settings. In 2022-23, 1.4 million COVID-19 vaccine doses were administered to Albertans and 26 per cent of the population 12 years of age and older had received a booster dose. While the federal government continued to cover the costs of the vaccines, Alberta Health spent $53 million in 2022-23 to distribute the vaccines to Albertans. The Alberta Vaccine Booking System (AVBS), launched in summer of 2021, continues to provide Albertans with access to book both COVID-19 and influenza vaccine appointments at participating Alberta Health Services (AHS) or pharmacy locations by providing a centralized, province-wide online appointment booking platform. The centralization of all vaccine booking appointments, including from AHS, Public Health, and Community Pharmacy helps Alberta Health forecast vaccine demand and strategically distribute vaccine supply. Vaccine eligibility criteria and system functionality continue to be updated based on direction from provincial immunization programs. In 2022-23, more than 575,000 appointments for COVID-19 and influenza immunization were scheduled using the AVBS. Updates continue to be released to support dynamic vaccine eligibility changes and to continually improve the user experience. Previously, Albertans had to call multiple pharmacies and Health Link in an attempt to find available vaccine supply. The Health Link 811 call centre continues to support Albertans who do not or cannot use the AVBS. To ensure a continued response to COVID-19, Alberta Health together with AHS extended the provision of free personal protective equipment (PPE) to primary care physicians, pediatricians, and their staff to support their operations and enhance safety to May 31, 2022. In 2022-23, inventory consumption expense associated with the COVID-19 response was $365 million; this includes PPE, testing supplies and $88.6 million for rapid test kits. In addition, the government worked with continuing care partners to protect residents of congregate care facilities and home care clients. A total of $286 million was provided in 2022-23 for additional staffing costs and cleaning supplies, PPE and screening of visitors to protect the health and safety of residents. In 2022-23, AHS, in collaboration with the Zone PCN Committees, worked towards the administration of an oral antiviral COVID-19 treatment in respective AHS geographical zones, enhancing capacity for testing and swabbing for respiratory illnesses. In 2021-22, intravenous Sotrovimab was made available on an outpatient basis to Albertans at higher risk of severe illness or death, followed by availability of Paxlovid, the first COVID-19 treatment approved by Health Canada that can be taken orally at home. Efforts were made to recruit sentinels (primary care physicians/nurse volunteers) to increase the effectiveness of the TARRANT Viral Watch Program, which monitors respiratory infections circulating in the community. 3.2 Safeguard Albertans from communicable diseases that can cause severe illness, permanent disability, or death. The ministry works to protect Albertans from a number of communicable diseases, such as influenza, measles, and sexually transmitted and blood borne infections. Over the past year, immunization programs for vaccine-preventable diseases continued to be a primary strategy in preventing disease, disease transmission and severe health outcomes. They are key to the health of a population and to decreasing the strain on the acute care system. Through promoting initiatives that aim to increase childhood and adult immunization rates, Alberta continued to offer immunizations programs, including influenza vaccine, to Albertans six months of age and older, free of charge in collaboration with many partners. Alberta’s 2022-23 influenza season started earlier with a surge of influenza A cases in early October. The highest positivity for influenza A was 31.9 per cent in the week of November 20, 2022, and cases and outbreaks decreased significantly by the end of December 2022. Alberta had sufficient supply of influenza vaccines to immunize 38 per cent of the population. Alberta Health worked with AHS to ensure respiratory outbreak definitions and management guidelines were in place for high-risk settings, including continuing care and acute care facilities, to minimize severe health outcomes and protect the most vulnerable Albertans in these settings. Despite the challenges of fatigued providers and a generally vaccine fatigued population, the overall influenza immunization rate is one per cent higher than in 2021-22. As of March 31, 2023, approximately 28 per cent of Albertans received an influenza vaccine. Budget 2022 included an increase of $14.3 million related to the approval of the high-dose influenza vaccine for Albertans 65 years of age or older. As of March 31, 2023, approximately 64 per cent of Albertans 65 years of age and older, and 75 per cent of Albertans 90 years of age and older received a high-dose influenza vaccine. The Alberta Outreach Program started the week of October 3, 2022, to immunize those at highest risk of severe outcomes from influenza. The 2022-23 Influenza Immunization Program for the general public began on October 17, 2022, and ended on March 31, 2023. Influenza vaccine was available at over 2,500 immunizing sites, including AHS clinics, Indigenous Services Canada clinics, community pharmacies, community medical clinics, and post-secondary institutions. Immunization programs save millions of dollars, helping people of all ages live longer, healthier lives, and decreasing the burden on the health care system. The pandemic did result in some disruptions to the routine school immunization program and overall infant and preschool immunization rates have decreased. However, AHS has hired additional staff to support addressing the school immunization backlog and in-school catch-up programs, and immunization rates for school-aged children are nearing pre-pandemic coverage levels. In 2022, by age two, 71 per cent of Albertans had received immunization with diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (DTaP-IPV-Hib) vaccine and 82 per cent had received immunization with measles, mumps, rubella (MMR) vaccine. These immunization rates are both lower than the national target of 95 per cent for these vaccines. As a result of the COVID-19 response, childhood immunization rates dropped between 2021 and 2022. AHS has a catch-up program to increase childhood immunization rates to help reach the national target of 95 per cent. This includes actions such as reminder calls for booked appointments, monitoring wait times and adding appointments as needed, and following up using a recall process for children with delayed immunizations. Work is underway with service providers to enhance testing, treatment and prevention strategies, including working with community-based organizations, to improve women’s health, reduce barriers to sexually transmitted and blood borne infections (STBBI) testing and treatment, and increase access to prenatal syphilis screening. Over $8 million annually is provided to organizations to prevent STBBIs and provide wrap-around supports for people living with those infections, including $1.2 million specifically for syphilis outbreak response. In September 2022, Alberta experienced a shigella outbreak in Edmonton, which ended in February 2023 after two weeks without new cases. However, the outbreak was re-opened in March 2023, when seven additional cases were reported and some patients hospitalized. As of March 31, 2023, 214 cases were reported since the outbreak initially started; no deaths were reported. In October 2022, the Shigella Task Force brought together cross-sector partners, including representatives from Alberta Health, AHS, shelters, inner-city agencies, the City of Edmonton, local family physicians, and Alberta Precision Labs to coordinate resources and discuss options for limiting spread. Syphilis has made a drastic resurgence in Alberta since 2019, with rates being the highest in more than 70 years. Alberta Health has resumed a leadership role in the provincial syphilis response, after an interruption due to COVID-19, through work with frontline service providers to support testing, treatment, and prevention strategies. By increasing access to syphilis testing and treatment services in a variety of novel health settings, the Government of Alberta will help create awareness and normalize sexually transmitted infections testing and treatment for all Albertans. The ministry is also leading and supporting a number of provincial outbreak responses and preparedness activities including: • leading the human health response to highly pathogenic avian influenza, including supporting the update of public health disease management guidelines and communication pieces for government websites; • supporting the coordinated provincial response to the international mpox (formally known as monkey pox) outbreak, including guidelines for contact management and guidance on pre and post-exposure vaccine use; and, • working with AHS public health in preparation for response to international communicable disease outbreaks, including Ebola and Polio. In early May 2022, cases of mpox began to occur in countries where mpox was not previously detected. Canada’s first case was reported on May 19, 2022, and Alberta reported its first case on June 2, 2022. By July 2022, mpox was declared a public health emergency of international concern by the World Health Organization. Alberta Health worked in collaboration with public health partners to develop testing criteria, case definitions and public health management guidelines. The Alberta Mpox Public Health Notifiable Disease Guideline was published in June 2022. Alberta began offering post-exposure vaccine on June 7, 2022, and the targeted pre-exposure vaccine campaign began at the end of June. As of March 31, 2023, Alberta recorded 45 cases of mpox. Alberta has administered 2,183 first doses and 1,715 second doses of the vaccine. 3.3 Expand access to a range of in‐person and virtual recovery‐oriented addiction and mental health services. Reporting responsibility for this objective has transferred to the Ministry of Mental Health and Addiction. Performance Measure 3.a Percentage of mental health and addiction‐related emergency department visits with no mental health service in previous two years Reporting responsibility for this performance measure has transferred to the Ministry of Mental Health and Addiction. 3.4 Prevent injuries and chronic diseases and conditions through health and wellness promotion, and environmental and individual initiatives. In 2022-23, $646 million was expensed to support population and public health initiatives to maintain and improve the health of Albertans through services promoting and protecting health and preventing injury and disease. Government provides leadership and support to protect the health and safety of Albertans and improve their health and well-being by setting public policy in a number of areas, such as maternal, infant and early child development; injury prevention; public health matters related to cannabis use; tobacco and vaping control; and, promotion of population wellness and health equity. Government recognizes that Albertans living with diabetes want to access health programs and services that will more effectively support their needs. On July 21, 2022, the Minister announced the establishment of the Diabetes Working Group (DWG) to review Alberta’s entire diabetes care pathway, identify gaps in care, and provide recommendations to improve diabetes prevention, diagnosis, treatment, and management. In addition, Alberta Health expanded the Insulin Pump Therapy Program to include newer pumps and supplies. Albertans enrolled in the pump program now have access to the newest technologies for management of diabetes. Improved access to the newer diabetes management technologies, and the work of the DWG will improve outcomes and quality of life for Albertans living with diabetes. Nearly $7 million was provided to AHS for cancer prevention initiatives supporting comprehensive projects that are reducing the risk of cancer across the province. These projects address healthy lifestyles, smoking cessation, workplace wellness, and partnerships with Indigenous communities. In 2022-23, the Cancer Prevention Screening and Innovation initiative worked with organizations such as Promoting Health, Chronic Disease Prevention and Oral Health, AHS Provincial Population and Public Health, the Alberta First Nations Information Governance Centre, the Métis Nation of Alberta, and the new AHS Indigenous Wellness Core to: • adopt the Alberta Healthy Communities Approach to focus on scaling and spreading successful interventions provincewide; • create a working partnership with the Human Papilloma Virus community innovation for sub-populations and the Provincial Population and Public Health Screening Programs and Communicable Disease Control divisions; • improve the Healthier Together Workplace program and recognition strategy; and, • strengthen work with Indigenous communities to facilitate community action to reduce modifiable factors, raise cancer awareness and improve cancer screening. A community support model was created, and tools were adapted to support the three initial Metis Settlements to create, implement and evaluate cancer prevention action plans. Alberta Health currently funds several health promotion-based initiatives to improve individual and community health and well-being: • Alberta Health continues to support the Injury Prevention Centre to provide unintentional injury prevention programs, research, and education. Through the Injury Prevention Centre, Albertans have access to programs and education that reduce the risk of injury and make communities safer. Injury prevention is a public health priority that directly reduces costs to the health care system. Injury bears an estimated financial cost of $7.1 billion annually in Alberta, $4.6 billion of which is direct health care costs. • Physician prescription to Get Active supports individuals to become more active through physical activity. Prescriptions can be filled at participating recreation facilities for free visits, free one month facility passes and/or free fitness classes. • The Communities ChooseWell program advances healthy eating and active living by supporting communities to create local conditions and environments that enable Albertans to eat well and be active. The program provides resources, education and support to community groups as well as offering small grants for implementing local healthy eating and active living initiatives. Alberta Health provides approximately $2 million in grants annually to five programs that support vulnerable mothers and their babies. From April 2022 to September 2022, programs provided intensive supports to 287 vulnerable women who were pregnant or of child-bearing age, and more vulnerable women were provided outreach supports to address gaps in support specific to the COVID-19 pandemic. Alberta Health and AHS also provided funding to support the University of Alberta’s ENRICH Maskwacîs Kokums and Mosoms Elders Mentoring Program, which creates enhanced support networks for parents-to-be. In addition, elder support helps address a gap in service within the prenatal clinical setting by connecting parents to traditional knowledge and culture. Budget 2021 provided a total of $6.75 million over three years, including $2.25 million in Budget 2022, to establish and operate the AHS Tobacco and Vaping Reduction Act Enforcement Team. As of March 31, 2023, over $2.4 million has been spent, and the team has conducted retail inspections, established a secret shopper program and a public complaint line, and created retailer resources (handbook and signage) that will improve compliance with the Act and regulation. The most current data (from the 2021-22 fiscal year) shows the enforcement team conducted 2,400 retail inspections and provided over 4,000 copies of the retailer handbook and signs to retailers. In 2022-23, Alberta Health established the Alberta Ukrainian Evacuees Health Benefit Program. The total cost of the program was $9.5 million, including physician services. As of March 31, 2023, 24,000 Ukrainians have applied for health coverage in Alberta. In addition, the ministry established a health benefit program that provided Ukrainian evacuees with access to supplemental coverage for prescription and non-prescription drugs, nutritional products, diabetic supplies, and dental, optical and emergency ambulance services. Work continues in partnership with the ministries of Agriculture and Irrigation and Environment and Protected Areas on a One Health approach to antimicrobial resistance (AMR) in the province. This work is critical to address the emerging threat of treatment-resistant microbes in human and animal populations and in the environment. An Antimicrobial Strategic Framework for Action and Implementation plan continues to be developed to help guide collective efforts to address the growing threat of AMR in Alberta. Stakeholders and partners were consulted and supported development of the framework. In 2022-23, the Office of One Health at the University of Calgary was contracted at a cost of $200,000 to support implementation of AMR priority areas for action. As part of the contract, an advisory group on stewardship was created to provide guidance on specific activities, measures, targets, and costs for implementation. Alberta Health worked with AHS, Alberta Environment and Protected Areas, and the Alberta Lake Management Society to quickly set up a water quality (fecal contamination and cyanobacterial blooms) monitoring program for four sites on Lac Ste. Anne to support the 2022 papal visit and annual Lac Ste. Anne pilgrimage. Data from this monitoring program provided the basis for issuance of a cyanobacterial bloom public health advisory for Lac Ste. Anne shortly before the event. Alberta Health regularly assesses the evidence on water fluoridation to help support municipal councils to make evidence-informed decisions regarding community water fluoridation. The ministry worked on updating community water fluoridation position statement with new relevant research, including new local data from Calgary. Alberta Health continues to provide transparent information about environmental public health data, while simultaneously providing risk communication materials to influence modifiable risk factors within the Alberta population. Examples of public health data and information available through the Open Government Portal include: • Routine chemistry and trace element data from domestic well water samples analyzed in 2016–17 and 2017–18 are available. Alberta Health funded routine chemistry and trace elements analysis of 4,842 samples of drinking water from private water wells and 307 samples from small, public, non-municipal drinking water systems. As well, data related to the study of two stormwater ponds in Lacombe, Alberta were released to the open government portal at https://open.alberta.ca/opendata/lacombe-stormwater-ponddataset. This data includes the analysis of contaminants (e.g., mercury, polycyclic aromatic hydrocarbons, trace metals, pesticides and volatile organic compounds) in fish, sediments, and water. • The Alberta Environmental Public Health Information Network, accessible at http://aephin.alberta.ca, supports awareness and provides opportunities for Albertans, academics, and cross-government partners to learn more about environmental hazards and public health in the province. In 2022-23, new visualizations were published for “Human Biomonitoring of Environmental Chemicals in Canada and the Prairies” and a “Search Interface for Environmental Site Assessment Repository”, along with enhancements including the incorporation of new, yearly data on the recreational water bodies and the impacts of poor air quality and heat. In addition, Alberta Health developed the Extreme Heat website and notification protocol at https://www.alberta.ca/extreme-heat.aspx. • Alberta Health continued to provide real-time information to Albertans about hazards and risks associated with recreational water quality at Alberta beaches and waterbodies. In 2022, over 2,300 samples were collected from 85 recreational sites to identify fecal contamination and 436 samples were collected from 50 lakes, reservoirs, and rivers to be assessed for cyanobacterial (blue green algal) blooms and microcystin toxin. This monitoring resulted in the issuing of 47 cyanobacterial bloom advisories and nine fecal contamination advisories to protect the health of Albertans and visitors to the province. Additionally, in May 2022, Alberta Health updated the Alberta Safe Beach Protocol available at https://open.alberta.ca/publications/9781460145395 to reflect new Health Canada Guidelines for cyanobacterial blooms in recreational water. In February 2023, Alberta Health released a position statement around use of stormwater ponds at https://open.alberta.ca/publications/stormwater-ponds-in-alberta-health-guidanceinformation-sheet. • Alberta Health, as part of the Scientific Working Group on Contaminated Sites in Alberta, has published a Site-Specific Risk Assessment guidance document to clarify the specific requirements of conducting a site-specific risk assessment in Alberta, available at: https://open.alberta.ca/publications/supplemental-guidance-on-site-specific-riskassessments-in-alberta. Alberta Health and the Alberta Centre for Toxicology at the University of Calgary have published the report and dataset of “Post-Horse River Wildfire Surface Water Quality Monitoring Using the Water Cytotoxicity Test” available at https://prism.ucalgary.ca/handle/1880/115412. 3.5 Improve access for underserved populations and for First Nations, Métis, and Inuit peoples to quality health services that support improved health outcomes. The most current result available from Statistics Canada’s Canadian Community Health Survey shows that in 2021, 87.3 per cent of Albertans had access to a regular health provider, an improvement from 85.3 per cent in 2020. Having a regular health care provider is important for early screening, prevention through health and wellness advice, diagnosis, and treatment of a health issue, as well as ensuring good continuity of care and connections to other health and social services. The desired result is to increase the percentage of Albertans who have access to a regular health care provider. Increasing access to a regular health care provider is consistent with progress towards the following provincial primary health care goals: • timely access to appropriate primary care services delivered by a regular health care provider or team; • coordinated, seamless delivery of primary care services through a patient’s ‘medical home’ and integration of primary care with other levels of the health care system; • efficient delivery of high-quality, evidence-informed primary care services; and, • involvement of Albertans as active partners in their own health and wellness. Alberta’s Primary Care Networks are involved in a variety of initiatives that support provincial and health zone primary care goals, including adopting a ‘medical home’ approach in their practices. This approach strengthens the connection between a patient and regular health care provider to improve access to care, chronic disease prevention and management, continuity of care, and innovations in primary health care including telemedicine and virtual care. The Government of Alberta is committed to addressing the health needs of First Nations, Métis and Inuit peoples residing in Alberta, including working with First Nations and Métis leaders, the Government of Canada and other partners to streamline how Indigenous peoples access health services, and ensuring that health services are more culturally appropriate. There is a significant gap in equitable access to primary health care for Indigenous peoples. This is evidenced by noting that in Alberta, Indigenous peoples’ life expectancy is 16.4 years below that of all other Albertans, falling below 64 years of age. An Indigenous Primary Health Care Advisory Panel was established in the fall of 2022 under MAPS to provide advice to the Minister on how the existing primary health care system could be improved to ensure First Nation, Métis, and Inuit peoples have access to high-quality, culturally safe primary health care no matter where they live. As part of their work, the Indigenous Panel convened an Indigenous Youth Innovation Forum, Indigenous Primary Health Care Innovation Forum, and participated in the MAPS Forum and Community Care Innovation Forum. These forums, along with engagements with First Nations, the Metis Settlements General Council, the Métis Nation of Alberta, and others ensured that a broad range of perspectives informed the Indigenous Panel’s work. As part of their deliberations, the Indigenous Panel submitted recommendations to the Minister in December 2022 for early opportunities for investment in enhancing Indigenous primary health care. These recommendations were approved in principle by the Minister as a first step to improving access to more culturally safe and integrated care. In 2022-23, Alberta Health provided $8.8 million to the Indigenous Wellness Program Alternative Relationship Plan to support 24 full-time equivalent physician positions to provide care in over 20 Indigenous health care centres throughout Alberta, including the Alberta Indigenous Virtual Care Clinic. Alberta Health has a separate Alternative Relationship Plan arrangement with Siksika Nation, and provides up to $1.1 million to support three full-time equivalent physician positions to provide care in the community. Alberta Health continues to engage Indigenous health care experts through the First Nations Health Advisory Panel and a Metis Settlements Health Advisory Panel. Panel members include Health Directors from across the province, as well as other associated stakeholders. The Panels inform health priorities and strategies and assist in identifying issues or gaps in programs and services, as well as working to identify potential solutions and areas of future collaboration. Alberta Health also continued work on Alberta’s Protocol Agreement Health Sub-Tables to collaborate on addressing the health gaps identified by the members of the Blackfoot Confederacy and the Stoney Nakoda Tsuut’ina Tribal Council. Alberta Health similarly worked with the Métis Nation of Alberta under their Framework Agreement with the Government of Alberta. Alberta upholds the Jordan’s Principle commitments by working with the Government of Canada and the First Nations Health Consortium, an Alberta-wide organization developed to improve access to health, social, and education services and supports to First Nations and Inuit children throughout the province, living both on and off reserve. To ensure compliance, Alberta Health established an Executive Leadership Group (including the ministries of Children’s Services, Seniors, Community and Social Services, Alberta Education, Indigenous Relations, and Alberta Health) to implement Jordan’s Principle in Alberta and to ensure that First Nations children have access to health, social, and educational resources when required, without denial or delay related to jurisdictional dispute over payment. Alberta Health has also established a Technical Cross-Jurisdictional Working Group to address barriers impacting access to programs and services. The working group includes the First Nations Health Consortium, the First Nations Inuit Health Branch, and the Ministries of Children Services, Seniors, Community and Social Services, Education, and Indigenous Relations. On October 24, 2022, government appointed a Parliamentary Secretary for Rural Health, to work with Alberta Health to address rural health challenges, such as access and health care professionals. Budget 2022 introduced a new Rural Capacity Investment Fund, as part of the provincial agreement that impacted more than 30,000 registered nurses and registered psychiatric nurses across the province. The fund supports recruitment and retention strategies in rural and remote areas of the province, including relocation assistance. Almost $4.4 million was spent in 2022-23 to assist nearly 200 employees who chose to relocate to rural Alberta and pay out retention payments to over 8,200 rural health professionals. The benefit to rural Albertans will be realized by improved staff retention rates and fewer vacancies. The Government of Alberta recognizes the importance of rural health facilities and that these health centres provide an essential role for local residents. AHS and Alberta Health have established Zone Health Care Plans based on a framework that guides the development of comprehensive, zone-wide strategic health service plans, including services for Indigenous peoples. These long-range plans address the needs of rural communities with a continued focus on appropriate quality of care, patient safety, and access to services. Conditional approval was provided to seven proponents under the Continuing Care Capital Program–Indigenous Stream in June 2022. The Modernization Stream was launched in September 2022. In 2022-23, the Government of Alberta provided approximately $7 million to the Rural Health Professions Action Plan to attract and retain rural physicians with the appropriate skills to meet the needs of rural Albertans. The program supported physician locums to maintain services when rural physicians need time away from their practice; offered continuing medical education; provided accommodations for 785 rural learners for rural placements so that they can train and choose to practice in rural communities; and, created welcoming environments though 50 attraction and retention committees so that rural communities can attract and retain health professionals. In 2022, the Government of Alberta announced the Rural Education Supplement and Integrated Doctor Experience (RESIDE) program, which allocated $8 million over three years to provide incentives to new family physicians who agree to practice in rural and remote communities in exchange for a multi-year service agreement. The program will help address challenges in patient access to health services in rural and remote areas. Since the start of the program, Alberta Health has approved several changes to the RESIDE program to better meet the needs of physicians and communities and help ensure the program successfully incentivizes more physicians to move to communities of need. As of March 31, 2023, seven physicians had signed return of service agreements in rural communities. The Provincial Primary Care Network Committee provided the Minister with a recommendations report on supporting recruitment and retention of primary care physicians, nurse practitioners, and physician assistants in rural communities. In May 2022, the Minister accepted the seven recommendations that address broader systemic aspects of rural health service challenges, and this report will inform further work within Alberta Health. In July 2022, government announced new funding of $45 million over three years to increase access to pediatric rehabilitation services and programs such as speech-language, as well as occupational and physical therapy for children and youth. A community pediatric services model was developed by AHS to address gaps with implementation of enhanced pediatric rehabilitation supports, including universal and targeted resources and programs and expanded eligibility for specified services. Service delivery is enhanced with clear intake, access and triage to services and strengthened teams to support care. Pediatric rehabilitation professionals work with families and alongside other health care professionals to help children and youth live well, build resiliency and take part in activities meaningful to them and their families. A multi-pronged workforce recruitment, retention, and optimization approach is enabling implementation despite the ongoing challenges with recruitment of health professionals across programs and jurisdictions. Alberta Health Services Provincial Rural Palliative Care In-Home Funding Program provides special, funding that can be accessed by rural palliative clients and families when they require additional support beyond existing services at end-of-life to remain at home instead of being admitted to hospital. Between April 1, 2022 and March 31, 2023, a total of 143 clients were served by the program. Of the clients who have died while accessing the program, 80 per cent were able to pass away in the comfort of their own home.	You must respond to the prompt using only the information provided in the context block.Here is the question you are to answer: How does the Government of Alberta's Ministry of Health plan to meet the three outcomes identified in their 2022-2023 Annual Health Report? Outcome One: An effective, accessible and coordinated health care system built around the needs of individuals, families, caregivers and communities, and supported by competent, accountable health professionals and secure digital information systems Key Objectives 1.1 Increase health system capacity and reduce wait times, particularly for publicly funded surgical procedures and diagnostic MRI and CT scans, emergency medical services, and intensive care units. As the province emerges from the pandemic, Alberta Health continues to prioritize health system capacity, including building surgical and Intensive Care Unit (ICU) capacity, as well as the health workforce. Several initiatives are underway to minimize disruptions to patient care and expand the capacity of Alberta’s publicly funded health care system permanently. This also includes preparing to respond more effectively to any future health crises and reducing wait times across the health care system. A resilient, sustainable health system will allow the system to operate at full capacity for longer periods before needing to adjust health care resources. The policy has overall goals of improving access to scheduled health services, improving wait time measurement and reporting, and ensuring timely communication for patients. In November 2022, Alberta released the Health Care Action Plan (HCAP). The HCAP identifies immediate government actions to build a better health care system for Albertans. In order to meet the growing demands of Alberta’s health care system, an Official Administrator was appointed to Alberta Health Services (AHS) to provide leadership to address the four goals of the HCAP: • decrease emergency department wait times; • improve emergency medical services response times; • reduce wait times for surgeries; and, • empower frontline workers to deliver health care. Since 2019, government has been committed to increasing surgical capacity to keep pace with demand and reduce the length of time Albertans are waiting for scheduled surgeries. Efforts are geared towards improving patient navigation of the health care system through enhanced care coordination and surgical pathways and resources; improving specialist advice and collaboration with family physicians before consultation; and, centralizing referrals for distribution to the most appropriate surgeon with a shorter wait list. Through the Alberta Surgical Initiative (ASI), Alberta Health continues to work with AHS to improve and standardize the entire surgical journey through: • prioritizing surgeries and allocating operating room time according to the greatest need; • streamlining referrals from primary care to specialists; • increasing surgeries at underutilized operating rooms, mainly in rural areas; and, • providing less complex surgeries through accredited chartered surgical facilities (CSFs) to provide publicly funded insured services and extend existing capacity in hospitals. Through these dedicated efforts, the total number of surgeries completed in 2022-23 was 292,500, which is over 13,900 more surgeries than the year before. Further, approximately 22,100 cancer surgeries were completed in 2022-23, which represents a 10 per cent increase compared to the pre-pandemic amount. Nearly 65 per cent of the cancer surgeries were completed within clinically recommended wait times. By the end of 2022-23, AHS had cleared all postponed surgeries due to COVID-19, and continues to work on reducing wait times. The main focus remains on those patients that are waiting the longest out of clinically recommended targets, and the most acute cases. As of March 31, 2023, AHS reduced the adult surgical waitlist by more than 7,000 patients, and the total number of cases on the adult surgical waitlist is 67,186 which is less than before the pandemic. In 2022-23, there were 38 existing CSFs and three new CSF contracts were implemented to expand publicly funded surgical capacity in these facilities. CSFs are an extension of existing capacity in hospitals and used in many other Canadian health systems. Under the Health Facilities Act, CSFs providing publicly funded insured services must be accredited by the College of Physicians and Surgeons of Alberta, and have a signed service contract with AHS. In 2022-23, accredited CSFs in Alberta provided approximately 47,400 surgeries, which is equivalent to 16.2 per cent of publicly funded scheduled surgeries. In Alberta and other provinces, wait times for three common surgical procedures (hip replacement, knee replacement and cataract surgeries) continue to be impacted by delays due to the COVID-19 pandemic and workforce shortages. The 2022-23 results for hip, knee and cataract surgical procedures showed a decline, meaning that fewer Albertans received these surgical procedures within national benchmark wait times when compared to 2021-22 results. The chart below shows quarterly trends for the three common surgical procedures completed within national benchmarks in 2022-23. There were improvements in the number of cases completed for hip and knee replacements over the course of 2022-23, showing increases of 13 per cent and 15 per cent (respectively), and demonstrating significant improvements with the appointment of the Official Administrator and the implementation of the HCAP in November 2022. While the quarterly results for cataract surgery declined in the second quarter, the number has stabilized in the third quarter since the implementation of HCAP and is beginning an upward trend in the fourth quarter, although it is slightly below the first quarter result. Since 2019-20, there has been a 20 per cent improvement in cases completed within national benchmarks for cataract surgeries, ranking Alberta as a top performer nationally. As part of ASI, Alberta Health has worked with AHS to implement additional measures aimed at improving access and wait times for surgery. Work is ongoing to increase the use of Rapid Access Clinics to reduce wait times for the assessment of orthopedic issues, reducing unnecessary consultations and decreasing wait times for consultations. The Facilitated Access to Specialized Treatment (FAST) program accelerates implementation of central intake for orthopedic and urology surgery to allow patients to see the first available surgeon. Work has begun on the implementation of the Electronic Referral System (ERS), which will expedite referrals for Albertans requiring assessment by surgical specialists. In addition, consultants have been contracted to enhance surgical capacity by improving inpatient surgeries scheduling, monitoring operating room capacity, and reducing patient flow variation. With the added capacity of additional CSFs offering surgeries and implementation of FAST and ERS, Albertans will experience a streamlined surgical journey from referral to consultation to surgery. More Albertans will get their surgery within the clinically recommended wait time targets, thereby reducing the amount of time they must live with pain and other inconveniences. Reducing wait times for medically necessary diagnostic tests is also a top priority for government. Each year, Alberta spends about $1 billion on diagnostic imaging, which includes ultrasounds, Xrays, mammography, MRI and CT scans. About 46 per cent of the $1 billion is allocated to AHS, while 54 per cent is allocated to community diagnostic imaging providers. Approximately one-third of all CT and MRI scans are emergency scans and are completed within clinically appropriate timelines (under 24 hours). In 2022-23, a total of 520,504 CT scans and 231,030 MRI scans were completed across the province. The wait time for both types of scans increased due to a sharp increase in demand and staffing issues. Alberta Health and AHS continue to implement the Diagnostic Imaging Action Plan developed in 2019 to facilitate timely access to CT and MRI scans. As part of the plan, there is a significant focus on triaging patients to ensure that those who need urgent scans can get one as soon as possible. In addition, the Clinical Decision Support (CDS) within Connect Care aims to improve appropriateness of referrals and triage decisions. AHS has reached a five-year agreement with radiologist groups in Edmonton and Calgary to reduce wait times, and signed a memorandum of understanding with the remaining three largest radiology providers in Alberta North, Central, and South Zones. In total, 83 per cent of provincial radiologists have signed agreements with AHS. As part of the HCAP, the Government of Alberta is working with AHS to improve emergency medical services (EMS) response times. Improved ambulance times means that Albertans are receiving the urgent care they need from highly skilled paramedics more quickly. The Alberta Emergency Medical Services Provincial Advisory Committee (AEPAC) was established and tasked with providing immediate and long-term recommendations that will better support staff and ensure a strengthened and sustainable EMS system for Albertans needing services now and into the future. AEPAC focused on the issues facing EMS, such as system pressures that may cause service gaps, staffing issues, and hours of work. This included issues related to ground ambulance, air ambulance, and dispatch. Furthermore, Alberta conducted an independent review of EMS dispatch (the Dispatch Review) to inform improvements that can be made to dispatch services overall. The Dispatch Review and full report from AEPAC were submitted to the Minister of Health in the fall of 2022 and released to the public in January 2023. The Government of Alberta accepted the final AEPAC report and Dispatch Review recommendations in full. The recommendations were focused on accountability, capacity, efficiencies, operations, performance, and workforce support. Adjustments are being made to improve EMS response times and get paramedics out of hospital waiting rooms and back into their communities. Implementation of recommendations on a priority basis has supported ongoing reduction in EMS response times and red alerts, and improvements in community coverage. In 2022-23, Alberta Health initiated several actions to address these recommendations and strengthen the EMS system across the province. Examples of projects include: • Implemented measures to improve the central dispatch system to better deal with lowacuity calls and prioritize emergent/urgent 911 calls for EMS and made workforcescheduling changes as part of the Fatigue Management Strategy. • Initiated pilot projects using an integrated Fire-EMS model to maximize the use of paramedics and increase ambulance capacity to the health care system. Examples of the projects included: using inbound EMS resources only when they are clinically required; staffing spare ambulances to support the EMS system during times of stress; and, expanding single member advanced care paramedic response units that provide immediate advanced life support care in anticipation of, or in the absence of, an available ambulance. • Introduced new provincial guidelines, including a 45-minute EMS emergency department (ED) wait time target for 911, to get ambulances back on the road more quickly. The new provincial guidelines enable fast-tracking ambulance transfers at EDs by moving less urgent patients to hospital waiting areas. • Put procedures in place to contract appropriately trained resources for non-emergency transfers between facilities in Calgary and Edmonton, freeing up paramedics. Instead of using highly trained paramedics for non-medical patient transfers to patients’ homes from a facility or acute care, alternative resources are now arranged by hospitals, also freeing up paramedics. • Granted an exemption to the minimum staffing requirements defined in the Ground Ambulance Regulation, significantly expanding the instances where an emergency medical responder can meet the staffing requirements for all classes of ambulance, to alleviate staffing challenges across the province. • Empowered paramedics to assess a patient's condition at the scene to decide if they need ambulance transport to the hospital. In 2022-23, a total of $590 million was spent on EMS. Capacity increases were laid out in the AHS’ EMS 10-Point Plan and recommendations by AEPAC, including increases in paramedic workforce and adding ambulances to the system. As of March 31, 2023, there are 8,417 regulated members in the province registered with the Alberta College of Paramedics, including 1,383 emergency medical responders, 4,050 primary care paramedics, and 2,984 advanced care paramedics. AHS added 19 new ambulances in Calgary and Edmonton and more ambulance coverage in Chestermere and Okotoks, and hired 457 new staff members, including 341 paramedics. Increased capacity helps reduce EMS response times and red alerts and improves working conditions for frontline practitioners and community coverage, especially for life-threatening conditions. Measures to address staffing issues include AHS’ Fatigue Management Strategy, a recruitment campaign aimed at other provinces and Australia, development of a Provincial Service Plan, and interim AEPAC recommendations brought forward in June 2022, granting an exemption to expand use of emergency medical responders and pilot projects to give greater autonomy to ambulance operators using an integrated fire-EMS model. In addition, keeping paramedics out of hospital waiting rooms and in communities has contributed to decreased EMS response times and red alerts, improved community coverage, and quicker access to EMS. The HCAP 90-day Report released in February 2023 (https://www.albertahealthservices.ca/assets/about/aop/ahs-aop-90-report.pdf ) shows an early reduction in response times and red alerts, and greater focus on urgent/emergent 911 calls through low-acuity diversion measures and non-clinical patient transport programs across Alberta, particularly in Calgary and Edmonton. Comparing November 2022 to March 2023, EMS response time for the most urgent calls in metro and urban areas was reduced from 21.8 minutes to 15 minutes. Improving access to EMS enables timely patient care and entry into the health care system. The government also launched the EMS/811 Shared Response program to ensure patients receive the level of care they need and reduce unnecessary ambulance responses. Calls that have been assessed as not experiencing a medical emergency that requires an ambulance are transferred to Health Link 811, where registered nurses provide further triage, assessment and care. Since the launch in January 2023, more than 2000 911-callers with non-urgent conditions were transferred and helped by Health Link 811, keeping more ambulances available for emergency calls. In October 2022, government appointed a Parliamentary Secretary of EMS Reform to work with health partners to set priorities for service improvement based on AEPAC and Dispatch Review report recommendations. Remaining AEPAC and Dispatch Review recommendations have been incorporated into the AHS Operations Plan and are being prioritized and monitored by the EMS Reform Parliamentary Secretary. There are almost two million visits to Alberta EDs every year. Alberta Health together with AHS is working to improve patient flow within the health system, in particular to reduce ED wait times. AHS is committed to improving the experience of patients and families from the time they seek emergency care until the time the patient is discharged or admitted. There are 780 more staff in EDs today than in December 2018. AHS is working diligently on several initiatives to improve access to emergency care including improving access to continuing care living options, expanding hospital capacity, and implementing initiatives in hospitals to streamline patient treatment and discharge. In 2022-23, alternate level of care days were reduced by enhancing social work supports in acute care to address barriers for discharge. This included adding a fast-track area at the Alberta Children’s Hospital in Calgary, and deploying additional units of EMS mobile Integrated Health Units in Calgary and Edmonton to provide care for unscheduled needs within the community (i.e., IV antibiotics, rehydration, and transfusions at home). In January 2023, the Bridge Healing Transitional Accommodation Program was launched in Edmonton to support transitioning of patients experiencing homelessness as they are discharged from emergency departments. The initiative aims to reduce hospital readmission rates for Albertans experiencing homelessness by providing wrap-around health and social services. This program provides 36 beds to support this vulnerable population. Over the next three years, $305 million will be provided for additional health care capacity on a permanent basis under the HCAP. This includes approximately $268.6 million in operating funds and $36.4 million for capital projects to increase ICU capacity on a permanent basis. Approximately $61 million was spent in 2022-23 to create 50 permanent new fully equipped and staffed adult ICU beds across the province, which brings the number of ICU beds up to 223 from 173 before the pandemic. The pandemic has shown that more permanent capacity and staff are needed, particularly in rural and remote areas. The ministry continues to address ICU staffing shortages across health care facilities in Alberta. As vacancies are filled, ICU beds are reopened. Temporary bed closures are implemented only as a last resort, and patients continue to receive safe, high-quality care. AHS filled 392 positions, as of the end of fiscal year 2022-23, to support the new beds. These positions included nurses, allied health professionals, pharmacists, and clinical support service positions for diagnostic imaging and service workers. The latest data available at the end of fiscal year 2022-23 indicated that the provincial ICU baseline occupancy rate was 82 per cent, a 29 per cent improvement from being at over capacity (115 per cent) in 2021-22. Increasing ICU capacity ensures that Albertans receive care when they need it most. However, unplanned temporary service disruptions, including bed reductions, are not unusual in any health system, as services and beds are managed based on patient need, staffing levels, acuity of patient health, and other factors. Government works to ensure patients continue to receive safe, high-quality care. Occasionally, however, temporary bed closures are implemented as a last resort. Government is committed to ensuring that any Albertan who needs acute care will receive it. Workforce challenges remain a significant barrier to improving wait times for surgery given the high demand for anesthesiologists in Canada and international jurisdictions. Alberta Health is reviewing and developing options to support continued implementation of the Anesthesia Care Team Model in AHS and CSFs. The implementation of the Anesthesia Care Team Model aims to use anesthesiologists more resourcefully for some ophthalmology and orthopedic surgeries by employing a multidisciplinary team that works under supervision of the anesthesiologist to support anesthesia services in the operating room. Recruitment efforts are underway through AHS to attract more anesthesiologists to Alberta, including in rural areas. In March 2023, government released MAPS Strategy, which sets out a framework for supporting the province’s current health care workers and building the future workforce that can support Albertans getting the health care they need when and where they need it. Alberta has various initiatives underway to attract and retain nurses and increase system capacity. Alberta Health worked with the College of Registered Nurses of Alberta to streamline registration processes for Internationally Educated Nurses (IEN) and developed a grant agreement with the Alberta Association of Nurses for nurse navigators to support IENs going through the assessment, education, and registration processes. Announced in September 2022, the Modernizing Alberta’s Primary Health Care System (MAPS) initiative formed three panels to provide advice to the Minister on ways to improve the primary health care system, thereby improving the overall efficiency of the health care system. On February 21, 2023, the Minister announced an investment into primary health care of $243 million over three years; of this, $125 million is allocated for MAPS recommendations. In addition, the Minister accepted, in principle, early opportunities for investment that could be implemented to enhance Albertans’ access to primary health care immediately. On March 31, 2023, the MAPS Strategic Advisory Panel and Indigenous Primary Health Care Advisory Panel submitted parallel final reports to the Minister, outlining transformative strategic roadmaps for the next 10 years of primary health care in Alberta. These reports address both Indigenous access to primary health care and advice on improving primary health care for all Albertans. The intent of the MAPS initiative will be to reorient the health system around primary health care, thereby improving patient outcomes and reducing costs and decreasing pressures on the acute care system in the long-term. Partnerships and collaboration between primary care providers and specialists will improve patient wait times and health outcomes. The ASI Care Pathways and Specialty Advice, which includes the Provincial Pathways Unit and provincially aligned non-urgent telephone advice service programs, support consistency and quality to ensure continuity of care across the patient journey. The Provincial Primary Care Network provided these projects with conditional endorsement to begin transition to operational shared service programs. Primary Care Networks (PCNs) are also working with other stakeholders on the ASI to improve primary care and specialist linkages and patient navigation of the health care system by building and leveraging PCN specialist linkage programs. Some initiatives include Strong Partnerships and Transitions of Care for the Central Zone; Patient’s Medical Home, including referral navigators; Specialist LINK Tool for the Calgary Zone; Connect MD for the Edmonton and North Zones; FAST General Surgery for the Edmonton Zone; and, Specialist Integration Task Group for the Calgary Zone. Modernize Alberta’s continuing care system, based on Alberta’s facility‐based continuing care and palliative and end‐of‐life care reviews, to improve continuing care services for Albertans living with disabilities and chronic conditions (including people living with dementia). Government continues to be committed to addressing gaps in the continuing care system, and meeting the needs of Albertans by implementing transformative changes within the system. Alberta Health worked with partners to develop a new legislative framework for the continuing care system. The Continuing Care Act (Act), which received Royal Assent on May 31, 2022, will increase clarity regarding services, address gaps and inconsistencies across services and settings, enable improved service delivery for Albertans, and support health system accountability and sustainability. Multiple pieces of legislation will be consolidated into the Act, which establishes clear and consistent oversight and authority over the delivery of continuing care services and settings. The new legislation was proclaimed to be in effect April 1, 2024, except for sections regarding administrative penalties, which will be proclaimed on April 1, 2025. Implementation of the legislative framework will better support Albertans transitioning between care types and settings, including home and community care, supportive living accommodations, and continuing care homes. The continuing care system in Alberta provides a range of services for health, personal care, and housing to ensure the safety, independence, and quality of life for people in Alberta, regardless of age, based on their evaluated need for continuing care assistance. Publicly funded care options include home and community care; continuing care homes, which includes Designated Supportive Living and Long-Term Care; and, Palliative and End-of-Life Care services (PEOLC). In addition, Albertans have the option to access housing support in supportive living settings, such as lodges, group homes, and seniors' complexes. In 2022-23, 871 new continuing care beds/spaces were created at AHS-operated or contracted facilities to meet Albertans’ needs. The government continues to be committed to expanding the number of available continuing care spaces throughout the province and enhancing the continuing care system to effectively meet the needs of Albertans by incorporating recommendations from the Facility-Based Continuing Care (FBCC) Review Final Report, which was released on May 31, 2021. Alberta Health has acted on several recommendations from the FBCC review, including the introduction of self-managed care as a way to provide greater choice regarding locations, types and providers of services. Further, Alberta Health has enhanced client choice by supporting more continuing care clients in the community rather than at FBCC sites. Alberta Health worked with Alberta Blue Cross and AHS to successfully implement the ClientDirected Home Care Invoicing model. This model was implemented in the Edmonton Zone in April 2022, and in the Calgary Zone in the fall of 2022. Expansion to rural areas of the province will move forward over the course of 2023 to provide Albertans with increased choice and flexibility in selecting their home care service provider and the ability to better direct how their care is provided. In June 2022, Alberta Health worked with AHS to initiate a Request for Expression of Interest and Qualification (RFEOIQ) procurement process to explore opportunities to optimize the provision of home care services in Alberta, as well as identify innovative service delivery solutions to support specialized needs and populations. Albertans will begin to see the outcomes and impacts of the RFEOIQ process during fiscal year 2023-24, as the successful proposals are implemented. Another recommendation from the FBCC report was to streamline inspections. Transition of continuing care facility audits from AHS to Alberta Health began in March 2022. A coordinated monitoring approach has reduced duplications of both reviews and site visits. In 2022-23, over 1,100 inspections were completed on accommodation and care in continuing care facilities across the province. Alberta Health also followed up on over 940 reportable incidents of resident safety or care concerns and conducted 103 complaint investigations. These activities continue to provide assurance that residents and clients are receiving safe and quality care and services. Budget 2022 allocated $204 million in capital grant funding over three years to expand capacity for continuing care. The inaugural Indigenous Stream was launched in 2021 to support continuing care facilities on and off reserves/settlements. As of June 2022, seven projects were approved for $67 million to develop 147 continuing care spaces. The inaugural Modernization Stream was launched on September 20, 2022, and concluded on January 6, 2023. This stream focused on refurbishing and/or replacing existing aging continuing care infrastructure at non-AHS owned facilities. The Government of Alberta continues to prioritize quality PEOLC by investing $20 million in over 30 projects since 2019. Progress to date on projects commenced in 2020 include: • Covenant Health continued to work to increase general awareness of PEOLC, increase uptake of advance care planning and develop standardized, competency-based education to support the provision of high-quality PEOLC. • In October 2022, Covenant Health’s Palliative Institute launched the Compassionate Alberta website, (compassionatealberta.ca) which is a resource aimed at increasing awareness around palliative care and to help Albertans have open and honest conversations about death. • Between April 2022 and March 2023, the Alberta Hospice Palliative Care Association successfully launched two programs that addresses the needs of caregivers and those with a life-limiting illness (the Living Every Season Program) as well as grief and bereavement needs for Albertans (the You’re Not Alone Grief Connection Program). In November 2021, Alberta Health released the PEOLC call for grant proposals. The grant program focused on projects that address the four PEOLC priority areas identified in the Advancing Palliative and End‐of‐Life Care in Alberta Report. As a result of this grant call, a total of 25 new PEOLC grants were initiated in April 2022, totaling $11.3 million. The funding and project breakdown is as follows: • Nearly $4.2 million for eight projects to expand community supports and services. • More than $4.1 million for 10 projects to improve health-care provider and caregiver education and training. • More than $1.9 million to support four projects that advance earlier access to palliative and end-of-life care. • More than $1.1 million for three projects for research and innovation. In June 2022, the Pilgrims Hospice Society completed a one-year, grant-funded project that supported care navigation services, which provided Albertans with information on residential support programming and provided staff training on hospice care. Pilgrims Hospice Society also received $2.5 million in October 2022 to support residential hospice care at the Roozen Family Hospice Centre in Edmonton. This demonstration project will provide important information on the standalone hospice model used at the centre, including usage data and service quality, to identify longer-term options for funding and expanding residential hospice services in Alberta. Government continued to invest in supporting the nearly one million Albertans who are caregivers for family and friends. This included approximately $2 million in grant funding since 2022 to Caregivers Alberta to enhance their programs and services; to Norquest College for the Skills Training for caregivers with a focus on rural areas; to the University of Alberta to reduce caregiver distress and support family and friend caregivers to maintain their health and well-being; and, to the Alzheimer Society of Alberta and the Northwest Territories to focus on delivering communitybased programming for persons living with dementia and their caregivers. In 2022-23, the Government of Alberta continued to support innovations in dementia care through the Community-based Innovations for Dementia Care initiative, which supported 15 communitylevel projects, and through multiple projects delivered by the Alzheimer Society of Alberta and the Northwest Territories: • The Alberta Employers Dementia Awareness Project identified the needs of employers to develop best practices to create inclusive workplaces. This included piloting and launch of the Dementia Alberta website (https://www.dementiaalberta.ca) to ensure dementia in the workplace awareness materials are available to Alberta employers. The project also helps to ensure that employers have access to materials describing the importance of brain health and dementia risk reductions, and that employers have access to sample guidance, facts, tips and scenarios applicable to Alberta employers and employees. • The expansion of the First Link® early intervention program by enhancing outreach to and in rural communities. During the project, 113 rural communities received outreach and 91 small cities, specialized municipalities, municipal districts, towns, villages or summer villages received outreach services. • The Community Dementia Ambassador Project, which created a program delivered by volunteers (Ambassadors) who live in or are familiar with the cultural and social values of Alberta communities. This project identified 22 Ambassadors from 16 communities, including Cardston, St. Paul and Peace River. Ambassadors reached more than 1,325 Albertans. To support the continuing care sector and its staffing needs, the government is exploring ways to increase the number of students enrolled in Health Care Aide (HCA) programs at various postsecondary institutions. Government is funding an additional 1,090 seats in HCA programs over three years, and invested $12.8 million to provide bursaries for HCA students to assist with education costs and encourage them to become HCAs. The HCA bursary program, administered by NorQuest College, went live July 1, 2022, and included three streams of funding: the Financial Incentive program, the HCA Tuition Bursary program, and the Workplace Tutor program. Under the Financial Incentive program, students who were enrolled in a licensed HCA program between January 1 and June 30, 2022, are eligible for up to $4,000 if they agree to work a minimum of 1,000 hours with an identified continuing care operator within one year of starting employment. Eligible HCA students may receive up to $9,000 through the HCA Tuition Bursary program. The Workplace Tutor program provides funding for identified continuing care operators to educate and train HCAs at their workplace. Demand for the bursaries is steady with over 600 students applying for the regular bursary and approximately 350 HCA students approved to receive the bursary. These bursaries will remove barriers for students, and pay for schooling and other expenses while they are completing their program. From July 2022 to March 31, 2023, government provided $20.6 million to continuing care operators to partially offset inflationary increases to accommodation charges for continuing care residents. This support made accommodation charges more affordable for residents and shielded them from the full cost of living pressures associated with higher-than-average inflation. The government provided $1 million to improve access to non-medical supports in the community. This included initiatives with United Way Calgary and the Edmonton Seniors Coordinating Council to provide more community supports and navigation assistance for clients seeking this help, expanding caregiver supports. In 2022-23, the percentage of medical patients with an unplanned hospital readmission within 30 days of discharge from hospital was 12.8 per cent. This was one per cent lower compared to last year (2021-22). A lower percentage means fewer patients have been readmitted to hospital within one month of discharge. A high rate of readmissions increases costs and may mean the health system is not performing as well as it could be. Although readmission may involve many factors, lower readmission rates show that Albertans are supported by discharge planning and continuity of services after discharge. Rates may also be impacted by the nature of the population served by a hospital facility, such as elderly patients or patients with complex health needs, or by the accessibility of post-discharge health care services in the community. Coordination of care is also improving with increased access to virtual care services and supports as well as recent enhancements to health information systems that enable electronic notification of primary care doctors when their patient is admitted or discharged from hospital. 1.3 Use digital technology to enable new models of care and reduce manual and paperbased processes. Government continues to enhance the digital health environment to provide Albertans with digital access to their health information and give health care providers more complete digital patient information at the point of care to enhance quality of care for Albertans. Collecting health system data helps support evidence-informed decisions to address changing circumstances and to keep Albertans informed. The digital modernization of the health care system involves several key elements. The MyHealth Records (MHR) portal allows Albertans to access their health information. In 2022-23, over $7.9 million was spent on MHR. Alberta Netcare, the province's Electronic Health Record, is available to health care professionals in the community and AHS. In addition, Connect Care, an integrated system with Alberta Netcare, serves as a common platform for clinical information and stores all medical records, prescriptions, and care history collected from AHS facilities, including doctor's notes. Giving Albertans digital access to their health information via the MHR portal reduces the need for them to manually request that information separately from each health provider. Albertans registered on MHR has grown from 1.25 million users in March of 2022 to just under 1.5 million users at the end of March 2023. MHR portal capabilities have been expanded with the addition of immediate release diagnostic imaging reports including CT and MRI scans. The Apple MHR App is now integrated with Apple Health Kit, allowing Albertans to connect health information from their Apple Health App account to MHR. These information technology components facilitate the shift from paper-based processes to digital processes and support the expansion of virtual care options. In 2022-23, new services to support electronic referral as part of the ASI were planned and developed. A data feed is being tested, paving the way for future referral notifications in MHR and in the Electronic Medical Records (EMR) systems of referring providers. Other improvements also included continuity of care services: • Patient data from the Central Patient Attachment Registry is now integrated with Alberta Netcare, enabling health care providers across Alberta to access information on the patient’s medical home, and who their primary provider is. Design work on Alberta’s version of the International Patient Summary is nearing completion and development work will begin shortly with EMR vendors. A patient summary is a collection of clinical and contextual information about a patient’s health details. The Alberta version of the national standard is being coordinated with Ontario and Canada Health Infoway (a not-for profit funded by the Government of Canada) and includes necessary minimum amount of information to inform patient treatment at point of care. Alberta is hoping to have at least one EMR vendor conformed to Alberta’s Patient Summary in 2023, with additional vendors onboarded in 2024. • The Community Information Integration (CII) project improves Albertans’ access to primary care and community health information by collecting patient data from physician offices and other community-based clinics and making it available to other health care providers through Alberta Netcare. Over $6.5 million was spent on CII in 2022-23. In January 2023, there were 1,764 providers live on CII, taken from 430 clinics across 40 PCNs, and nearly 1.2 million Albertans in the Central Patient Attachment Registry database. More than seven million patient encounters and over 500,000 consult reports have been submitted to Netcare as of March 31, 2023. As the province emerges from the pandemic, the expectations of Albertans have shifted and there is a greater reliance on accessing on-demand virtual government services. In alignment with the Government of Alberta Digital Strategy and Alberta Health’s eHealth Strategy, developed in 202122, Alberta Health will modernize digital service delivery, increase productivity, save tax dollars, and improve user experience by better integrating technologies into the delivery of government services. In 2022-23, $5.7 million was spent through the Health Canada Bilateral Agreement for PanCanadian Virtual Care to address secure messaging, secure video-conferencing technology, remote patient monitoring technologies, patient access to COVID-19 and other lab results, and back-end supports for integration of new platforms. This investment supported Alberta Health’s ongoing initiatives foundational to expanding the virtual health care system. Alberta Health has identified four strategic priorities for virtual care delivery in the province, which are reflected in Alberta’s Virtual Care Action Plan: • establishment of an eHealth Strategy that includes a strategy for virtual care; • expansion of the MyHealth Records patient portal capabilities, including expansion of lab results and addition of diagnostic imaging results; • development of secure messaging services for Alberta, including advanced services for twoway integration between community EMRs and Alberta Netcare; and, • development of a privacy and security framework for virtual care. Access to the MHR portal is free at https://myhealth.alberta.ca/myhealthrecords. Currently, Albertans can view parts of their Netcare record, including their medications dispensed through community pharmacies, lab results and immunization history through MHR. In 2022-23, discussions and approval processes for MHR and Alberta Netcare were underway for implementation. This enables Albertans to be active participants in their own health management. The ministry continues to make progress on a phased roll out of Connect Care within all AHS facilities to support digital modernization of the health system. In 2022-23, five of the nine planned launches for this multi-year project had been completed. Connect Care provides a single source of information in AHS to support team-based, integrated care with a focus on the patient and the efficient and effective provision of services. In 2022-23, over $260 million was spent on Connect Care. The total cost of Connect Care when completed is expected to be $1.45 billion. Although progress was slowed by the pandemic, work continues on the remaining four launches of deployment. All launches are expected to be completed by fall 2024 and approximately 145,400 users are expected with full roll out of the program. The application of modern technologies will support the delivery of innovative care models that empower patients, families and their health care teams to improve quality of care. In 2022-23, eight digital health projects were funded at the Universities of Alberta and Calgary for a total investment of $9.6 million from AHS and Alberta Innovates. These academic-clinical collaborations will help AHS identify and advance solutions that improve health care quality, health outcomes, and overall value for Albertans. Projects include the integration of prevention into Connect Care to improve the health of Albertans; digital tools such as clinical decision support and remote monitoring for people with kidney issues to reduce acute care use; tele monitoring to reduce adverse events for hospitalized patients; and, an integrated digital health approach to diabetes with First Nations in Alberta. Digital technology is also being leveraged to modernize critical capabilities to administer the Alberta Health Care Insurance Plan (AHCIP) and support core business, such as claims processing and payment to health care providers. To better meet the needs of Albertans and care providers, work continued on future models of care and emerging digital technology to replace and redesign mainframe systems to increase functionality and reduce maintenance costs. In 2022-23, over $6.5 million was spent on this initiative and the work towards the replacement and redesign of nine applications used to administer the AHCIP is ongoing. 1.4 Ensure processes for resolving patient concerns are effective, streamlined, and consistent across the province. It is important that Albertans are aware of what resources are available to help them resolve patient concerns, and how their valuable feedback can help improve the quality and safety of health services. The Office of the Alberta Health Advocates empowers Albertans to advocate for their health needs; resolves their concerns and refers individuals to programs and services to address their complaints; educates Albertans about the province’s Health Charter; and, provides health selfadvocacy skills and health literacy education to promote early resolution of issues and remove barriers and gaps in care. In February 2023, government appointed a new Health and Mental Health Advocate to be a strong voice for Albertans when it comes to their health care and to ensure the health system operates effectively for all Albertans. From April 1, 2022, to March 31, 2023, there were 2,589 Albertans served by the Office of the Alberta Health Advocates. More specifically, there were 1,565 under the Health Advocate’s jurisdiction, 742 under the Mental Health Advocate’s jurisdiction, and 175 files that were under both jurisdictions. The Office of the Alberta Health Advocates hears the patient perspective on care experiences and provides feedback to entities in the health system through effective partnership and collaboration to encourage system improvement/change and effective legislative development. The ministry is committed to ensuring the patient complaints process is fair, responsive, and accessible and has processes in place to review and respond to feedback from patients and families. Recommendations to improve the current processes for resolving patient concerns and complaints have been developed, informed by consultation and research led by the Health Quality Council of Alberta. These recommendations were approved by government in the summer of 2022; Alberta Health is working on their implementation which is to expand the role and mandate of the Health Advocate; centralize intake, triage, navigation and standardize follow up with Albertans for all patient complaints; and, require mandatory information exchange between stakeholders to support improved public reporting for health care complaints. Once the recommendations are fully implemented, Albertans will have a simplified process to raise concerns and complaints about health care, and the Health Advocate will help them find the appropriate body to review and investigate the complaints. The Health Advocate will help improve accountability by monitoring the status of the resolution processes for completion and closure. Concerns and complaints will continue to be reviewed and investigated by AHS, health professions and other bodies created under statute to hear concerns. Alberta Health continues working with First Nations and Métis health leaders to better understand their experiences with the current complaints management systems in Alberta, involve them in identifying ways to build Indigenous patient trust in the health care they receive, and to ensure their concerns are addressed appropriately. The outcome of this work will improve the current complaints management system by removing existing red tape and making the system easier to navigate for patients and families. Outcome Two: A modernized, safe, person-centred, high quality and resilient health system that provides the most effective care now and in the future for each tax dollar spent Key Objectives 2.1 Continue to implement strategies to bring Alberta’s health spending and health outcomes more in line with comparator provinces and national norms, including implementation of AHS review recommendations and working with the Alberta Medical Association to reach a fiscally sustainable agreement. Albertans want and deserve a health care system that meets their needs, while also understanding the system needs to be sustainable. Government’s focus on ensuring value for money spent on health care supports this vision through actions and initiatives that make the most of taxpayer dollars. Budget 2022 invested $22.5 billion in Health’s operating budget to keep Albertans safe and healthy. In 2022-23, Alberta received $5.8 billion in Government of Canada transfers, of which $5.5 billion was the Canada Health Transfer (CHT). The CHT included a $232 million one-time funding to address surgery backlog resulting from the COVID-19 pandemic. In February 2023, Alberta reached an agreement with the Government of Canada to invest more than $24 billion in Alberta's health care system over the next 10 years through the CHT. This funding aims to respond to the immediate needs of Albertans under the Health Care Action Plan, as well as improve access to family health services, including in rural and remote areas and in underserved communities; foster a resilient and supported health workforce; improve mental health care and addictions services; and, allow Albertans access to their own electronic health information. The ministry continues to closely monitor provincial per capita spending on health care to quantify progress on government’s broader commitment to get the most value for each dollar and improve access, and make the health system work better for Albertans, while managing cost growth in health care. The Government of Alberta continues to collaborate with health system partners to manage the biggest cost drivers in the health system – namely hospital services, labour and physician compensation, and publicly funded drug benefit programs. In 2022-23, the Government of Alberta spent $4.3 billion on hospital services (i.e., acute care), $6.0 billion on physician compensation and development, and $2.5 billion on drugs and supplemental health benefits. The pandemic caused per capita health care spending for all provinces to increase significantly. The national average increased from $4,835 in 2019-20 to $5,628 in 2021-22. The Alberta provincial per capita spending on health care in 2021-22 is estimated to be $5,384, on par with the Canadian average. Improving efficiency and ensuring more value for tax dollars will improve health outcomes and support fiscal sustainability of the health system. The Alberta Health Services (AHS) Performance Review identified opportunities for AHS to reduce costs and improve health outcomes by using resources more efficiently. The ministry will continue to pursue opportunities to align spending with British Columbia, Ontario and Quebec by implementing efficiencies and reducing drug costs through the work of the pan-Canadian Pharmaceutical Alliance. AHS continues to find ways to improve the health system and access to services to Albertans. Actions implemented as a result of the 2019 AHS Performance Review have had substantial impacts on the health care system and savings have been used to improve front-line care and system sustainability (https://open.alberta.ca/publications/alberta-health-services-performance-reviewsummary-report). Implementation of the AHS Review initiatives was concurrent with a global pandemic, labour negotiations and development of a new agreement between the government and the Alberta Medical Association (AMA). Operating expenditures (excluding COVID-19 costs) increased by 6.1 per cent in 2022-23 when compared to 2021-22. Alberta’s population growth and aging population has resulted in increased demand for healthcare services. The overall increase also reflected implementation of the new agreement with the AMA and recent settlements with various health labour unions. Despite these cost pressures, health spending growth is lower than the combined population growth and inflation increase. Protecting and improving the quality of health care in Alberta also requires capital investments. In 2022-23, a total of $841 million was invested in health-related capital projects across the province, including technology and information systems maintenance and renewal of existing facilities. Alberta continues to expand and modernize hospitals and other facilities to protect quality health care and grow system capacity. Investments in health system infrastructure is fundamental to improving efficiency in the health care system, reducing wait-times, providing additional surgical capacity, and to generally improve patient outcomes. Budget 2022 invested $193 million over three years for the redevelopment and expansion of the Red Deer Regional Hospital Centre to increase critical services and add capacity to one of the busiest hospitals in the province. The Red Deer Regional Hospital Centre redevelopment project functional program was completed in late April. The functional program develops and validates the scope of services and projected workload, staffing, and space to meet current and emerging acute health care needs of all residents of the Red Deer Regional Hospital’s catchment area. The functional program also addresses capacity and quality of space to improve patient and staff safety, support quality of care, manage utilization efficiently and sustainably, and ensure timely access to care. When completed this project will expand inpatient capacity from 370 beds to 570 beds and add three surgical suites, plus space to add three more suites when required in the future. There will be a new cardiac catheterization laboratory, a new medical device reprocessing space, expanded ambulatory care capacity, and expansion of many other clinical programs throughout the hospital. In 2022-23, over $133 million was allocated over three years for Alberta Surgical Initiative capital projects at AHS-owned facilities. This includes the renovation of the Medicine Hat Regional Hospital, the Edson Health Centre, and the Royal Alexandra Hospital in Edmonton. Construction also progressed on the University of Alberta Hospital in Edmonton, which will include a postanesthetic recovery unit and medical device reprocessing area when completed, and the Rocky Mountain House Health Centre, which is undergoing renovations for a new procedure room and the development of a new medical device reprocessing area. Design was completed for redevelopment at the Chinook Regional Hospital that will modernize and increase surgical procedure capacity. Other work also included designing 11 operating suites at the Calgary Foothills Medical Centre. As part of Budget 2022, $2.2 billion was allocated over three years to move forward with a number of capital projects, for example: • The University of Alberta Hospital Brain Centre received $50 million over three years for a Neurosciences Intensive Care Unit. The design development report is nearing completion. • Provincial Pharmacy Central Drug Production and Distribution Centre ($49 million over three years). The design development report is complete. • The Norwood Tower at the Gene Zwozdesky Centre ($142 million over two years) received an occupancy permit in March 2023 and was turned over to AHS for operational commissioning. In 2022-23, $116 million was spent to complete the Calgary Cancer Centre. The Calgary Cancer Centre Construction is complete and AHS is preparing the hospital to open in 2024. The hospital will have 160 new inpatient cancer beds, 100 patient exam rooms, 100 chemotherapy chairs, increased space for clinical trials, 12 radiation vaults, outpatient cancer clinics, and designated areas for clinical and operational support services and research laboratories. The completed project will increase cancer care capacity in Calgary by consolidating and expanding existing services to support integrated and comprehensive cancer care. On October 6, 2022, the government executed a four-year agreement with the AMA to address common interests such as quality of care, health care system sustainability, and stability of physician practices. Implementation of the AMA Agreement is underway and includes over $250 million in new spending over four years on initiatives targeted at communities and physician specialties facing recruitment and retention issues. The agreement included concrete solutions and the financial resources to support Albertans’ health care needs by promoting system stability through competitive compensation and providing targeted funding to address pressures that require immediate and longer-term stabilization. The agreement also allows physicians to provide greater input into longer-term approaches on improving patient care and physician compensation reform initiatives. Physicians received a one per cent lump sum COVID-19 recognition payment in 2022-23. Alberta physicians were at the forefront of the pandemic and the one-time payment for eligible practicing physicians is in recognition of that work during the 2021-22 fiscal year. The lump sum payment is approximately $45 million and was provided to the AMA in December 2022 to distribute to their members. Physicians will receive an average one per cent rate increase to compensation for each of the next three years. As part of implementation of the AMA Agreement, the Business Costs Program premium rate was increased by about 22 per cent. This increase will help physicians deal with inflation and keep practices open. The increase is estimated to cost $20 million annually, providing on average an extra $2,300 annually for each physician. This is in addition to about $80 million the government currently invests in the program each year. Following the ratification of the AMA Agreement, a commitment for collaboration between Alberta Health and the AMA regarding primary health care, including one-time investments of $20 million in Primary Care Networks (PCNs) for two fiscal years, was established. The Provincial PCN Committee provided significant contributions to the work of the Modernizing Alberta’s Primary Health Care System (MAPS) initiative to improve access and quality of primary and community health services. The MAPS initiative goal is to provide recommendations on ways to strengthen primary health care and achieve a primary health care-oriented health system. MAPS is engaging leaders and experts with hands-on experience in primary health care and health systems improvement to examine the current landscape and propose improvements. By March 31, 2023, a final report was delivered proposing a strategic direction for primary health care over the next 10 years, with a parallel report providing strategic directions to improve the delivery of primary health care for Indigenous peoples in Alberta. The $20 million investment in primary health care provides significant relief across the primary health care system, particularly for PCNs that have experienced a decline in their per capita payments from declining numbers of patients. This funding provides stabilization while work is undertaken to review and improve the overall funding model for PCNs, which will consider recommendations from the MAPS initiative. For many Albertans, prescription drugs have tremendous benefits in terms of improving quality of life, managing illnesses, and in some cases, precluding the need for more extensive treatments. Alberta continued to work with the pan-Canadian Pharmaceutical Alliance (pCPA) to reduce prescription drug costs and increase access to clinically effective and cost-effective drug treatment options, including cell and gene therapy. All new drugs and/or new indications for use undergo price negotiations between the pCPA and drug manufacturers. In 2022-23, rebates have increased to an estimated $327 million from $275 million in 2021-22. This is a successful trend that shows the importance of the pCPA and Alberta’s involvement as a member to push health jurisdictions for more value and budgetary protection. In 2022-23, the province spent $2.5 billion on drugs and supplemental health benefits and continued to improve existing drug benefit programs and add innovative and effective therapies through the addition of 320 new products in 2022-23. Of the 320 products added, 48 were brand name drug products and 272 were generic products. Alberta’s Biosimilars Initiative will expand the use of biosimilars by replacing the use of biologic drugs with their biosimilar versions whenever possible. This means patients will continue receiving safe and effective treatment, but at a lower cost. In 2022-23, savings from this initiative increased to an estimated $65.7 million from $48.9 million in 2021-22. 2.2 Increase regulations and oversight to improve safety, while reducing red tape within the health system by restructuring and modernizing health legislation, streamlining processes, and reducing duplication. As of March 31, 2023, the ministry, including AHS, achieved a 36.1 per cent reduction of its regulatory and administrative requirements, exceeding the government target of 33 per cent. AHS will continue to see reductions with the ongoing launches of Connect Care across the organization, continuing through 2024. Connect Care supports digital modernization of more complete central access to patient information related to AHS services. It provides resources, including medication alerts; evidencebased order sets; test and treatment suggestions; and, care paths and best practice advisories, which result in fewer repeated tests and consistent information across the province wherever care is being provided at AHS facilities. This system also reduces the number of forms used by AHS and helps to eliminate data entry duplication. Connect Care also facilitates direct communication between patients and providers through a patient portal, MyAHS Connect, which helps patients better manage their health with online access to their health information, including reports and test results. It also allows for online interaction with their care team, an ability to review and manage appointments and after visit care summaries, and less repeating of their health histories or need to remember complex histories or medication lists. The ministry continues to monitor Alberta’s health system to ensure standards are maintained and to improve safety and quality of health care. As of March 31, 2023, amendments to the Health Professions Act have been proclaimed into force that modernize Alberta’s professional regulatory structure. This included changes to 29 regulatory college regulations and one regulation that enhance professional regulation by health profession regulatory bodies and will make it easier for regulatory colleges to be more agile and adapt faster to changing best practices. The PCN Nurse Practitioner (NP) Support Program was created to enable NPs to work to the full scope of their skills. In 2022-23, $7.6 million was provided and the program facilitated the incorporation of NPs working more than 57 full-time equivalent positions as of March 2023. The program increases access to primary health care, including after hours, weekends, and in rural and remote areas and underserved populations; supports chronic disease management; and, helps meet unmet demand for primary health care services. Challenges for the program include NP compensation, recruitment and retention, and the desire of NPs for an independent practice model. Alberta Health is currently consulting with key stakeholders on a draft NP Compensation Model to address the challenges of the program. Amendments to the Pharmacy and Drug Act and the Pharmacy and Drug Regulation came into effect June 1, 2022. These amendments allow the Alberta College of Pharmacy and pharmacies to better respond to changes in the provision of pharmacy services to Albertans and reduce significant government red tape faced by pharmacy operators. To address the current challenges in continuing care legislation and help to initiate transformative change within continuing care, Alberta Health worked with partners to develop a new legislative framework for the continuing care system to increase clarity regarding services, address gaps and inconsistencies across settings, enable improved service delivery for Albertans, and support health system accountability and sustainability. On May 31, 2022, the Continuing Care Act (Act) received Royal Assent. The Act will come into force on April 1, 2024, after the development and approval of regulations and standards. The ministry is currently working with partners on the development of those regulations and standards. When proclaimed, the Act will regulate the full spectrum of continuing care services and settings in Alberta, including continuing care homes, supportive living accommodations, and home and community care. Consequential amendments to the Act are included in The Red Tape Reduction Statutes Amendment Act, 2023. These amendments ensure alignment of terminology in existing legislation with the Act while maintaining the policies and intent of the current legislation. In May 2022, the Food Regulation under the Public Health Act was amended to eliminate the requirement for food establishments to request an approval from a public health inspector to allow dogs into outdoor eating areas. The amendment reduced red tape for operators and provided them greater flexibility in meeting the needs of their customers. The Food Regulation provides clear requirements to support the change so dogs can stay with their owners on outdoor patios, while maintaining a high degree of food safety. 2.3 Improve measuring, monitoring and reporting of health system performance to drive health care improvements. Measuring performance is the clearest way to show investments in the health care system are leading to better outcomes for Albertans. Alberta Health worked with the Health Quality Council of Alberta (HQCA) to ensure alignment of their plans and priorities with government key priorities and achieve improvements through various initiatives. On July 26, 2022, Alberta Health executed a $23 million operating grant agreement with the HQCA over three years (April 1, 2022 to March 31, 2025) to keep the organization working with patients, families, and partners from across health care and academia to inspire improvement in patient safety, person-centred care, and health service quality. As an example, Alberta Health worked with the HQCA to develop a Primary Care Patient Experience survey to engage Albertans on their experiences within the health care system. Work continued towards transitioning manual surveys to a digital, computer-adaptive testing methodologies format to use digital technology to enable new models of care and reduce manual and paper-based processes. Digital formats for surveys and reports across primary and continuing care increased Albertans’ engagement within the health system and allowed more timely feedback to service providers about care concerns, including patients’ opinions. Alberta Health worked with HQCA to create primary health care panel reports to support planning, quality improvement, health system management for overall purpose of improving primary health care delivery. The panel reports provide family physicians with information on their patients’ continuity, as well as valuable data on screening and vaccination rates, chronic conditions, pharmaceutical use, and emergency and hospital visits. Alberta Health worked with AHS and the HQCA to develop a value-based assessment tool for objectively assessing value from the Government of Alberta annual investment into health outcomes of Albertans and benchmark against other jurisdictions, particularly the comparator provinces of British Columbia, Ontario and Quebec. Alberta Health also worked with the HQCA to complete priority work on identifying emergency medical services key performance indicators. Performance measures were developed and are under ministry review, with a shift in focus to reducing response times measured at the 90th percentile, rather than the 50th percentile. Releasing the results and performance information improves quality and patient safety and assures Albertans of the government’s commitment to increase accountability and transparency in Alberta’s health care system. The adoption of best practices and monitoring of performance measures help to improve health outcomes. Work continued with the HQCA on developing the Patient Experience Awards and Quality Exchange to support excellence in care and sharing of best practices. This included continuing to develop resources and information to support and inform program planning, panel management, quality improvement and policy development in primary health care, as well as patient experience information for designated supportive living and continuing care. Information is published for Albertans in FOCUS, a dynamic online reporting tool which collects information about what patients experience in the provincial health care system, including: emergency departments, primary health care, long-term care, designated supportive living and home care. Outcome Three: The health and well-being of all Albertans is protected, supported and improved, and health inequities among population groups are reduced Key Objectives 3.1 Ensure a continued, effective response to the COVID‐19 pandemic by optimizing access to treatments and vaccine, and reducing vaccine hesitancy. The Government of Alberta remains committed to supporting Albertans as we shift to managing COVID-19 similar to how other endemic respiratory viruses are managed. Alberta’s capacity to treat and clinically manage cases of COVID-19 continues to improve. Immunization, including receiving a booster dose of COVID-19 vaccine, is one of the best choices Albertans can make to protect themselves from severe illness due to COVID-19 infection. In 2022-23, $1.2 billion was spent on COVID-19 response to ensure the health care system had the resources required to address health care pressures resulting from the pandemic. By the end of June 2022, all mandatory public health measures related to COVID-19 were lifted. This was due to increased immunization coverage, attenuation of severity of new circulating variants, and the ability to treat and clinically manage cases of COVID-19. This signaled the beginning of a shift in Alberta’s handling of COVID-19 from an emergency pandemic response to an endemic state. Government supported this transition by working across multiple facets of health care (e.g., primary care, continuing care, workplace health and safety, public health, provincial laboratory, etc.) to align public health recommendations, such as testing and isolation, across all common respiratory viral illnesses. The ministry continued to monitor the impacts and transmission of COVID-19 and other respiratory viruses in the community by working with partners on the implementation of ongoing and new COVID-19 immunization programs, including the introduction of bivalent booster vaccines, and implementing treatment protocols for COVID-19. Alberta Health and the Health Quality Council of Alberta established a COVID-19 Data Task Force, comprised of health professionals, to conduct a data review of the last several years of health information with a view to offering recommendations to the Government of Alberta on how to better manage a future pandemic. The purpose of the review is an opportunity to reflect on Alberta’s pandemic response from a data quality and validity lens to identify opportunities for improvements to manage future pandemics. To minimize the impact of COVID-19 and protect public health, COVID-19 Rapid Antigen Tests were made available across the province to all Albertans free of charge through participating community pharmacies. Initially, supply was limited and this distribution model enabled an equitable distribution of tests across the province. Between March 2021 to March 31, 2023, Alberta distributed 48.5 million rapid antigen tests to acute and continuing care sites, primary care clinics, businesses, K-12 schools, municipalities, First Nations and Métis communities, and the general public. Government developed COVID-19 vaccine strategies to help reduce the spread, minimize severe outcomes and protect vulnerable Albertans. Work continued to support the review of ongoing evidence and recommendations for immunization against COVID-19, including guidance for immunization post-infection (or hybrid immunity), as well as for fall/spring booster programs. In 2022, Alberta continuously achieved key milestones on COVID-19 vaccine administration and roll out for different age groups and populations. In April 2022, 40 per cent of Albertans 12 and older had received their third vaccine dose. In June 2022, 35 per cent of Albertans aged five to 11 had received two doses of COVID-19 vaccine. On November 14, 2022, the Pfizer vaccine was made available for individuals six months to four years of age, and on March 20, 2023, a second bivalent vaccine (spring booster) was made available for residents living in senior congregate living settings. In 2022-23, 1.4 million COVID-19 vaccine doses were administered to Albertans and 26 per cent of the population 12 years of age and older had received a booster dose. While the federal government continued to cover the costs of the vaccines, Alberta Health spent $53 million in 2022-23 to distribute the vaccines to Albertans. The Alberta Vaccine Booking System (AVBS), launched in summer of 2021, continues to provide Albertans with access to book both COVID-19 and influenza vaccine appointments at participating Alberta Health Services (AHS) or pharmacy locations by providing a centralized, province-wide online appointment booking platform. The centralization of all vaccine booking appointments, including from AHS, Public Health, and Community Pharmacy helps Alberta Health forecast vaccine demand and strategically distribute vaccine supply. Vaccine eligibility criteria and system functionality continue to be updated based on direction from provincial immunization programs. In 2022-23, more than 575,000 appointments for COVID-19 and influenza immunization were scheduled using the AVBS. Updates continue to be released to support dynamic vaccine eligibility changes and to continually improve the user experience. Previously, Albertans had to call multiple pharmacies and Health Link in an attempt to find available vaccine supply. The Health Link 811 call centre continues to support Albertans who do not or cannot use the AVBS. To ensure a continued response to COVID-19, Alberta Health together with AHS extended the provision of free personal protective equipment (PPE) to primary care physicians, pediatricians, and their staff to support their operations and enhance safety to May 31, 2022. In 2022-23, inventory consumption expense associated with the COVID-19 response was $365 million; this includes PPE, testing supplies and $88.6 million for rapid test kits. In addition, the government worked with continuing care partners to protect residents of congregate care facilities and home care clients. A total of $286 million was provided in 2022-23 for additional staffing costs and cleaning supplies, PPE and screening of visitors to protect the health and safety of residents. In 2022-23, AHS, in collaboration with the Zone PCN Committees, worked towards the administration of an oral antiviral COVID-19 treatment in respective AHS geographical zones, enhancing capacity for testing and swabbing for respiratory illnesses. In 2021-22, intravenous Sotrovimab was made available on an outpatient basis to Albertans at higher risk of severe illness or death, followed by availability of Paxlovid, the first COVID-19 treatment approved by Health Canada that can be taken orally at home. Efforts were made to recruit sentinels (primary care physicians/nurse volunteers) to increase the effectiveness of the TARRANT Viral Watch Program, which monitors respiratory infections circulating in the community. 3.2 Safeguard Albertans from communicable diseases that can cause severe illness, permanent disability, or death. The ministry works to protect Albertans from a number of communicable diseases, such as influenza, measles, and sexually transmitted and blood borne infections. Over the past year, immunization programs for vaccine-preventable diseases continued to be a primary strategy in preventing disease, disease transmission and severe health outcomes. They are key to the health of a population and to decreasing the strain on the acute care system. Through promoting initiatives that aim to increase childhood and adult immunization rates, Alberta continued to offer immunizations programs, including influenza vaccine, to Albertans six months of age and older, free of charge in collaboration with many partners. Alberta’s 2022-23 influenza season started earlier with a surge of influenza A cases in early October. The highest positivity for influenza A was 31.9 per cent in the week of November 20, 2022, and cases and outbreaks decreased significantly by the end of December 2022. Alberta had sufficient supply of influenza vaccines to immunize 38 per cent of the population. Alberta Health worked with AHS to ensure respiratory outbreak definitions and management guidelines were in place for high-risk settings, including continuing care and acute care facilities, to minimize severe health outcomes and protect the most vulnerable Albertans in these settings. Despite the challenges of fatigued providers and a generally vaccine fatigued population, the overall influenza immunization rate is one per cent higher than in 2021-22. As of March 31, 2023, approximately 28 per cent of Albertans received an influenza vaccine. Budget 2022 included an increase of $14.3 million related to the approval of the high-dose influenza vaccine for Albertans 65 years of age or older. As of March 31, 2023, approximately 64 per cent of Albertans 65 years of age and older, and 75 per cent of Albertans 90 years of age and older received a high-dose influenza vaccine. The Alberta Outreach Program started the week of October 3, 2022, to immunize those at highest risk of severe outcomes from influenza. The 2022-23 Influenza Immunization Program for the general public began on October 17, 2022, and ended on March 31, 2023. Influenza vaccine was available at over 2,500 immunizing sites, including AHS clinics, Indigenous Services Canada clinics, community pharmacies, community medical clinics, and post-secondary institutions. Immunization programs save millions of dollars, helping people of all ages live longer, healthier lives, and decreasing the burden on the health care system. The pandemic did result in some disruptions to the routine school immunization program and overall infant and preschool immunization rates have decreased. However, AHS has hired additional staff to support addressing the school immunization backlog and in-school catch-up programs, and immunization rates for school-aged children are nearing pre-pandemic coverage levels. In 2022, by age two, 71 per cent of Albertans had received immunization with diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (DTaP-IPV-Hib) vaccine and 82 per cent had received immunization with measles, mumps, rubella (MMR) vaccine. These immunization rates are both lower than the national target of 95 per cent for these vaccines. As a result of the COVID-19 response, childhood immunization rates dropped between 2021 and 2022. AHS has a catch-up program to increase childhood immunization rates to help reach the national target of 95 per cent. This includes actions such as reminder calls for booked appointments, monitoring wait times and adding appointments as needed, and following up using a recall process for children with delayed immunizations. Work is underway with service providers to enhance testing, treatment and prevention strategies, including working with community-based organizations, to improve women’s health, reduce barriers to sexually transmitted and blood borne infections (STBBI) testing and treatment, and increase access to prenatal syphilis screening. Over $8 million annually is provided to organizations to prevent STBBIs and provide wrap-around supports for people living with those infections, including $1.2 million specifically for syphilis outbreak response. In September 2022, Alberta experienced a shigella outbreak in Edmonton, which ended in February 2023 after two weeks without new cases. However, the outbreak was re-opened in March 2023, when seven additional cases were reported and some patients hospitalized. As of March 31, 2023, 214 cases were reported since the outbreak initially started; no deaths were reported. In October 2022, the Shigella Task Force brought together cross-sector partners, including representatives from Alberta Health, AHS, shelters, inner-city agencies, the City of Edmonton, local family physicians, and Alberta Precision Labs to coordinate resources and discuss options for limiting spread. Syphilis has made a drastic resurgence in Alberta since 2019, with rates being the highest in more than 70 years. Alberta Health has resumed a leadership role in the provincial syphilis response, after an interruption due to COVID-19, through work with frontline service providers to support testing, treatment, and prevention strategies. By increasing access to syphilis testing and treatment services in a variety of novel health settings, the Government of Alberta will help create awareness and normalize sexually transmitted infections testing and treatment for all Albertans. The ministry is also leading and supporting a number of provincial outbreak responses and preparedness activities including: • leading the human health response to highly pathogenic avian influenza, including supporting the update of public health disease management guidelines and communication pieces for government websites; • supporting the coordinated provincial response to the international mpox (formally known as monkey pox) outbreak, including guidelines for contact management and guidance on pre and post-exposure vaccine use; and, • working with AHS public health in preparation for response to international communicable disease outbreaks, including Ebola and Polio. In early May 2022, cases of mpox began to occur in countries where mpox was not previously detected. Canada’s first case was reported on May 19, 2022, and Alberta reported its first case on June 2, 2022. By July 2022, mpox was declared a public health emergency of international concern by the World Health Organization. Alberta Health worked in collaboration with public health partners to develop testing criteria, case definitions and public health management guidelines. The Alberta Mpox Public Health Notifiable Disease Guideline was published in June 2022. Alberta began offering post-exposure vaccine on June 7, 2022, and the targeted pre-exposure vaccine campaign began at the end of June. As of March 31, 2023, Alberta recorded 45 cases of mpox. Alberta has administered 2,183 first doses and 1,715 second doses of the vaccine. 3.3 Expand access to a range of in‐person and virtual recovery‐oriented addiction and mental health services. Reporting responsibility for this objective has transferred to the Ministry of Mental Health and Addiction. Performance Measure 3.a Percentage of mental health and addiction‐related emergency department visits with no mental health service in previous two years Reporting responsibility for this performance measure has transferred to the Ministry of Mental Health and Addiction. 3.4 Prevent injuries and chronic diseases and conditions through health and wellness promotion, and environmental and individual initiatives. In 2022-23, $646 million was expensed to support population and public health initiatives to maintain and improve the health of Albertans through services promoting and protecting health and preventing injury and disease. Government provides leadership and support to protect the health and safety of Albertans and improve their health and well-being by setting public policy in a number of areas, such as maternal, infant and early child development; injury prevention; public health matters related to cannabis use; tobacco and vaping control; and, promotion of population wellness and health equity. Government recognizes that Albertans living with diabetes want to access health programs and services that will more effectively support their needs. On July 21, 2022, the Minister announced the establishment of the Diabetes Working Group (DWG) to review Alberta’s entire diabetes care pathway, identify gaps in care, and provide recommendations to improve diabetes prevention, diagnosis, treatment, and management. In addition, Alberta Health expanded the Insulin Pump Therapy Program to include newer pumps and supplies. Albertans enrolled in the pump program now have access to the newest technologies for management of diabetes. Improved access to the newer diabetes management technologies, and the work of the DWG will improve outcomes and quality of life for Albertans living with diabetes. Nearly $7 million was provided to AHS for cancer prevention initiatives supporting comprehensive projects that are reducing the risk of cancer across the province. These projects address healthy lifestyles, smoking cessation, workplace wellness, and partnerships with Indigenous communities. In 2022-23, the Cancer Prevention Screening and Innovation initiative worked with organizations such as Promoting Health, Chronic Disease Prevention and Oral Health, AHS Provincial Population and Public Health, the Alberta First Nations Information Governance Centre, the Métis Nation of Alberta, and the new AHS Indigenous Wellness Core to: • adopt the Alberta Healthy Communities Approach to focus on scaling and spreading successful interventions provincewide; • create a working partnership with the Human Papilloma Virus community innovation for sub-populations and the Provincial Population and Public Health Screening Programs and Communicable Disease Control divisions; • improve the Healthier Together Workplace program and recognition strategy; and, • strengthen work with Indigenous communities to facilitate community action to reduce modifiable factors, raise cancer awareness and improve cancer screening. A community support model was created, and tools were adapted to support the three initial Metis Settlements to create, implement and evaluate cancer prevention action plans. Alberta Health currently funds several health promotion-based initiatives to improve individual and community health and well-being: • Alberta Health continues to support the Injury Prevention Centre to provide unintentional injury prevention programs, research, and education. Through the Injury Prevention Centre, Albertans have access to programs and education that reduce the risk of injury and make communities safer. Injury prevention is a public health priority that directly reduces costs to the health care system. Injury bears an estimated financial cost of $7.1 billion annually in Alberta, $4.6 billion of which is direct health care costs. • Physician prescription to Get Active supports individuals to become more active through physical activity. Prescriptions can be filled at participating recreation facilities for free visits, free one month facility passes and/or free fitness classes. • The Communities ChooseWell program advances healthy eating and active living by supporting communities to create local conditions and environments that enable Albertans to eat well and be active. The program provides resources, education and support to community groups as well as offering small grants for implementing local healthy eating and active living initiatives. Alberta Health provides approximately $2 million in grants annually to five programs that support vulnerable mothers and their babies. From April 2022 to September 2022, programs provided intensive supports to 287 vulnerable women who were pregnant or of child-bearing age, and more vulnerable women were provided outreach supports to address gaps in support specific to the COVID-19 pandemic. Alberta Health and AHS also provided funding to support the University of Alberta’s ENRICH Maskwacîs Kokums and Mosoms Elders Mentoring Program, which creates enhanced support networks for parents-to-be. In addition, elder support helps address a gap in service within the prenatal clinical setting by connecting parents to traditional knowledge and culture. Budget 2021 provided a total of $6.75 million over three years, including $2.25 million in Budget 2022, to establish and operate the AHS Tobacco and Vaping Reduction Act Enforcement Team. As of March 31, 2023, over $2.4 million has been spent, and the team has conducted retail inspections, established a secret shopper program and a public complaint line, and created retailer resources (handbook and signage) that will improve compliance with the Act and regulation. The most current data (from the 2021-22 fiscal year) shows the enforcement team conducted 2,400 retail inspections and provided over 4,000 copies of the retailer handbook and signs to retailers. In 2022-23, Alberta Health established the Alberta Ukrainian Evacuees Health Benefit Program. The total cost of the program was $9.5 million, including physician services. As of March 31, 2023, 24,000 Ukrainians have applied for health coverage in Alberta. In addition, the ministry established a health benefit program that provided Ukrainian evacuees with access to supplemental coverage for prescription and non-prescription drugs, nutritional products, diabetic supplies, and dental, optical and emergency ambulance services. Work continues in partnership with the ministries of Agriculture and Irrigation and Environment and Protected Areas on a One Health approach to antimicrobial resistance (AMR) in the province. This work is critical to address the emerging threat of treatment-resistant microbes in human and animal populations and in the environment. An Antimicrobial Strategic Framework for Action and Implementation plan continues to be developed to help guide collective efforts to address the growing threat of AMR in Alberta. Stakeholders and partners were consulted and supported development of the framework. In 2022-23, the Office of One Health at the University of Calgary was contracted at a cost of $200,000 to support implementation of AMR priority areas for action. As part of the contract, an advisory group on stewardship was created to provide guidance on specific activities, measures, targets, and costs for implementation. Alberta Health worked with AHS, Alberta Environment and Protected Areas, and the Alberta Lake Management Society to quickly set up a water quality (fecal contamination and cyanobacterial blooms) monitoring program for four sites on Lac Ste. Anne to support the 2022 papal visit and annual Lac Ste. Anne pilgrimage. Data from this monitoring program provided the basis for issuance of a cyanobacterial bloom public health advisory for Lac Ste. Anne shortly before the event. Alberta Health regularly assesses the evidence on water fluoridation to help support municipal councils to make evidence-informed decisions regarding community water fluoridation. The ministry worked on updating community water fluoridation position statement with new relevant research, including new local data from Calgary. Alberta Health continues to provide transparent information about environmental public health data, while simultaneously providing risk communication materials to influence modifiable risk factors within the Alberta population. Examples of public health data and information available through the Open Government Portal include: • Routine chemistry and trace element data from domestic well water samples analyzed in 2016–17 and 2017–18 are available. Alberta Health funded routine chemistry and trace elements analysis of 4,842 samples of drinking water from private water wells and 307 samples from small, public, non-municipal drinking water systems. As well, data related to the study of two stormwater ponds in Lacombe, Alberta were released to the open government portal at https://open.alberta.ca/opendata/lacombe-stormwater-ponddataset. This data includes the analysis of contaminants (e.g., mercury, polycyclic aromatic hydrocarbons, trace metals, pesticides and volatile organic compounds) in fish, sediments, and water. • The Alberta Environmental Public Health Information Network, accessible at http://aephin.alberta.ca, supports awareness and provides opportunities for Albertans, academics, and cross-government partners to learn more about environmental hazards and public health in the province. In 2022-23, new visualizations were published for “Human Biomonitoring of Environmental Chemicals in Canada and the Prairies” and a “Search Interface for Environmental Site Assessment Repository”, along with enhancements including the incorporation of new, yearly data on the recreational water bodies and the impacts of poor air quality and heat. In addition, Alberta Health developed the Extreme Heat website and notification protocol at https://www.alberta.ca/extreme-heat.aspx. • Alberta Health continued to provide real-time information to Albertans about hazards and risks associated with recreational water quality at Alberta beaches and waterbodies. In 2022, over 2,300 samples were collected from 85 recreational sites to identify fecal contamination and 436 samples were collected from 50 lakes, reservoirs, and rivers to be assessed for cyanobacterial (blue green algal) blooms and microcystin toxin. This monitoring resulted in the issuing of 47 cyanobacterial bloom advisories and nine fecal contamination advisories to protect the health of Albertans and visitors to the province. Additionally, in May 2022, Alberta Health updated the Alberta Safe Beach Protocol available at https://open.alberta.ca/publications/9781460145395 to reflect new Health Canada Guidelines for cyanobacterial blooms in recreational water. In February 2023, Alberta Health released a position statement around use of stormwater ponds at https://open.alberta.ca/publications/stormwater-ponds-in-alberta-health-guidanceinformation-sheet. • Alberta Health, as part of the Scientific Working Group on Contaminated Sites in Alberta, has published a Site-Specific Risk Assessment guidance document to clarify the specific requirements of conducting a site-specific risk assessment in Alberta, available at: https://open.alberta.ca/publications/supplemental-guidance-on-site-specific-riskassessments-in-alberta. Alberta Health and the Alberta Centre for Toxicology at the University of Calgary have published the report and dataset of “Post-Horse River Wildfire Surface Water Quality Monitoring Using the Water Cytotoxicity Test” available at https://prism.ucalgary.ca/handle/1880/115412. 3.5 Improve access for underserved populations and for First Nations, Métis, and Inuit peoples to quality health services that support improved health outcomes. The most current result available from Statistics Canada’s Canadian Community Health Survey shows that in 2021, 87.3 per cent of Albertans had access to a regular health provider, an improvement from 85.3 per cent in 2020. Having a regular health care provider is important for early screening, prevention through health and wellness advice, diagnosis, and treatment of a health issue, as well as ensuring good continuity of care and connections to other health and social services. The desired result is to increase the percentage of Albertans who have access to a regular health care provider. Increasing access to a regular health care provider is consistent with progress towards the following provincial primary health care goals: • timely access to appropriate primary care services delivered by a regular health care provider or team; • coordinated, seamless delivery of primary care services through a patient’s ‘medical home’ and integration of primary care with other levels of the health care system; • efficient delivery of high-quality, evidence-informed primary care services; and, • involvement of Albertans as active partners in their own health and wellness. Alberta’s Primary Care Networks are involved in a variety of initiatives that support provincial and health zone primary care goals, including adopting a ‘medical home’ approach in their practices. This approach strengthens the connection between a patient and regular health care provider to improve access to care, chronic disease prevention and management, continuity of care, and innovations in primary health care including telemedicine and virtual care. The Government of Alberta is committed to addressing the health needs of First Nations, Métis and Inuit peoples residing in Alberta, including working with First Nations and Métis leaders, the Government of Canada and other partners to streamline how Indigenous peoples access health services, and ensuring that health services are more culturally appropriate. There is a significant gap in equitable access to primary health care for Indigenous peoples. This is evidenced by noting that in Alberta, Indigenous peoples’ life expectancy is 16.4 years below that of all other Albertans, falling below 64 years of age. An Indigenous Primary Health Care Advisory Panel was established in the fall of 2022 under MAPS to provide advice to the Minister on how the existing primary health care system could be improved to ensure First Nation, Métis, and Inuit peoples have access to high-quality, culturally safe primary health care no matter where they live. As part of their work, the Indigenous Panel convened an Indigenous Youth Innovation Forum, Indigenous Primary Health Care Innovation Forum, and participated in the MAPS Forum and Community Care Innovation Forum. These forums, along with engagements with First Nations, the Metis Settlements General Council, the Métis Nation of Alberta, and others ensured that a broad range of perspectives informed the Indigenous Panel’s work. As part of their deliberations, the Indigenous Panel submitted recommendations to the Minister in December 2022 for early opportunities for investment in enhancing Indigenous primary health care. These recommendations were approved in principle by the Minister as a first step to improving access to more culturally safe and integrated care. In 2022-23, Alberta Health provided $8.8 million to the Indigenous Wellness Program Alternative Relationship Plan to support 24 full-time equivalent physician positions to provide care in over 20 Indigenous health care centres throughout Alberta, including the Alberta Indigenous Virtual Care Clinic. Alberta Health has a separate Alternative Relationship Plan arrangement with Siksika Nation, and provides up to $1.1 million to support three full-time equivalent physician positions to provide care in the community. Alberta Health continues to engage Indigenous health care experts through the First Nations Health Advisory Panel and a Metis Settlements Health Advisory Panel. Panel members include Health Directors from across the province, as well as other associated stakeholders. The Panels inform health priorities and strategies and assist in identifying issues or gaps in programs and services, as well as working to identify potential solutions and areas of future collaboration. Alberta Health also continued work on Alberta’s Protocol Agreement Health Sub-Tables to collaborate on addressing the health gaps identified by the members of the Blackfoot Confederacy and the Stoney Nakoda Tsuut’ina Tribal Council. Alberta Health similarly worked with the Métis Nation of Alberta under their Framework Agreement with the Government of Alberta. Alberta upholds the Jordan’s Principle commitments by working with the Government of Canada and the First Nations Health Consortium, an Alberta-wide organization developed to improve access to health, social, and education services and supports to First Nations and Inuit children throughout the province, living both on and off reserve. To ensure compliance, Alberta Health established an Executive Leadership Group (including the ministries of Children’s Services, Seniors, Community and Social Services, Alberta Education, Indigenous Relations, and Alberta Health) to implement Jordan’s Principle in Alberta and to ensure that First Nations children have access to health, social, and educational resources when required, without denial or delay related to jurisdictional dispute over payment. Alberta Health has also established a Technical Cross-Jurisdictional Working Group to address barriers impacting access to programs and services. The working group includes the First Nations Health Consortium, the First Nations Inuit Health Branch, and the Ministries of Children Services, Seniors, Community and Social Services, Education, and Indigenous Relations. On October 24, 2022, government appointed a Parliamentary Secretary for Rural Health, to work with Alberta Health to address rural health challenges, such as access and health care professionals. Budget 2022 introduced a new Rural Capacity Investment Fund, as part of the provincial agreement that impacted more than 30,000 registered nurses and registered psychiatric nurses across the province. The fund supports recruitment and retention strategies in rural and remote areas of the province, including relocation assistance. Almost $4.4 million was spent in 2022-23 to assist nearly 200 employees who chose to relocate to rural Alberta and pay out retention payments to over 8,200 rural health professionals. The benefit to rural Albertans will be realized by improved staff retention rates and fewer vacancies. The Government of Alberta recognizes the importance of rural health facilities and that these health centres provide an essential role for local residents. AHS and Alberta Health have established Zone Health Care Plans based on a framework that guides the development of comprehensive, zone-wide strategic health service plans, including services for Indigenous peoples. These long-range plans address the needs of rural communities with a continued focus on appropriate quality of care, patient safety, and access to services. Conditional approval was provided to seven proponents under the Continuing Care Capital Program–Indigenous Stream in June 2022. The Modernization Stream was launched in September 2022. In 2022-23, the Government of Alberta provided approximately $7 million to the Rural Health Professions Action Plan to attract and retain rural physicians with the appropriate skills to meet the needs of rural Albertans. The program supported physician locums to maintain services when rural physicians need time away from their practice; offered continuing medical education; provided accommodations for 785 rural learners for rural placements so that they can train and choose to practice in rural communities; and, created welcoming environments though 50 attraction and retention committees so that rural communities can attract and retain health professionals. In 2022, the Government of Alberta announced the Rural Education Supplement and Integrated Doctor Experience (RESIDE) program, which allocated $8 million over three years to provide incentives to new family physicians who agree to practice in rural and remote communities in exchange for a multi-year service agreement. The program will help address challenges in patient access to health services in rural and remote areas. Since the start of the program, Alberta Health has approved several changes to the RESIDE program to better meet the needs of physicians and communities and help ensure the program successfully incentivizes more physicians to move to communities of need. As of March 31, 2023, seven physicians had signed return of service agreements in rural communities. The Provincial Primary Care Network Committee provided the Minister with a recommendations report on supporting recruitment and retention of primary care physicians, nurse practitioners, and physician assistants in rural communities. In May 2022, the Minister accepted the seven recommendations that address broader systemic aspects of rural health service challenges, and this report will inform further work within Alberta Health. In July 2022, government announced new funding of $45 million over three years to increase access to pediatric rehabilitation services and programs such as speech-language, as well as occupational and physical therapy for children and youth. A community pediatric services model was developed by AHS to address gaps with implementation of enhanced pediatric rehabilitation supports, including universal and targeted resources and programs and expanded eligibility for specified services. Service delivery is enhanced with clear intake, access and triage to services and strengthened teams to support care. Pediatric rehabilitation professionals work with families and alongside other health care professionals to help children and youth live well, build resiliency and take part in activities meaningful to them and their families. A multi-pronged workforce recruitment, retention, and optimization approach is enabling implementation despite the ongoing challenges with recruitment of health professionals across programs and jurisdictions. Alberta Health Services Provincial Rural Palliative Care In-Home Funding Program provides special, funding that can be accessed by rural palliative clients and families when they require additional support beyond existing services at end-of-life to remain at home instead of being admitted to hospital. Between April 1, 2022 and March 31, 2023, a total of 143 clients were served by the program. Of the clients who have died while accessing the program, 80 per cent were able to pass away in the comfort of their own home.	You must respond to the prompt using only the information provided in the context block.Here is the question you are to answer: EVIDENCE: Outcome One: An effective, accessible and coordinated health care system built around the needs of individuals, families, caregivers and communities, and supported by competent, accountable health professionals and secure digital information systems Key Objectives 1.1 Increase health system capacity and reduce wait times, particularly for publicly funded surgical procedures and diagnostic MRI and CT scans, emergency medical services, and intensive care units. As the province emerges from the pandemic, Alberta Health continues to prioritize health system capacity, including building surgical and Intensive Care Unit (ICU) capacity, as well as the health workforce. Several initiatives are underway to minimize disruptions to patient care and expand the capacity of Alberta’s publicly funded health care system permanently. This also includes preparing to respond more effectively to any future health crises and reducing wait times across the health care system. A resilient, sustainable health system will allow the system to operate at full capacity for longer periods before needing to adjust health care resources. The policy has overall goals of improving access to scheduled health services, improving wait time measurement and reporting, and ensuring timely communication for patients. In November 2022, Alberta released the Health Care Action Plan (HCAP). The HCAP identifies immediate government actions to build a better health care system for Albertans. In order to meet the growing demands of Alberta’s health care system, an Official Administrator was appointed to Alberta Health Services (AHS) to provide leadership to address the four goals of the HCAP: • decrease emergency department wait times; • improve emergency medical services response times; • reduce wait times for surgeries; and, • empower frontline workers to deliver health care. Since 2019, government has been committed to increasing surgical capacity to keep pace with demand and reduce the length of time Albertans are waiting for scheduled surgeries. Efforts are geared towards improving patient navigation of the health care system through enhanced care coordination and surgical pathways and resources; improving specialist advice and collaboration with family physicians before consultation; and, centralizing referrals for distribution to the most appropriate surgeon with a shorter wait list. Through the Alberta Surgical Initiative (ASI), Alberta Health continues to work with AHS to improve and standardize the entire surgical journey through: • prioritizing surgeries and allocating operating room time according to the greatest need; • streamlining referrals from primary care to specialists; • increasing surgeries at underutilized operating rooms, mainly in rural areas; and, • providing less complex surgeries through accredited chartered surgical facilities (CSFs) to provide publicly funded insured services and extend existing capacity in hospitals. Through these dedicated efforts, the total number of surgeries completed in 2022-23 was 292,500, which is over 13,900 more surgeries than the year before. Further, approximately 22,100 cancer surgeries were completed in 2022-23, which represents a 10 per cent increase compared to the pre-pandemic amount. Nearly 65 per cent of the cancer surgeries were completed within clinically recommended wait times. By the end of 2022-23, AHS had cleared all postponed surgeries due to COVID-19, and continues to work on reducing wait times. The main focus remains on those patients that are waiting the longest out of clinically recommended targets, and the most acute cases. As of March 31, 2023, AHS reduced the adult surgical waitlist by more than 7,000 patients, and the total number of cases on the adult surgical waitlist is 67,186 which is less than before the pandemic. In 2022-23, there were 38 existing CSFs and three new CSF contracts were implemented to expand publicly funded surgical capacity in these facilities. CSFs are an extension of existing capacity in hospitals and used in many other Canadian health systems. Under the Health Facilities Act, CSFs providing publicly funded insured services must be accredited by the College of Physicians and Surgeons of Alberta, and have a signed service contract with AHS. In 2022-23, accredited CSFs in Alberta provided approximately 47,400 surgeries, which is equivalent to 16.2 per cent of publicly funded scheduled surgeries. In Alberta and other provinces, wait times for three common surgical procedures (hip replacement, knee replacement and cataract surgeries) continue to be impacted by delays due to the COVID-19 pandemic and workforce shortages. The 2022-23 results for hip, knee and cataract surgical procedures showed a decline, meaning that fewer Albertans received these surgical procedures within national benchmark wait times when compared to 2021-22 results. The chart below shows quarterly trends for the three common surgical procedures completed within national benchmarks in 2022-23. There were improvements in the number of cases completed for hip and knee replacements over the course of 2022-23, showing increases of 13 per cent and 15 per cent (respectively), and demonstrating significant improvements with the appointment of the Official Administrator and the implementation of the HCAP in November 2022. While the quarterly results for cataract surgery declined in the second quarter, the number has stabilized in the third quarter since the implementation of HCAP and is beginning an upward trend in the fourth quarter, although it is slightly below the first quarter result. Since 2019-20, there has been a 20 per cent improvement in cases completed within national benchmarks for cataract surgeries, ranking Alberta as a top performer nationally. As part of ASI, Alberta Health has worked with AHS to implement additional measures aimed at improving access and wait times for surgery. Work is ongoing to increase the use of Rapid Access Clinics to reduce wait times for the assessment of orthopedic issues, reducing unnecessary consultations and decreasing wait times for consultations. The Facilitated Access to Specialized Treatment (FAST) program accelerates implementation of central intake for orthopedic and urology surgery to allow patients to see the first available surgeon. Work has begun on the implementation of the Electronic Referral System (ERS), which will expedite referrals for Albertans requiring assessment by surgical specialists. In addition, consultants have been contracted to enhance surgical capacity by improving inpatient surgeries scheduling, monitoring operating room capacity, and reducing patient flow variation. With the added capacity of additional CSFs offering surgeries and implementation of FAST and ERS, Albertans will experience a streamlined surgical journey from referral to consultation to surgery. More Albertans will get their surgery within the clinically recommended wait time targets, thereby reducing the amount of time they must live with pain and other inconveniences. Reducing wait times for medically necessary diagnostic tests is also a top priority for government. Each year, Alberta spends about $1 billion on diagnostic imaging, which includes ultrasounds, Xrays, mammography, MRI and CT scans. About 46 per cent of the $1 billion is allocated to AHS, while 54 per cent is allocated to community diagnostic imaging providers. Approximately one-third of all CT and MRI scans are emergency scans and are completed within clinically appropriate timelines (under 24 hours). In 2022-23, a total of 520,504 CT scans and 231,030 MRI scans were completed across the province. The wait time for both types of scans increased due to a sharp increase in demand and staffing issues. Alberta Health and AHS continue to implement the Diagnostic Imaging Action Plan developed in 2019 to facilitate timely access to CT and MRI scans. As part of the plan, there is a significant focus on triaging patients to ensure that those who need urgent scans can get one as soon as possible. In addition, the Clinical Decision Support (CDS) within Connect Care aims to improve appropriateness of referrals and triage decisions. AHS has reached a five-year agreement with radiologist groups in Edmonton and Calgary to reduce wait times, and signed a memorandum of understanding with the remaining three largest radiology providers in Alberta North, Central, and South Zones. In total, 83 per cent of provincial radiologists have signed agreements with AHS. As part of the HCAP, the Government of Alberta is working with AHS to improve emergency medical services (EMS) response times. Improved ambulance times means that Albertans are receiving the urgent care they need from highly skilled paramedics more quickly. The Alberta Emergency Medical Services Provincial Advisory Committee (AEPAC) was established and tasked with providing immediate and long-term recommendations that will better support staff and ensure a strengthened and sustainable EMS system for Albertans needing services now and into the future. AEPAC focused on the issues facing EMS, such as system pressures that may cause service gaps, staffing issues, and hours of work. This included issues related to ground ambulance, air ambulance, and dispatch. Furthermore, Alberta conducted an independent review of EMS dispatch (the Dispatch Review) to inform improvements that can be made to dispatch services overall. The Dispatch Review and full report from AEPAC were submitted to the Minister of Health in the fall of 2022 and released to the public in January 2023. The Government of Alberta accepted the final AEPAC report and Dispatch Review recommendations in full. The recommendations were focused on accountability, capacity, efficiencies, operations, performance, and workforce support. Adjustments are being made to improve EMS response times and get paramedics out of hospital waiting rooms and back into their communities. Implementation of recommendations on a priority basis has supported ongoing reduction in EMS response times and red alerts, and improvements in community coverage. In 2022-23, Alberta Health initiated several actions to address these recommendations and strengthen the EMS system across the province. Examples of projects include: • Implemented measures to improve the central dispatch system to better deal with lowacuity calls and prioritize emergent/urgent 911 calls for EMS and made workforcescheduling changes as part of the Fatigue Management Strategy. • Initiated pilot projects using an integrated Fire-EMS model to maximize the use of paramedics and increase ambulance capacity to the health care system. Examples of the projects included: using inbound EMS resources only when they are clinically required; staffing spare ambulances to support the EMS system during times of stress; and, expanding single member advanced care paramedic response units that provide immediate advanced life support care in anticipation of, or in the absence of, an available ambulance. • Introduced new provincial guidelines, including a 45-minute EMS emergency department (ED) wait time target for 911, to get ambulances back on the road more quickly. The new provincial guidelines enable fast-tracking ambulance transfers at EDs by moving less urgent patients to hospital waiting areas. • Put procedures in place to contract appropriately trained resources for non-emergency transfers between facilities in Calgary and Edmonton, freeing up paramedics. Instead of using highly trained paramedics for non-medical patient transfers to patients’ homes from a facility or acute care, alternative resources are now arranged by hospitals, also freeing up paramedics. • Granted an exemption to the minimum staffing requirements defined in the Ground Ambulance Regulation, significantly expanding the instances where an emergency medical responder can meet the staffing requirements for all classes of ambulance, to alleviate staffing challenges across the province. • Empowered paramedics to assess a patient's condition at the scene to decide if they need ambulance transport to the hospital. In 2022-23, a total of $590 million was spent on EMS. Capacity increases were laid out in the AHS’ EMS 10-Point Plan and recommendations by AEPAC, including increases in paramedic workforce and adding ambulances to the system. As of March 31, 2023, there are 8,417 regulated members in the province registered with the Alberta College of Paramedics, including 1,383 emergency medical responders, 4,050 primary care paramedics, and 2,984 advanced care paramedics. AHS added 19 new ambulances in Calgary and Edmonton and more ambulance coverage in Chestermere and Okotoks, and hired 457 new staff members, including 341 paramedics. Increased capacity helps reduce EMS response times and red alerts and improves working conditions for frontline practitioners and community coverage, especially for life-threatening conditions. Measures to address staffing issues include AHS’ Fatigue Management Strategy, a recruitment campaign aimed at other provinces and Australia, development of a Provincial Service Plan, and interim AEPAC recommendations brought forward in June 2022, granting an exemption to expand use of emergency medical responders and pilot projects to give greater autonomy to ambulance operators using an integrated fire-EMS model. In addition, keeping paramedics out of hospital waiting rooms and in communities has contributed to decreased EMS response times and red alerts, improved community coverage, and quicker access to EMS. The HCAP 90-day Report released in February 2023 (https://www.albertahealthservices.ca/assets/about/aop/ahs-aop-90-report.pdf ) shows an early reduction in response times and red alerts, and greater focus on urgent/emergent 911 calls through low-acuity diversion measures and non-clinical patient transport programs across Alberta, particularly in Calgary and Edmonton. Comparing November 2022 to March 2023, EMS response time for the most urgent calls in metro and urban areas was reduced from 21.8 minutes to 15 minutes. Improving access to EMS enables timely patient care and entry into the health care system. The government also launched the EMS/811 Shared Response program to ensure patients receive the level of care they need and reduce unnecessary ambulance responses. Calls that have been assessed as not experiencing a medical emergency that requires an ambulance are transferred to Health Link 811, where registered nurses provide further triage, assessment and care. Since the launch in January 2023, more than 2000 911-callers with non-urgent conditions were transferred and helped by Health Link 811, keeping more ambulances available for emergency calls. In October 2022, government appointed a Parliamentary Secretary of EMS Reform to work with health partners to set priorities for service improvement based on AEPAC and Dispatch Review report recommendations. Remaining AEPAC and Dispatch Review recommendations have been incorporated into the AHS Operations Plan and are being prioritized and monitored by the EMS Reform Parliamentary Secretary. There are almost two million visits to Alberta EDs every year. Alberta Health together with AHS is working to improve patient flow within the health system, in particular to reduce ED wait times. AHS is committed to improving the experience of patients and families from the time they seek emergency care until the time the patient is discharged or admitted. There are 780 more staff in EDs today than in December 2018. AHS is working diligently on several initiatives to improve access to emergency care including improving access to continuing care living options, expanding hospital capacity, and implementing initiatives in hospitals to streamline patient treatment and discharge. In 2022-23, alternate level of care days were reduced by enhancing social work supports in acute care to address barriers for discharge. This included adding a fast-track area at the Alberta Children’s Hospital in Calgary, and deploying additional units of EMS mobile Integrated Health Units in Calgary and Edmonton to provide care for unscheduled needs within the community (i.e., IV antibiotics, rehydration, and transfusions at home). In January 2023, the Bridge Healing Transitional Accommodation Program was launched in Edmonton to support transitioning of patients experiencing homelessness as they are discharged from emergency departments. The initiative aims to reduce hospital readmission rates for Albertans experiencing homelessness by providing wrap-around health and social services. This program provides 36 beds to support this vulnerable population. Over the next three years, $305 million will be provided for additional health care capacity on a permanent basis under the HCAP. This includes approximately $268.6 million in operating funds and $36.4 million for capital projects to increase ICU capacity on a permanent basis. Approximately $61 million was spent in 2022-23 to create 50 permanent new fully equipped and staffed adult ICU beds across the province, which brings the number of ICU beds up to 223 from 173 before the pandemic. The pandemic has shown that more permanent capacity and staff are needed, particularly in rural and remote areas. The ministry continues to address ICU staffing shortages across health care facilities in Alberta. As vacancies are filled, ICU beds are reopened. Temporary bed closures are implemented only as a last resort, and patients continue to receive safe, high-quality care. AHS filled 392 positions, as of the end of fiscal year 2022-23, to support the new beds. These positions included nurses, allied health professionals, pharmacists, and clinical support service positions for diagnostic imaging and service workers. The latest data available at the end of fiscal year 2022-23 indicated that the provincial ICU baseline occupancy rate was 82 per cent, a 29 per cent improvement from being at over capacity (115 per cent) in 2021-22. Increasing ICU capacity ensures that Albertans receive care when they need it most. However, unplanned temporary service disruptions, including bed reductions, are not unusual in any health system, as services and beds are managed based on patient need, staffing levels, acuity of patient health, and other factors. Government works to ensure patients continue to receive safe, high-quality care. Occasionally, however, temporary bed closures are implemented as a last resort. Government is committed to ensuring that any Albertan who needs acute care will receive it. Workforce challenges remain a significant barrier to improving wait times for surgery given the high demand for anesthesiologists in Canada and international jurisdictions. Alberta Health is reviewing and developing options to support continued implementation of the Anesthesia Care Team Model in AHS and CSFs. The implementation of the Anesthesia Care Team Model aims to use anesthesiologists more resourcefully for some ophthalmology and orthopedic surgeries by employing a multidisciplinary team that works under supervision of the anesthesiologist to support anesthesia services in the operating room. Recruitment efforts are underway through AHS to attract more anesthesiologists to Alberta, including in rural areas. In March 2023, government released MAPS Strategy, which sets out a framework for supporting the province’s current health care workers and building the future workforce that can support Albertans getting the health care they need when and where they need it. Alberta has various initiatives underway to attract and retain nurses and increase system capacity. Alberta Health worked with the College of Registered Nurses of Alberta to streamline registration processes for Internationally Educated Nurses (IEN) and developed a grant agreement with the Alberta Association of Nurses for nurse navigators to support IENs going through the assessment, education, and registration processes. Announced in September 2022, the Modernizing Alberta’s Primary Health Care System (MAPS) initiative formed three panels to provide advice to the Minister on ways to improve the primary health care system, thereby improving the overall efficiency of the health care system. On February 21, 2023, the Minister announced an investment into primary health care of $243 million over three years; of this, $125 million is allocated for MAPS recommendations. In addition, the Minister accepted, in principle, early opportunities for investment that could be implemented to enhance Albertans’ access to primary health care immediately. On March 31, 2023, the MAPS Strategic Advisory Panel and Indigenous Primary Health Care Advisory Panel submitted parallel final reports to the Minister, outlining transformative strategic roadmaps for the next 10 years of primary health care in Alberta. These reports address both Indigenous access to primary health care and advice on improving primary health care for all Albertans. The intent of the MAPS initiative will be to reorient the health system around primary health care, thereby improving patient outcomes and reducing costs and decreasing pressures on the acute care system in the long-term. Partnerships and collaboration between primary care providers and specialists will improve patient wait times and health outcomes. The ASI Care Pathways and Specialty Advice, which includes the Provincial Pathways Unit and provincially aligned non-urgent telephone advice service programs, support consistency and quality to ensure continuity of care across the patient journey. The Provincial Primary Care Network provided these projects with conditional endorsement to begin transition to operational shared service programs. Primary Care Networks (PCNs) are also working with other stakeholders on the ASI to improve primary care and specialist linkages and patient navigation of the health care system by building and leveraging PCN specialist linkage programs. Some initiatives include Strong Partnerships and Transitions of Care for the Central Zone; Patient’s Medical Home, including referral navigators; Specialist LINK Tool for the Calgary Zone; Connect MD for the Edmonton and North Zones; FAST General Surgery for the Edmonton Zone; and, Specialist Integration Task Group for the Calgary Zone. Modernize Alberta’s continuing care system, based on Alberta’s facility‐based continuing care and palliative and end‐of‐life care reviews, to improve continuing care services for Albertans living with disabilities and chronic conditions (including people living with dementia). Government continues to be committed to addressing gaps in the continuing care system, and meeting the needs of Albertans by implementing transformative changes within the system. Alberta Health worked with partners to develop a new legislative framework for the continuing care system. The Continuing Care Act (Act), which received Royal Assent on May 31, 2022, will increase clarity regarding services, address gaps and inconsistencies across services and settings, enable improved service delivery for Albertans, and support health system accountability and sustainability. Multiple pieces of legislation will be consolidated into the Act, which establishes clear and consistent oversight and authority over the delivery of continuing care services and settings. The new legislation was proclaimed to be in effect April 1, 2024, except for sections regarding administrative penalties, which will be proclaimed on April 1, 2025. Implementation of the legislative framework will better support Albertans transitioning between care types and settings, including home and community care, supportive living accommodations, and continuing care homes. The continuing care system in Alberta provides a range of services for health, personal care, and housing to ensure the safety, independence, and quality of life for people in Alberta, regardless of age, based on their evaluated need for continuing care assistance. Publicly funded care options include home and community care; continuing care homes, which includes Designated Supportive Living and Long-Term Care; and, Palliative and End-of-Life Care services (PEOLC). In addition, Albertans have the option to access housing support in supportive living settings, such as lodges, group homes, and seniors' complexes. In 2022-23, 871 new continuing care beds/spaces were created at AHS-operated or contracted facilities to meet Albertans’ needs. The government continues to be committed to expanding the number of available continuing care spaces throughout the province and enhancing the continuing care system to effectively meet the needs of Albertans by incorporating recommendations from the Facility-Based Continuing Care (FBCC) Review Final Report, which was released on May 31, 2021. Alberta Health has acted on several recommendations from the FBCC review, including the introduction of self-managed care as a way to provide greater choice regarding locations, types and providers of services. Further, Alberta Health has enhanced client choice by supporting more continuing care clients in the community rather than at FBCC sites. Alberta Health worked with Alberta Blue Cross and AHS to successfully implement the ClientDirected Home Care Invoicing model. This model was implemented in the Edmonton Zone in April 2022, and in the Calgary Zone in the fall of 2022. Expansion to rural areas of the province will move forward over the course of 2023 to provide Albertans with increased choice and flexibility in selecting their home care service provider and the ability to better direct how their care is provided. In June 2022, Alberta Health worked with AHS to initiate a Request for Expression of Interest and Qualification (RFEOIQ) procurement process to explore opportunities to optimize the provision of home care services in Alberta, as well as identify innovative service delivery solutions to support specialized needs and populations. Albertans will begin to see the outcomes and impacts of the RFEOIQ process during fiscal year 2023-24, as the successful proposals are implemented. Another recommendation from the FBCC report was to streamline inspections. Transition of continuing care facility audits from AHS to Alberta Health began in March 2022. A coordinated monitoring approach has reduced duplications of both reviews and site visits. In 2022-23, over 1,100 inspections were completed on accommodation and care in continuing care facilities across the province. Alberta Health also followed up on over 940 reportable incidents of resident safety or care concerns and conducted 103 complaint investigations. These activities continue to provide assurance that residents and clients are receiving safe and quality care and services. Budget 2022 allocated $204 million in capital grant funding over three years to expand capacity for continuing care. The inaugural Indigenous Stream was launched in 2021 to support continuing care facilities on and off reserves/settlements. As of June 2022, seven projects were approved for $67 million to develop 147 continuing care spaces. The inaugural Modernization Stream was launched on September 20, 2022, and concluded on January 6, 2023. This stream focused on refurbishing and/or replacing existing aging continuing care infrastructure at non-AHS owned facilities. The Government of Alberta continues to prioritize quality PEOLC by investing $20 million in over 30 projects since 2019. Progress to date on projects commenced in 2020 include: • Covenant Health continued to work to increase general awareness of PEOLC, increase uptake of advance care planning and develop standardized, competency-based education to support the provision of high-quality PEOLC. • In October 2022, Covenant Health’s Palliative Institute launched the Compassionate Alberta website, (compassionatealberta.ca) which is a resource aimed at increasing awareness around palliative care and to help Albertans have open and honest conversations about death. • Between April 2022 and March 2023, the Alberta Hospice Palliative Care Association successfully launched two programs that addresses the needs of caregivers and those with a life-limiting illness (the Living Every Season Program) as well as grief and bereavement needs for Albertans (the You’re Not Alone Grief Connection Program). In November 2021, Alberta Health released the PEOLC call for grant proposals. The grant program focused on projects that address the four PEOLC priority areas identified in the Advancing Palliative and End‐of‐Life Care in Alberta Report. As a result of this grant call, a total of 25 new PEOLC grants were initiated in April 2022, totaling $11.3 million. The funding and project breakdown is as follows: • Nearly $4.2 million for eight projects to expand community supports and services. • More than $4.1 million for 10 projects to improve health-care provider and caregiver education and training. • More than $1.9 million to support four projects that advance earlier access to palliative and end-of-life care. • More than $1.1 million for three projects for research and innovation. In June 2022, the Pilgrims Hospice Society completed a one-year, grant-funded project that supported care navigation services, which provided Albertans with information on residential support programming and provided staff training on hospice care. Pilgrims Hospice Society also received $2.5 million in October 2022 to support residential hospice care at the Roozen Family Hospice Centre in Edmonton. This demonstration project will provide important information on the standalone hospice model used at the centre, including usage data and service quality, to identify longer-term options for funding and expanding residential hospice services in Alberta. Government continued to invest in supporting the nearly one million Albertans who are caregivers for family and friends. This included approximately $2 million in grant funding since 2022 to Caregivers Alberta to enhance their programs and services; to Norquest College for the Skills Training for caregivers with a focus on rural areas; to the University of Alberta to reduce caregiver distress and support family and friend caregivers to maintain their health and well-being; and, to the Alzheimer Society of Alberta and the Northwest Territories to focus on delivering communitybased programming for persons living with dementia and their caregivers. In 2022-23, the Government of Alberta continued to support innovations in dementia care through the Community-based Innovations for Dementia Care initiative, which supported 15 communitylevel projects, and through multiple projects delivered by the Alzheimer Society of Alberta and the Northwest Territories: • The Alberta Employers Dementia Awareness Project identified the needs of employers to develop best practices to create inclusive workplaces. This included piloting and launch of the Dementia Alberta website (https://www.dementiaalberta.ca) to ensure dementia in the workplace awareness materials are available to Alberta employers. The project also helps to ensure that employers have access to materials describing the importance of brain health and dementia risk reductions, and that employers have access to sample guidance, facts, tips and scenarios applicable to Alberta employers and employees. • The expansion of the First Link® early intervention program by enhancing outreach to and in rural communities. During the project, 113 rural communities received outreach and 91 small cities, specialized municipalities, municipal districts, towns, villages or summer villages received outreach services. • The Community Dementia Ambassador Project, which created a program delivered by volunteers (Ambassadors) who live in or are familiar with the cultural and social values of Alberta communities. This project identified 22 Ambassadors from 16 communities, including Cardston, St. Paul and Peace River. Ambassadors reached more than 1,325 Albertans. To support the continuing care sector and its staffing needs, the government is exploring ways to increase the number of students enrolled in Health Care Aide (HCA) programs at various postsecondary institutions. Government is funding an additional 1,090 seats in HCA programs over three years, and invested $12.8 million to provide bursaries for HCA students to assist with education costs and encourage them to become HCAs. The HCA bursary program, administered by NorQuest College, went live July 1, 2022, and included three streams of funding: the Financial Incentive program, the HCA Tuition Bursary program, and the Workplace Tutor program. Under the Financial Incentive program, students who were enrolled in a licensed HCA program between January 1 and June 30, 2022, are eligible for up to $4,000 if they agree to work a minimum of 1,000 hours with an identified continuing care operator within one year of starting employment. Eligible HCA students may receive up to $9,000 through the HCA Tuition Bursary program. The Workplace Tutor program provides funding for identified continuing care operators to educate and train HCAs at their workplace. Demand for the bursaries is steady with over 600 students applying for the regular bursary and approximately 350 HCA students approved to receive the bursary. These bursaries will remove barriers for students, and pay for schooling and other expenses while they are completing their program. From July 2022 to March 31, 2023, government provided $20.6 million to continuing care operators to partially offset inflationary increases to accommodation charges for continuing care residents. This support made accommodation charges more affordable for residents and shielded them from the full cost of living pressures associated with higher-than-average inflation. The government provided $1 million to improve access to non-medical supports in the community. This included initiatives with United Way Calgary and the Edmonton Seniors Coordinating Council to provide more community supports and navigation assistance for clients seeking this help, expanding caregiver supports. In 2022-23, the percentage of medical patients with an unplanned hospital readmission within 30 days of discharge from hospital was 12.8 per cent. This was one per cent lower compared to last year (2021-22). A lower percentage means fewer patients have been readmitted to hospital within one month of discharge. A high rate of readmissions increases costs and may mean the health system is not performing as well as it could be. Although readmission may involve many factors, lower readmission rates show that Albertans are supported by discharge planning and continuity of services after discharge. Rates may also be impacted by the nature of the population served by a hospital facility, such as elderly patients or patients with complex health needs, or by the accessibility of post-discharge health care services in the community. Coordination of care is also improving with increased access to virtual care services and supports as well as recent enhancements to health information systems that enable electronic notification of primary care doctors when their patient is admitted or discharged from hospital. 1.3 Use digital technology to enable new models of care and reduce manual and paperbased processes. Government continues to enhance the digital health environment to provide Albertans with digital access to their health information and give health care providers more complete digital patient information at the point of care to enhance quality of care for Albertans. Collecting health system data helps support evidence-informed decisions to address changing circumstances and to keep Albertans informed. The digital modernization of the health care system involves several key elements. The MyHealth Records (MHR) portal allows Albertans to access their health information. In 2022-23, over $7.9 million was spent on MHR. Alberta Netcare, the province's Electronic Health Record, is available to health care professionals in the community and AHS. In addition, Connect Care, an integrated system with Alberta Netcare, serves as a common platform for clinical information and stores all medical records, prescriptions, and care history collected from AHS facilities, including doctor's notes. Giving Albertans digital access to their health information via the MHR portal reduces the need for them to manually request that information separately from each health provider. Albertans registered on MHR has grown from 1.25 million users in March of 2022 to just under 1.5 million users at the end of March 2023. MHR portal capabilities have been expanded with the addition of immediate release diagnostic imaging reports including CT and MRI scans. The Apple MHR App is now integrated with Apple Health Kit, allowing Albertans to connect health information from their Apple Health App account to MHR. These information technology components facilitate the shift from paper-based processes to digital processes and support the expansion of virtual care options. In 2022-23, new services to support electronic referral as part of the ASI were planned and developed. A data feed is being tested, paving the way for future referral notifications in MHR and in the Electronic Medical Records (EMR) systems of referring providers. Other improvements also included continuity of care services: • Patient data from the Central Patient Attachment Registry is now integrated with Alberta Netcare, enabling health care providers across Alberta to access information on the patient’s medical home, and who their primary provider is. Design work on Alberta’s version of the International Patient Summary is nearing completion and development work will begin shortly with EMR vendors. A patient summary is a collection of clinical and contextual information about a patient’s health details. The Alberta version of the national standard is being coordinated with Ontario and Canada Health Infoway (a not-for profit funded by the Government of Canada) and includes necessary minimum amount of information to inform patient treatment at point of care. Alberta is hoping to have at least one EMR vendor conformed to Alberta’s Patient Summary in 2023, with additional vendors onboarded in 2024. • The Community Information Integration (CII) project improves Albertans’ access to primary care and community health information by collecting patient data from physician offices and other community-based clinics and making it available to other health care providers through Alberta Netcare. Over $6.5 million was spent on CII in 2022-23. In January 2023, there were 1,764 providers live on CII, taken from 430 clinics across 40 PCNs, and nearly 1.2 million Albertans in the Central Patient Attachment Registry database. More than seven million patient encounters and over 500,000 consult reports have been submitted to Netcare as of March 31, 2023. As the province emerges from the pandemic, the expectations of Albertans have shifted and there is a greater reliance on accessing on-demand virtual government services. In alignment with the Government of Alberta Digital Strategy and Alberta Health’s eHealth Strategy, developed in 202122, Alberta Health will modernize digital service delivery, increase productivity, save tax dollars, and improve user experience by better integrating technologies into the delivery of government services. In 2022-23, $5.7 million was spent through the Health Canada Bilateral Agreement for PanCanadian Virtual Care to address secure messaging, secure video-conferencing technology, remote patient monitoring technologies, patient access to COVID-19 and other lab results, and back-end supports for integration of new platforms. This investment supported Alberta Health’s ongoing initiatives foundational to expanding the virtual health care system. Alberta Health has identified four strategic priorities for virtual care delivery in the province, which are reflected in Alberta’s Virtual Care Action Plan: • establishment of an eHealth Strategy that includes a strategy for virtual care; • expansion of the MyHealth Records patient portal capabilities, including expansion of lab results and addition of diagnostic imaging results; • development of secure messaging services for Alberta, including advanced services for twoway integration between community EMRs and Alberta Netcare; and, • development of a privacy and security framework for virtual care. Access to the MHR portal is free at https://myhealth.alberta.ca/myhealthrecords. Currently, Albertans can view parts of their Netcare record, including their medications dispensed through community pharmacies, lab results and immunization history through MHR. In 2022-23, discussions and approval processes for MHR and Alberta Netcare were underway for implementation. This enables Albertans to be active participants in their own health management. The ministry continues to make progress on a phased roll out of Connect Care within all AHS facilities to support digital modernization of the health system. In 2022-23, five of the nine planned launches for this multi-year project had been completed. Connect Care provides a single source of information in AHS to support team-based, integrated care with a focus on the patient and the efficient and effective provision of services. In 2022-23, over $260 million was spent on Connect Care. The total cost of Connect Care when completed is expected to be $1.45 billion. Although progress was slowed by the pandemic, work continues on the remaining four launches of deployment. All launches are expected to be completed by fall 2024 and approximately 145,400 users are expected with full roll out of the program. The application of modern technologies will support the delivery of innovative care models that empower patients, families and their health care teams to improve quality of care. In 2022-23, eight digital health projects were funded at the Universities of Alberta and Calgary for a total investment of $9.6 million from AHS and Alberta Innovates. These academic-clinical collaborations will help AHS identify and advance solutions that improve health care quality, health outcomes, and overall value for Albertans. Projects include the integration of prevention into Connect Care to improve the health of Albertans; digital tools such as clinical decision support and remote monitoring for people with kidney issues to reduce acute care use; tele monitoring to reduce adverse events for hospitalized patients; and, an integrated digital health approach to diabetes with First Nations in Alberta. Digital technology is also being leveraged to modernize critical capabilities to administer the Alberta Health Care Insurance Plan (AHCIP) and support core business, such as claims processing and payment to health care providers. To better meet the needs of Albertans and care providers, work continued on future models of care and emerging digital technology to replace and redesign mainframe systems to increase functionality and reduce maintenance costs. In 2022-23, over $6.5 million was spent on this initiative and the work towards the replacement and redesign of nine applications used to administer the AHCIP is ongoing. 1.4 Ensure processes for resolving patient concerns are effective, streamlined, and consistent across the province. It is important that Albertans are aware of what resources are available to help them resolve patient concerns, and how their valuable feedback can help improve the quality and safety of health services. The Office of the Alberta Health Advocates empowers Albertans to advocate for their health needs; resolves their concerns and refers individuals to programs and services to address their complaints; educates Albertans about the province’s Health Charter; and, provides health selfadvocacy skills and health literacy education to promote early resolution of issues and remove barriers and gaps in care. In February 2023, government appointed a new Health and Mental Health Advocate to be a strong voice for Albertans when it comes to their health care and to ensure the health system operates effectively for all Albertans. From April 1, 2022, to March 31, 2023, there were 2,589 Albertans served by the Office of the Alberta Health Advocates. More specifically, there were 1,565 under the Health Advocate’s jurisdiction, 742 under the Mental Health Advocate’s jurisdiction, and 175 files that were under both jurisdictions. The Office of the Alberta Health Advocates hears the patient perspective on care experiences and provides feedback to entities in the health system through effective partnership and collaboration to encourage system improvement/change and effective legislative development. The ministry is committed to ensuring the patient complaints process is fair, responsive, and accessible and has processes in place to review and respond to feedback from patients and families. Recommendations to improve the current processes for resolving patient concerns and complaints have been developed, informed by consultation and research led by the Health Quality Council of Alberta. These recommendations were approved by government in the summer of 2022; Alberta Health is working on their implementation which is to expand the role and mandate of the Health Advocate; centralize intake, triage, navigation and standardize follow up with Albertans for all patient complaints; and, require mandatory information exchange between stakeholders to support improved public reporting for health care complaints. Once the recommendations are fully implemented, Albertans will have a simplified process to raise concerns and complaints about health care, and the Health Advocate will help them find the appropriate body to review and investigate the complaints. The Health Advocate will help improve accountability by monitoring the status of the resolution processes for completion and closure. Concerns and complaints will continue to be reviewed and investigated by AHS, health professions and other bodies created under statute to hear concerns. Alberta Health continues working with First Nations and Métis health leaders to better understand their experiences with the current complaints management systems in Alberta, involve them in identifying ways to build Indigenous patient trust in the health care they receive, and to ensure their concerns are addressed appropriately. The outcome of this work will improve the current complaints management system by removing existing red tape and making the system easier to navigate for patients and families. Outcome Two: A modernized, safe, person-centred, high quality and resilient health system that provides the most effective care now and in the future for each tax dollar spent Key Objectives 2.1 Continue to implement strategies to bring Alberta’s health spending and health outcomes more in line with comparator provinces and national norms, including implementation of AHS review recommendations and working with the Alberta Medical Association to reach a fiscally sustainable agreement. Albertans want and deserve a health care system that meets their needs, while also understanding the system needs to be sustainable. Government’s focus on ensuring value for money spent on health care supports this vision through actions and initiatives that make the most of taxpayer dollars. Budget 2022 invested $22.5 billion in Health’s operating budget to keep Albertans safe and healthy. In 2022-23, Alberta received $5.8 billion in Government of Canada transfers, of which $5.5 billion was the Canada Health Transfer (CHT). The CHT included a $232 million one-time funding to address surgery backlog resulting from the COVID-19 pandemic. In February 2023, Alberta reached an agreement with the Government of Canada to invest more than $24 billion in Alberta's health care system over the next 10 years through the CHT. This funding aims to respond to the immediate needs of Albertans under the Health Care Action Plan, as well as improve access to family health services, including in rural and remote areas and in underserved communities; foster a resilient and supported health workforce; improve mental health care and addictions services; and, allow Albertans access to their own electronic health information. The ministry continues to closely monitor provincial per capita spending on health care to quantify progress on government’s broader commitment to get the most value for each dollar and improve access, and make the health system work better for Albertans, while managing cost growth in health care. The Government of Alberta continues to collaborate with health system partners to manage the biggest cost drivers in the health system – namely hospital services, labour and physician compensation, and publicly funded drug benefit programs. In 2022-23, the Government of Alberta spent $4.3 billion on hospital services (i.e., acute care), $6.0 billion on physician compensation and development, and $2.5 billion on drugs and supplemental health benefits. The pandemic caused per capita health care spending for all provinces to increase significantly. The national average increased from $4,835 in 2019-20 to $5,628 in 2021-22. The Alberta provincial per capita spending on health care in 2021-22 is estimated to be $5,384, on par with the Canadian average. Improving efficiency and ensuring more value for tax dollars will improve health outcomes and support fiscal sustainability of the health system. The Alberta Health Services (AHS) Performance Review identified opportunities for AHS to reduce costs and improve health outcomes by using resources more efficiently. The ministry will continue to pursue opportunities to align spending with British Columbia, Ontario and Quebec by implementing efficiencies and reducing drug costs through the work of the pan-Canadian Pharmaceutical Alliance. AHS continues to find ways to improve the health system and access to services to Albertans. Actions implemented as a result of the 2019 AHS Performance Review have had substantial impacts on the health care system and savings have been used to improve front-line care and system sustainability (https://open.alberta.ca/publications/alberta-health-services-performance-reviewsummary-report). Implementation of the AHS Review initiatives was concurrent with a global pandemic, labour negotiations and development of a new agreement between the government and the Alberta Medical Association (AMA). Operating expenditures (excluding COVID-19 costs) increased by 6.1 per cent in 2022-23 when compared to 2021-22. Alberta’s population growth and aging population has resulted in increased demand for healthcare services. The overall increase also reflected implementation of the new agreement with the AMA and recent settlements with various health labour unions. Despite these cost pressures, health spending growth is lower than the combined population growth and inflation increase. Protecting and improving the quality of health care in Alberta also requires capital investments. In 2022-23, a total of $841 million was invested in health-related capital projects across the province, including technology and information systems maintenance and renewal of existing facilities. Alberta continues to expand and modernize hospitals and other facilities to protect quality health care and grow system capacity. Investments in health system infrastructure is fundamental to improving efficiency in the health care system, reducing wait-times, providing additional surgical capacity, and to generally improve patient outcomes. Budget 2022 invested $193 million over three years for the redevelopment and expansion of the Red Deer Regional Hospital Centre to increase critical services and add capacity to one of the busiest hospitals in the province. The Red Deer Regional Hospital Centre redevelopment project functional program was completed in late April. The functional program develops and validates the scope of services and projected workload, staffing, and space to meet current and emerging acute health care needs of all residents of the Red Deer Regional Hospital’s catchment area. The functional program also addresses capacity and quality of space to improve patient and staff safety, support quality of care, manage utilization efficiently and sustainably, and ensure timely access to care. When completed this project will expand inpatient capacity from 370 beds to 570 beds and add three surgical suites, plus space to add three more suites when required in the future. There will be a new cardiac catheterization laboratory, a new medical device reprocessing space, expanded ambulatory care capacity, and expansion of many other clinical programs throughout the hospital. In 2022-23, over $133 million was allocated over three years for Alberta Surgical Initiative capital projects at AHS-owned facilities. This includes the renovation of the Medicine Hat Regional Hospital, the Edson Health Centre, and the Royal Alexandra Hospital in Edmonton. Construction also progressed on the University of Alberta Hospital in Edmonton, which will include a postanesthetic recovery unit and medical device reprocessing area when completed, and the Rocky Mountain House Health Centre, which is undergoing renovations for a new procedure room and the development of a new medical device reprocessing area. Design was completed for redevelopment at the Chinook Regional Hospital that will modernize and increase surgical procedure capacity. Other work also included designing 11 operating suites at the Calgary Foothills Medical Centre. As part of Budget 2022, $2.2 billion was allocated over three years to move forward with a number of capital projects, for example: • The University of Alberta Hospital Brain Centre received $50 million over three years for a Neurosciences Intensive Care Unit. The design development report is nearing completion. • Provincial Pharmacy Central Drug Production and Distribution Centre ($49 million over three years). The design development report is complete. • The Norwood Tower at the Gene Zwozdesky Centre ($142 million over two years) received an occupancy permit in March 2023 and was turned over to AHS for operational commissioning. In 2022-23, $116 million was spent to complete the Calgary Cancer Centre. The Calgary Cancer Centre Construction is complete and AHS is preparing the hospital to open in 2024. The hospital will have 160 new inpatient cancer beds, 100 patient exam rooms, 100 chemotherapy chairs, increased space for clinical trials, 12 radiation vaults, outpatient cancer clinics, and designated areas for clinical and operational support services and research laboratories. The completed project will increase cancer care capacity in Calgary by consolidating and expanding existing services to support integrated and comprehensive cancer care. On October 6, 2022, the government executed a four-year agreement with the AMA to address common interests such as quality of care, health care system sustainability, and stability of physician practices. Implementation of the AMA Agreement is underway and includes over $250 million in new spending over four years on initiatives targeted at communities and physician specialties facing recruitment and retention issues. The agreement included concrete solutions and the financial resources to support Albertans’ health care needs by promoting system stability through competitive compensation and providing targeted funding to address pressures that require immediate and longer-term stabilization. The agreement also allows physicians to provide greater input into longer-term approaches on improving patient care and physician compensation reform initiatives. Physicians received a one per cent lump sum COVID-19 recognition payment in 2022-23. Alberta physicians were at the forefront of the pandemic and the one-time payment for eligible practicing physicians is in recognition of that work during the 2021-22 fiscal year. The lump sum payment is approximately $45 million and was provided to the AMA in December 2022 to distribute to their members. Physicians will receive an average one per cent rate increase to compensation for each of the next three years. As part of implementation of the AMA Agreement, the Business Costs Program premium rate was increased by about 22 per cent. This increase will help physicians deal with inflation and keep practices open. The increase is estimated to cost $20 million annually, providing on average an extra $2,300 annually for each physician. This is in addition to about $80 million the government currently invests in the program each year. Following the ratification of the AMA Agreement, a commitment for collaboration between Alberta Health and the AMA regarding primary health care, including one-time investments of $20 million in Primary Care Networks (PCNs) for two fiscal years, was established. The Provincial PCN Committee provided significant contributions to the work of the Modernizing Alberta’s Primary Health Care System (MAPS) initiative to improve access and quality of primary and community health services. The MAPS initiative goal is to provide recommendations on ways to strengthen primary health care and achieve a primary health care-oriented health system. MAPS is engaging leaders and experts with hands-on experience in primary health care and health systems improvement to examine the current landscape and propose improvements. By March 31, 2023, a final report was delivered proposing a strategic direction for primary health care over the next 10 years, with a parallel report providing strategic directions to improve the delivery of primary health care for Indigenous peoples in Alberta. The $20 million investment in primary health care provides significant relief across the primary health care system, particularly for PCNs that have experienced a decline in their per capita payments from declining numbers of patients. This funding provides stabilization while work is undertaken to review and improve the overall funding model for PCNs, which will consider recommendations from the MAPS initiative. For many Albertans, prescription drugs have tremendous benefits in terms of improving quality of life, managing illnesses, and in some cases, precluding the need for more extensive treatments. Alberta continued to work with the pan-Canadian Pharmaceutical Alliance (pCPA) to reduce prescription drug costs and increase access to clinically effective and cost-effective drug treatment options, including cell and gene therapy. All new drugs and/or new indications for use undergo price negotiations between the pCPA and drug manufacturers. In 2022-23, rebates have increased to an estimated $327 million from $275 million in 2021-22. This is a successful trend that shows the importance of the pCPA and Alberta’s involvement as a member to push health jurisdictions for more value and budgetary protection. In 2022-23, the province spent $2.5 billion on drugs and supplemental health benefits and continued to improve existing drug benefit programs and add innovative and effective therapies through the addition of 320 new products in 2022-23. Of the 320 products added, 48 were brand name drug products and 272 were generic products. Alberta’s Biosimilars Initiative will expand the use of biosimilars by replacing the use of biologic drugs with their biosimilar versions whenever possible. This means patients will continue receiving safe and effective treatment, but at a lower cost. In 2022-23, savings from this initiative increased to an estimated $65.7 million from $48.9 million in 2021-22. 2.2 Increase regulations and oversight to improve safety, while reducing red tape within the health system by restructuring and modernizing health legislation, streamlining processes, and reducing duplication. As of March 31, 2023, the ministry, including AHS, achieved a 36.1 per cent reduction of its regulatory and administrative requirements, exceeding the government target of 33 per cent. AHS will continue to see reductions with the ongoing launches of Connect Care across the organization, continuing through 2024. Connect Care supports digital modernization of more complete central access to patient information related to AHS services. It provides resources, including medication alerts; evidencebased order sets; test and treatment suggestions; and, care paths and best practice advisories, which result in fewer repeated tests and consistent information across the province wherever care is being provided at AHS facilities. This system also reduces the number of forms used by AHS and helps to eliminate data entry duplication. Connect Care also facilitates direct communication between patients and providers through a patient portal, MyAHS Connect, which helps patients better manage their health with online access to their health information, including reports and test results. It also allows for online interaction with their care team, an ability to review and manage appointments and after visit care summaries, and less repeating of their health histories or need to remember complex histories or medication lists. The ministry continues to monitor Alberta’s health system to ensure standards are maintained and to improve safety and quality of health care. As of March 31, 2023, amendments to the Health Professions Act have been proclaimed into force that modernize Alberta’s professional regulatory structure. This included changes to 29 regulatory college regulations and one regulation that enhance professional regulation by health profession regulatory bodies and will make it easier for regulatory colleges to be more agile and adapt faster to changing best practices. The PCN Nurse Practitioner (NP) Support Program was created to enable NPs to work to the full scope of their skills. In 2022-23, $7.6 million was provided and the program facilitated the incorporation of NPs working more than 57 full-time equivalent positions as of March 2023. The program increases access to primary health care, including after hours, weekends, and in rural and remote areas and underserved populations; supports chronic disease management; and, helps meet unmet demand for primary health care services. Challenges for the program include NP compensation, recruitment and retention, and the desire of NPs for an independent practice model. Alberta Health is currently consulting with key stakeholders on a draft NP Compensation Model to address the challenges of the program. Amendments to the Pharmacy and Drug Act and the Pharmacy and Drug Regulation came into effect June 1, 2022. These amendments allow the Alberta College of Pharmacy and pharmacies to better respond to changes in the provision of pharmacy services to Albertans and reduce significant government red tape faced by pharmacy operators. To address the current challenges in continuing care legislation and help to initiate transformative change within continuing care, Alberta Health worked with partners to develop a new legislative framework for the continuing care system to increase clarity regarding services, address gaps and inconsistencies across settings, enable improved service delivery for Albertans, and support health system accountability and sustainability. On May 31, 2022, the Continuing Care Act (Act) received Royal Assent. The Act will come into force on April 1, 2024, after the development and approval of regulations and standards. The ministry is currently working with partners on the development of those regulations and standards. When proclaimed, the Act will regulate the full spectrum of continuing care services and settings in Alberta, including continuing care homes, supportive living accommodations, and home and community care. Consequential amendments to the Act are included in The Red Tape Reduction Statutes Amendment Act, 2023. These amendments ensure alignment of terminology in existing legislation with the Act while maintaining the policies and intent of the current legislation. In May 2022, the Food Regulation under the Public Health Act was amended to eliminate the requirement for food establishments to request an approval from a public health inspector to allow dogs into outdoor eating areas. The amendment reduced red tape for operators and provided them greater flexibility in meeting the needs of their customers. The Food Regulation provides clear requirements to support the change so dogs can stay with their owners on outdoor patios, while maintaining a high degree of food safety. 2.3 Improve measuring, monitoring and reporting of health system performance to drive health care improvements. Measuring performance is the clearest way to show investments in the health care system are leading to better outcomes for Albertans. Alberta Health worked with the Health Quality Council of Alberta (HQCA) to ensure alignment of their plans and priorities with government key priorities and achieve improvements through various initiatives. On July 26, 2022, Alberta Health executed a $23 million operating grant agreement with the HQCA over three years (April 1, 2022 to March 31, 2025) to keep the organization working with patients, families, and partners from across health care and academia to inspire improvement in patient safety, person-centred care, and health service quality. As an example, Alberta Health worked with the HQCA to develop a Primary Care Patient Experience survey to engage Albertans on their experiences within the health care system. Work continued towards transitioning manual surveys to a digital, computer-adaptive testing methodologies format to use digital technology to enable new models of care and reduce manual and paper-based processes. Digital formats for surveys and reports across primary and continuing care increased Albertans’ engagement within the health system and allowed more timely feedback to service providers about care concerns, including patients’ opinions. Alberta Health worked with HQCA to create primary health care panel reports to support planning, quality improvement, health system management for overall purpose of improving primary health care delivery. The panel reports provide family physicians with information on their patients’ continuity, as well as valuable data on screening and vaccination rates, chronic conditions, pharmaceutical use, and emergency and hospital visits. Alberta Health worked with AHS and the HQCA to develop a value-based assessment tool for objectively assessing value from the Government of Alberta annual investment into health outcomes of Albertans and benchmark against other jurisdictions, particularly the comparator provinces of British Columbia, Ontario and Quebec. Alberta Health also worked with the HQCA to complete priority work on identifying emergency medical services key performance indicators. Performance measures were developed and are under ministry review, with a shift in focus to reducing response times measured at the 90th percentile, rather than the 50th percentile. Releasing the results and performance information improves quality and patient safety and assures Albertans of the government’s commitment to increase accountability and transparency in Alberta’s health care system. The adoption of best practices and monitoring of performance measures help to improve health outcomes. Work continued with the HQCA on developing the Patient Experience Awards and Quality Exchange to support excellence in care and sharing of best practices. This included continuing to develop resources and information to support and inform program planning, panel management, quality improvement and policy development in primary health care, as well as patient experience information for designated supportive living and continuing care. Information is published for Albertans in FOCUS, a dynamic online reporting tool which collects information about what patients experience in the provincial health care system, including: emergency departments, primary health care, long-term care, designated supportive living and home care. Outcome Three: The health and well-being of all Albertans is protected, supported and improved, and health inequities among population groups are reduced Key Objectives 3.1 Ensure a continued, effective response to the COVID‐19 pandemic by optimizing access to treatments and vaccine, and reducing vaccine hesitancy. The Government of Alberta remains committed to supporting Albertans as we shift to managing COVID-19 similar to how other endemic respiratory viruses are managed. Alberta’s capacity to treat and clinically manage cases of COVID-19 continues to improve. Immunization, including receiving a booster dose of COVID-19 vaccine, is one of the best choices Albertans can make to protect themselves from severe illness due to COVID-19 infection. In 2022-23, $1.2 billion was spent on COVID-19 response to ensure the health care system had the resources required to address health care pressures resulting from the pandemic. By the end of June 2022, all mandatory public health measures related to COVID-19 were lifted. This was due to increased immunization coverage, attenuation of severity of new circulating variants, and the ability to treat and clinically manage cases of COVID-19. This signaled the beginning of a shift in Alberta’s handling of COVID-19 from an emergency pandemic response to an endemic state. Government supported this transition by working across multiple facets of health care (e.g., primary care, continuing care, workplace health and safety, public health, provincial laboratory, etc.) to align public health recommendations, such as testing and isolation, across all common respiratory viral illnesses. The ministry continued to monitor the impacts and transmission of COVID-19 and other respiratory viruses in the community by working with partners on the implementation of ongoing and new COVID-19 immunization programs, including the introduction of bivalent booster vaccines, and implementing treatment protocols for COVID-19. Alberta Health and the Health Quality Council of Alberta established a COVID-19 Data Task Force, comprised of health professionals, to conduct a data review of the last several years of health information with a view to offering recommendations to the Government of Alberta on how to better manage a future pandemic. The purpose of the review is an opportunity to reflect on Alberta’s pandemic response from a data quality and validity lens to identify opportunities for improvements to manage future pandemics. To minimize the impact of COVID-19 and protect public health, COVID-19 Rapid Antigen Tests were made available across the province to all Albertans free of charge through participating community pharmacies. Initially, supply was limited and this distribution model enabled an equitable distribution of tests across the province. Between March 2021 to March 31, 2023, Alberta distributed 48.5 million rapid antigen tests to acute and continuing care sites, primary care clinics, businesses, K-12 schools, municipalities, First Nations and Métis communities, and the general public. Government developed COVID-19 vaccine strategies to help reduce the spread, minimize severe outcomes and protect vulnerable Albertans. Work continued to support the review of ongoing evidence and recommendations for immunization against COVID-19, including guidance for immunization post-infection (or hybrid immunity), as well as for fall/spring booster programs. In 2022, Alberta continuously achieved key milestones on COVID-19 vaccine administration and roll out for different age groups and populations. In April 2022, 40 per cent of Albertans 12 and older had received their third vaccine dose. In June 2022, 35 per cent of Albertans aged five to 11 had received two doses of COVID-19 vaccine. On November 14, 2022, the Pfizer vaccine was made available for individuals six months to four years of age, and on March 20, 2023, a second bivalent vaccine (spring booster) was made available for residents living in senior congregate living settings. In 2022-23, 1.4 million COVID-19 vaccine doses were administered to Albertans and 26 per cent of the population 12 years of age and older had received a booster dose. While the federal government continued to cover the costs of the vaccines, Alberta Health spent $53 million in 2022-23 to distribute the vaccines to Albertans. The Alberta Vaccine Booking System (AVBS), launched in summer of 2021, continues to provide Albertans with access to book both COVID-19 and influenza vaccine appointments at participating Alberta Health Services (AHS) or pharmacy locations by providing a centralized, province-wide online appointment booking platform. The centralization of all vaccine booking appointments, including from AHS, Public Health, and Community Pharmacy helps Alberta Health forecast vaccine demand and strategically distribute vaccine supply. Vaccine eligibility criteria and system functionality continue to be updated based on direction from provincial immunization programs. In 2022-23, more than 575,000 appointments for COVID-19 and influenza immunization were scheduled using the AVBS. Updates continue to be released to support dynamic vaccine eligibility changes and to continually improve the user experience. Previously, Albertans had to call multiple pharmacies and Health Link in an attempt to find available vaccine supply. The Health Link 811 call centre continues to support Albertans who do not or cannot use the AVBS. To ensure a continued response to COVID-19, Alberta Health together with AHS extended the provision of free personal protective equipment (PPE) to primary care physicians, pediatricians, and their staff to support their operations and enhance safety to May 31, 2022. In 2022-23, inventory consumption expense associated with the COVID-19 response was $365 million; this includes PPE, testing supplies and $88.6 million for rapid test kits. In addition, the government worked with continuing care partners to protect residents of congregate care facilities and home care clients. A total of $286 million was provided in 2022-23 for additional staffing costs and cleaning supplies, PPE and screening of visitors to protect the health and safety of residents. In 2022-23, AHS, in collaboration with the Zone PCN Committees, worked towards the administration of an oral antiviral COVID-19 treatment in respective AHS geographical zones, enhancing capacity for testing and swabbing for respiratory illnesses. In 2021-22, intravenous Sotrovimab was made available on an outpatient basis to Albertans at higher risk of severe illness or death, followed by availability of Paxlovid, the first COVID-19 treatment approved by Health Canada that can be taken orally at home. Efforts were made to recruit sentinels (primary care physicians/nurse volunteers) to increase the effectiveness of the TARRANT Viral Watch Program, which monitors respiratory infections circulating in the community. 3.2 Safeguard Albertans from communicable diseases that can cause severe illness, permanent disability, or death. The ministry works to protect Albertans from a number of communicable diseases, such as influenza, measles, and sexually transmitted and blood borne infections. Over the past year, immunization programs for vaccine-preventable diseases continued to be a primary strategy in preventing disease, disease transmission and severe health outcomes. They are key to the health of a population and to decreasing the strain on the acute care system. Through promoting initiatives that aim to increase childhood and adult immunization rates, Alberta continued to offer immunizations programs, including influenza vaccine, to Albertans six months of age and older, free of charge in collaboration with many partners. Alberta’s 2022-23 influenza season started earlier with a surge of influenza A cases in early October. The highest positivity for influenza A was 31.9 per cent in the week of November 20, 2022, and cases and outbreaks decreased significantly by the end of December 2022. Alberta had sufficient supply of influenza vaccines to immunize 38 per cent of the population. Alberta Health worked with AHS to ensure respiratory outbreak definitions and management guidelines were in place for high-risk settings, including continuing care and acute care facilities, to minimize severe health outcomes and protect the most vulnerable Albertans in these settings. Despite the challenges of fatigued providers and a generally vaccine fatigued population, the overall influenza immunization rate is one per cent higher than in 2021-22. As of March 31, 2023, approximately 28 per cent of Albertans received an influenza vaccine. Budget 2022 included an increase of $14.3 million related to the approval of the high-dose influenza vaccine for Albertans 65 years of age or older. As of March 31, 2023, approximately 64 per cent of Albertans 65 years of age and older, and 75 per cent of Albertans 90 years of age and older received a high-dose influenza vaccine. The Alberta Outreach Program started the week of October 3, 2022, to immunize those at highest risk of severe outcomes from influenza. The 2022-23 Influenza Immunization Program for the general public began on October 17, 2022, and ended on March 31, 2023. Influenza vaccine was available at over 2,500 immunizing sites, including AHS clinics, Indigenous Services Canada clinics, community pharmacies, community medical clinics, and post-secondary institutions. Immunization programs save millions of dollars, helping people of all ages live longer, healthier lives, and decreasing the burden on the health care system. The pandemic did result in some disruptions to the routine school immunization program and overall infant and preschool immunization rates have decreased. However, AHS has hired additional staff to support addressing the school immunization backlog and in-school catch-up programs, and immunization rates for school-aged children are nearing pre-pandemic coverage levels. In 2022, by age two, 71 per cent of Albertans had received immunization with diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (DTaP-IPV-Hib) vaccine and 82 per cent had received immunization with measles, mumps, rubella (MMR) vaccine. These immunization rates are both lower than the national target of 95 per cent for these vaccines. As a result of the COVID-19 response, childhood immunization rates dropped between 2021 and 2022. AHS has a catch-up program to increase childhood immunization rates to help reach the national target of 95 per cent. This includes actions such as reminder calls for booked appointments, monitoring wait times and adding appointments as needed, and following up using a recall process for children with delayed immunizations. Work is underway with service providers to enhance testing, treatment and prevention strategies, including working with community-based organizations, to improve women’s health, reduce barriers to sexually transmitted and blood borne infections (STBBI) testing and treatment, and increase access to prenatal syphilis screening. Over $8 million annually is provided to organizations to prevent STBBIs and provide wrap-around supports for people living with those infections, including $1.2 million specifically for syphilis outbreak response. In September 2022, Alberta experienced a shigella outbreak in Edmonton, which ended in February 2023 after two weeks without new cases. However, the outbreak was re-opened in March 2023, when seven additional cases were reported and some patients hospitalized. As of March 31, 2023, 214 cases were reported since the outbreak initially started; no deaths were reported. In October 2022, the Shigella Task Force brought together cross-sector partners, including representatives from Alberta Health, AHS, shelters, inner-city agencies, the City of Edmonton, local family physicians, and Alberta Precision Labs to coordinate resources and discuss options for limiting spread. Syphilis has made a drastic resurgence in Alberta since 2019, with rates being the highest in more than 70 years. Alberta Health has resumed a leadership role in the provincial syphilis response, after an interruption due to COVID-19, through work with frontline service providers to support testing, treatment, and prevention strategies. By increasing access to syphilis testing and treatment services in a variety of novel health settings, the Government of Alberta will help create awareness and normalize sexually transmitted infections testing and treatment for all Albertans. The ministry is also leading and supporting a number of provincial outbreak responses and preparedness activities including: • leading the human health response to highly pathogenic avian influenza, including supporting the update of public health disease management guidelines and communication pieces for government websites; • supporting the coordinated provincial response to the international mpox (formally known as monkey pox) outbreak, including guidelines for contact management and guidance on pre and post-exposure vaccine use; and, • working with AHS public health in preparation for response to international communicable disease outbreaks, including Ebola and Polio. In early May 2022, cases of mpox began to occur in countries where mpox was not previously detected. Canada’s first case was reported on May 19, 2022, and Alberta reported its first case on June 2, 2022. By July 2022, mpox was declared a public health emergency of international concern by the World Health Organization. Alberta Health worked in collaboration with public health partners to develop testing criteria, case definitions and public health management guidelines. The Alberta Mpox Public Health Notifiable Disease Guideline was published in June 2022. Alberta began offering post-exposure vaccine on June 7, 2022, and the targeted pre-exposure vaccine campaign began at the end of June. As of March 31, 2023, Alberta recorded 45 cases of mpox. Alberta has administered 2,183 first doses and 1,715 second doses of the vaccine. 3.3 Expand access to a range of in‐person and virtual recovery‐oriented addiction and mental health services. Reporting responsibility for this objective has transferred to the Ministry of Mental Health and Addiction. Performance Measure 3.a Percentage of mental health and addiction‐related emergency department visits with no mental health service in previous two years Reporting responsibility for this performance measure has transferred to the Ministry of Mental Health and Addiction. 3.4 Prevent injuries and chronic diseases and conditions through health and wellness promotion, and environmental and individual initiatives. In 2022-23, $646 million was expensed to support population and public health initiatives to maintain and improve the health of Albertans through services promoting and protecting health and preventing injury and disease. Government provides leadership and support to protect the health and safety of Albertans and improve their health and well-being by setting public policy in a number of areas, such as maternal, infant and early child development; injury prevention; public health matters related to cannabis use; tobacco and vaping control; and, promotion of population wellness and health equity. Government recognizes that Albertans living with diabetes want to access health programs and services that will more effectively support their needs. On July 21, 2022, the Minister announced the establishment of the Diabetes Working Group (DWG) to review Alberta’s entire diabetes care pathway, identify gaps in care, and provide recommendations to improve diabetes prevention, diagnosis, treatment, and management. In addition, Alberta Health expanded the Insulin Pump Therapy Program to include newer pumps and supplies. Albertans enrolled in the pump program now have access to the newest technologies for management of diabetes. Improved access to the newer diabetes management technologies, and the work of the DWG will improve outcomes and quality of life for Albertans living with diabetes. Nearly $7 million was provided to AHS for cancer prevention initiatives supporting comprehensive projects that are reducing the risk of cancer across the province. These projects address healthy lifestyles, smoking cessation, workplace wellness, and partnerships with Indigenous communities. In 2022-23, the Cancer Prevention Screening and Innovation initiative worked with organizations such as Promoting Health, Chronic Disease Prevention and Oral Health, AHS Provincial Population and Public Health, the Alberta First Nations Information Governance Centre, the Métis Nation of Alberta, and the new AHS Indigenous Wellness Core to: • adopt the Alberta Healthy Communities Approach to focus on scaling and spreading successful interventions provincewide; • create a working partnership with the Human Papilloma Virus community innovation for sub-populations and the Provincial Population and Public Health Screening Programs and Communicable Disease Control divisions; • improve the Healthier Together Workplace program and recognition strategy; and, • strengthen work with Indigenous communities to facilitate community action to reduce modifiable factors, raise cancer awareness and improve cancer screening. A community support model was created, and tools were adapted to support the three initial Metis Settlements to create, implement and evaluate cancer prevention action plans. Alberta Health currently funds several health promotion-based initiatives to improve individual and community health and well-being: • Alberta Health continues to support the Injury Prevention Centre to provide unintentional injury prevention programs, research, and education. Through the Injury Prevention Centre, Albertans have access to programs and education that reduce the risk of injury and make communities safer. Injury prevention is a public health priority that directly reduces costs to the health care system. Injury bears an estimated financial cost of $7.1 billion annually in Alberta, $4.6 billion of which is direct health care costs. • Physician prescription to Get Active supports individuals to become more active through physical activity. Prescriptions can be filled at participating recreation facilities for free visits, free one month facility passes and/or free fitness classes. • The Communities ChooseWell program advances healthy eating and active living by supporting communities to create local conditions and environments that enable Albertans to eat well and be active. The program provides resources, education and support to community groups as well as offering small grants for implementing local healthy eating and active living initiatives. Alberta Health provides approximately $2 million in grants annually to five programs that support vulnerable mothers and their babies. From April 2022 to September 2022, programs provided intensive supports to 287 vulnerable women who were pregnant or of child-bearing age, and more vulnerable women were provided outreach supports to address gaps in support specific to the COVID-19 pandemic. Alberta Health and AHS also provided funding to support the University of Alberta’s ENRICH Maskwacîs Kokums and Mosoms Elders Mentoring Program, which creates enhanced support networks for parents-to-be. In addition, elder support helps address a gap in service within the prenatal clinical setting by connecting parents to traditional knowledge and culture. Budget 2021 provided a total of $6.75 million over three years, including $2.25 million in Budget 2022, to establish and operate the AHS Tobacco and Vaping Reduction Act Enforcement Team. As of March 31, 2023, over $2.4 million has been spent, and the team has conducted retail inspections, established a secret shopper program and a public complaint line, and created retailer resources (handbook and signage) that will improve compliance with the Act and regulation. The most current data (from the 2021-22 fiscal year) shows the enforcement team conducted 2,400 retail inspections and provided over 4,000 copies of the retailer handbook and signs to retailers. In 2022-23, Alberta Health established the Alberta Ukrainian Evacuees Health Benefit Program. The total cost of the program was $9.5 million, including physician services. As of March 31, 2023, 24,000 Ukrainians have applied for health coverage in Alberta. In addition, the ministry established a health benefit program that provided Ukrainian evacuees with access to supplemental coverage for prescription and non-prescription drugs, nutritional products, diabetic supplies, and dental, optical and emergency ambulance services. Work continues in partnership with the ministries of Agriculture and Irrigation and Environment and Protected Areas on a One Health approach to antimicrobial resistance (AMR) in the province. This work is critical to address the emerging threat of treatment-resistant microbes in human and animal populations and in the environment. An Antimicrobial Strategic Framework for Action and Implementation plan continues to be developed to help guide collective efforts to address the growing threat of AMR in Alberta. Stakeholders and partners were consulted and supported development of the framework. In 2022-23, the Office of One Health at the University of Calgary was contracted at a cost of $200,000 to support implementation of AMR priority areas for action. As part of the contract, an advisory group on stewardship was created to provide guidance on specific activities, measures, targets, and costs for implementation. Alberta Health worked with AHS, Alberta Environment and Protected Areas, and the Alberta Lake Management Society to quickly set up a water quality (fecal contamination and cyanobacterial blooms) monitoring program for four sites on Lac Ste. Anne to support the 2022 papal visit and annual Lac Ste. Anne pilgrimage. Data from this monitoring program provided the basis for issuance of a cyanobacterial bloom public health advisory for Lac Ste. Anne shortly before the event. Alberta Health regularly assesses the evidence on water fluoridation to help support municipal councils to make evidence-informed decisions regarding community water fluoridation. The ministry worked on updating community water fluoridation position statement with new relevant research, including new local data from Calgary. Alberta Health continues to provide transparent information about environmental public health data, while simultaneously providing risk communication materials to influence modifiable risk factors within the Alberta population. Examples of public health data and information available through the Open Government Portal include: • Routine chemistry and trace element data from domestic well water samples analyzed in 2016–17 and 2017–18 are available. Alberta Health funded routine chemistry and trace elements analysis of 4,842 samples of drinking water from private water wells and 307 samples from small, public, non-municipal drinking water systems. As well, data related to the study of two stormwater ponds in Lacombe, Alberta were released to the open government portal at https://open.alberta.ca/opendata/lacombe-stormwater-ponddataset. This data includes the analysis of contaminants (e.g., mercury, polycyclic aromatic hydrocarbons, trace metals, pesticides and volatile organic compounds) in fish, sediments, and water. • The Alberta Environmental Public Health Information Network, accessible at http://aephin.alberta.ca, supports awareness and provides opportunities for Albertans, academics, and cross-government partners to learn more about environmental hazards and public health in the province. In 2022-23, new visualizations were published for “Human Biomonitoring of Environmental Chemicals in Canada and the Prairies” and a “Search Interface for Environmental Site Assessment Repository”, along with enhancements including the incorporation of new, yearly data on the recreational water bodies and the impacts of poor air quality and heat. In addition, Alberta Health developed the Extreme Heat website and notification protocol at https://www.alberta.ca/extreme-heat.aspx. • Alberta Health continued to provide real-time information to Albertans about hazards and risks associated with recreational water quality at Alberta beaches and waterbodies. In 2022, over 2,300 samples were collected from 85 recreational sites to identify fecal contamination and 436 samples were collected from 50 lakes, reservoirs, and rivers to be assessed for cyanobacterial (blue green algal) blooms and microcystin toxin. This monitoring resulted in the issuing of 47 cyanobacterial bloom advisories and nine fecal contamination advisories to protect the health of Albertans and visitors to the province. Additionally, in May 2022, Alberta Health updated the Alberta Safe Beach Protocol available at https://open.alberta.ca/publications/9781460145395 to reflect new Health Canada Guidelines for cyanobacterial blooms in recreational water. In February 2023, Alberta Health released a position statement around use of stormwater ponds at https://open.alberta.ca/publications/stormwater-ponds-in-alberta-health-guidanceinformation-sheet. • Alberta Health, as part of the Scientific Working Group on Contaminated Sites in Alberta, has published a Site-Specific Risk Assessment guidance document to clarify the specific requirements of conducting a site-specific risk assessment in Alberta, available at: https://open.alberta.ca/publications/supplemental-guidance-on-site-specific-riskassessments-in-alberta. Alberta Health and the Alberta Centre for Toxicology at the University of Calgary have published the report and dataset of “Post-Horse River Wildfire Surface Water Quality Monitoring Using the Water Cytotoxicity Test” available at https://prism.ucalgary.ca/handle/1880/115412. 3.5 Improve access for underserved populations and for First Nations, Métis, and Inuit peoples to quality health services that support improved health outcomes. The most current result available from Statistics Canada’s Canadian Community Health Survey shows that in 2021, 87.3 per cent of Albertans had access to a regular health provider, an improvement from 85.3 per cent in 2020. Having a regular health care provider is important for early screening, prevention through health and wellness advice, diagnosis, and treatment of a health issue, as well as ensuring good continuity of care and connections to other health and social services. The desired result is to increase the percentage of Albertans who have access to a regular health care provider. Increasing access to a regular health care provider is consistent with progress towards the following provincial primary health care goals: • timely access to appropriate primary care services delivered by a regular health care provider or team; • coordinated, seamless delivery of primary care services through a patient’s ‘medical home’ and integration of primary care with other levels of the health care system; • efficient delivery of high-quality, evidence-informed primary care services; and, • involvement of Albertans as active partners in their own health and wellness. Alberta’s Primary Care Networks are involved in a variety of initiatives that support provincial and health zone primary care goals, including adopting a ‘medical home’ approach in their practices. This approach strengthens the connection between a patient and regular health care provider to improve access to care, chronic disease prevention and management, continuity of care, and innovations in primary health care including telemedicine and virtual care. The Government of Alberta is committed to addressing the health needs of First Nations, Métis and Inuit peoples residing in Alberta, including working with First Nations and Métis leaders, the Government of Canada and other partners to streamline how Indigenous peoples access health services, and ensuring that health services are more culturally appropriate. There is a significant gap in equitable access to primary health care for Indigenous peoples. This is evidenced by noting that in Alberta, Indigenous peoples’ life expectancy is 16.4 years below that of all other Albertans, falling below 64 years of age. An Indigenous Primary Health Care Advisory Panel was established in the fall of 2022 under MAPS to provide advice to the Minister on how the existing primary health care system could be improved to ensure First Nation, Métis, and Inuit peoples have access to high-quality, culturally safe primary health care no matter where they live. As part of their work, the Indigenous Panel convened an Indigenous Youth Innovation Forum, Indigenous Primary Health Care Innovation Forum, and participated in the MAPS Forum and Community Care Innovation Forum. These forums, along with engagements with First Nations, the Metis Settlements General Council, the Métis Nation of Alberta, and others ensured that a broad range of perspectives informed the Indigenous Panel’s work. As part of their deliberations, the Indigenous Panel submitted recommendations to the Minister in December 2022 for early opportunities for investment in enhancing Indigenous primary health care. These recommendations were approved in principle by the Minister as a first step to improving access to more culturally safe and integrated care. In 2022-23, Alberta Health provided $8.8 million to the Indigenous Wellness Program Alternative Relationship Plan to support 24 full-time equivalent physician positions to provide care in over 20 Indigenous health care centres throughout Alberta, including the Alberta Indigenous Virtual Care Clinic. Alberta Health has a separate Alternative Relationship Plan arrangement with Siksika Nation, and provides up to $1.1 million to support three full-time equivalent physician positions to provide care in the community. Alberta Health continues to engage Indigenous health care experts through the First Nations Health Advisory Panel and a Metis Settlements Health Advisory Panel. Panel members include Health Directors from across the province, as well as other associated stakeholders. The Panels inform health priorities and strategies and assist in identifying issues or gaps in programs and services, as well as working to identify potential solutions and areas of future collaboration. Alberta Health also continued work on Alberta’s Protocol Agreement Health Sub-Tables to collaborate on addressing the health gaps identified by the members of the Blackfoot Confederacy and the Stoney Nakoda Tsuut’ina Tribal Council. Alberta Health similarly worked with the Métis Nation of Alberta under their Framework Agreement with the Government of Alberta. Alberta upholds the Jordan’s Principle commitments by working with the Government of Canada and the First Nations Health Consortium, an Alberta-wide organization developed to improve access to health, social, and education services and supports to First Nations and Inuit children throughout the province, living both on and off reserve. To ensure compliance, Alberta Health established an Executive Leadership Group (including the ministries of Children’s Services, Seniors, Community and Social Services, Alberta Education, Indigenous Relations, and Alberta Health) to implement Jordan’s Principle in Alberta and to ensure that First Nations children have access to health, social, and educational resources when required, without denial or delay related to jurisdictional dispute over payment. Alberta Health has also established a Technical Cross-Jurisdictional Working Group to address barriers impacting access to programs and services. The working group includes the First Nations Health Consortium, the First Nations Inuit Health Branch, and the Ministries of Children Services, Seniors, Community and Social Services, Education, and Indigenous Relations. On October 24, 2022, government appointed a Parliamentary Secretary for Rural Health, to work with Alberta Health to address rural health challenges, such as access and health care professionals. Budget 2022 introduced a new Rural Capacity Investment Fund, as part of the provincial agreement that impacted more than 30,000 registered nurses and registered psychiatric nurses across the province. The fund supports recruitment and retention strategies in rural and remote areas of the province, including relocation assistance. Almost $4.4 million was spent in 2022-23 to assist nearly 200 employees who chose to relocate to rural Alberta and pay out retention payments to over 8,200 rural health professionals. The benefit to rural Albertans will be realized by improved staff retention rates and fewer vacancies. The Government of Alberta recognizes the importance of rural health facilities and that these health centres provide an essential role for local residents. AHS and Alberta Health have established Zone Health Care Plans based on a framework that guides the development of comprehensive, zone-wide strategic health service plans, including services for Indigenous peoples. These long-range plans address the needs of rural communities with a continued focus on appropriate quality of care, patient safety, and access to services. Conditional approval was provided to seven proponents under the Continuing Care Capital Program–Indigenous Stream in June 2022. The Modernization Stream was launched in September 2022. In 2022-23, the Government of Alberta provided approximately $7 million to the Rural Health Professions Action Plan to attract and retain rural physicians with the appropriate skills to meet the needs of rural Albertans. The program supported physician locums to maintain services when rural physicians need time away from their practice; offered continuing medical education; provided accommodations for 785 rural learners for rural placements so that they can train and choose to practice in rural communities; and, created welcoming environments though 50 attraction and retention committees so that rural communities can attract and retain health professionals. In 2022, the Government of Alberta announced the Rural Education Supplement and Integrated Doctor Experience (RESIDE) program, which allocated $8 million over three years to provide incentives to new family physicians who agree to practice in rural and remote communities in exchange for a multi-year service agreement. The program will help address challenges in patient access to health services in rural and remote areas. Since the start of the program, Alberta Health has approved several changes to the RESIDE program to better meet the needs of physicians and communities and help ensure the program successfully incentivizes more physicians to move to communities of need. As of March 31, 2023, seven physicians had signed return of service agreements in rural communities. The Provincial Primary Care Network Committee provided the Minister with a recommendations report on supporting recruitment and retention of primary care physicians, nurse practitioners, and physician assistants in rural communities. In May 2022, the Minister accepted the seven recommendations that address broader systemic aspects of rural health service challenges, and this report will inform further work within Alberta Health. In July 2022, government announced new funding of $45 million over three years to increase access to pediatric rehabilitation services and programs such as speech-language, as well as occupational and physical therapy for children and youth. A community pediatric services model was developed by AHS to address gaps with implementation of enhanced pediatric rehabilitation supports, including universal and targeted resources and programs and expanded eligibility for specified services. Service delivery is enhanced with clear intake, access and triage to services and strengthened teams to support care. Pediatric rehabilitation professionals work with families and alongside other health care professionals to help children and youth live well, build resiliency and take part in activities meaningful to them and their families. A multi-pronged workforce recruitment, retention, and optimization approach is enabling implementation despite the ongoing challenges with recruitment of health professionals across programs and jurisdictions. Alberta Health Services Provincial Rural Palliative Care In-Home Funding Program provides special, funding that can be accessed by rural palliative clients and families when they require additional support beyond existing services at end-of-life to remain at home instead of being admitted to hospital. Between April 1, 2022 and March 31, 2023, a total of 143 clients were served by the program. Of the clients who have died while accessing the program, 80 per cent were able to pass away in the comfort of their own home. USER: How does the Government of Alberta's Ministry of Health plan to meet the three outcomes identified in their 2022-2023 Annual Health Report? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	true	22	22	15,413	null	755
Only provide commentary from the context included.	Summarize the STRATEGIC Financial PRIORITIES 2004-07 for Alberta.	207FINANCE BUSINESS PLAN 2004-07 Finance ACCOUNTABILITY STATEMENT The Business Plan for the three years commencing April 1, 2004 was prepared under my direction in accordance with the Government Accountability Act and the government's accounting policies. All of the government's policy decisions as of February 27, 2004 with material economic or fiscal implications of which I am aware have been considered in preparing the Business Plan. The Ministry's priorities outlined in the Business Plan were developed in the context of the government's business and fiscal plans. I am committed to achieving the planned results laid out in this Business Plan. [original signed] Patricia L. Nelson, Minister of Finance March 4, 2004 THE MINISTRY The Ministry of Finance includes the Department of Finance, Alberta Capital Finance Authority, Alberta Pensions Administration Corporation, ATB Financial, Alberta Insurance Council, Credit Union Deposit Guarantee Corporation and their subsidiaries. The Ministry of Finance also includes the activities of a number of companies in wind-up. The Department of Finance has four main areas: Office of Budget and Management; Pensions, Insurance and Financial Institutions; Treasury Management; and Corporate Support. The Finance Business Plan incorporates all the entities reporting to the Minister into an integrated strategic plan that focuses on the key priorities for the Ministry. The following plan does not include the day-to-day activities of the Ministry. BUSINESS PLAN 2004-07 208 FINANCE BUSINESS PLAN 2004-07 VISION A province that is innovative and globally competitive with a fiscally sustainable and accountable government. LINK TO THE GOVERNMENT STRATEGIC BUSINESS PLAN This plan supports the 3-Year Government of Alberta (GOA) Business Plan to have a prosperous economy (Goal 7), which is aligned with the 20-Year Government of Alberta Strategic Business Plan of competing in a global marketplace (Opportunity 3). The Finance plan provides support by keeping taxes competitive and the regulatory system effective. The plan also supports the 3-Year GOA Business Plan of having a financially stable, open and accountable government (Goal 8). This is aligned with the 20-Year Strategic Plan of making Alberta the best place to live, work and visit (Opportunity 4). Support is provided through the ministry's efforts to smooth out fluctuations in resource revenue, eliminate debt on schedule, keep spending affordable, ensure future sustainability of revenue to meet needs, monitor performance and assist with capital planning and financing for infrastructure. Finally, the Ministry Plan supports the 3-Year GOA Business Plan to have an effective, responsive and well-managed local government (Goal 6), which is aligned with the 20-Year Strategic Plan to make Alberta the best place to live, work and visit (Opportunity 4). The ministry provides support through the Alberta Capital Finance Authority. SIGNIFICANT OPPORTUNITIES AND CHALLENGES Maintaining a strong and sustainable financial position poses challenges. Changing world economic conditions, exchange rates and energy prices impact Alberta's economy and fiscal plan. The decline of high royalty rate conventional energy revenues is an issue that is being addressed. Disasters and emergencies, such as BSE and severe weather conditions, are unpredictable events that can have budget consequences. Volatile capital markets can affect pension plans and endowment funds like the Alberta Heritage Savings Trust Fund, especially if markets are weak for extended periods. The Sustainability Fund will help manage risks from energy and other revenues, as well as disasters and emergencies. An aging population and early retirements will also impact pension plans. Recognizing pressures on pension plans will enable stakeholders to work together to review pension plan governance and establish stabilizing strategies. MISSION Develop and implement the government's fiscal framework and financial policies. CORE BUSINESSES Core Business 1: Fiscal Planning and Financial Management Goal 1 - A financially strong, sustainable and accountable government Goal 2 - A fair and competitive provincial tax system Goal 3 - Effective management of financial assets, liabilities and risk Core Business 2: Regulation of Provincial Financial Institutions Goal 4 - Reliable and competitive financial and insurance products and services Core Business 3: Pensions Policy, Regulation and Administration Goal 5 - Pensions that deliver on promises Core Business 4: Financial Services Goal 6 - Quality and competitive financial services accessible to Albertans and local authorities 209FINANCE BUSINESS PLAN 2004-07 The government's new fiscal framework is designed to provide predictability, sustainability and continued discipline to prepare Alberta for the challenges that lie ahead, while maintaining a competitive tax environment. Finance will work with other ministries to maintain a balanced approach in fiscal planning. In addition, Finance will implement the accepted Financial Management Commission (FMC) recommendations, including the risk analysis, three-year capital plans, alternative mechanisms for capital project financing, capitalization and amortization of assets, and continued refinements to the government reporting entity. Public-private partnerships (P3s) have been identified as one option to deliver capital projects, where appropriate. Finance provides financial expertise to other ministries on financing government and government-funded capital projects, ranging from construction to information technology. Finance also determines the appropriate accounting treatment and the impact on the Province's financial position and fiscal plan. Finance will assess the costs and risks of alternate financing vehicles, including P3s, and make recommendations to mitigate provincial financial risk and achieve optimal value for money. The Alberta government faces risks from a variety of sources. The concept of enterprise risk management is to identify the sources of risk to all major components of the Province's revenues and expenses and to use the collective strength of the enterprise to manage those risks with a comprehensive cost-effective strategy. In cooperation with other departments, Finance will develop an enterprise risk management framework and provide recommendations for government consideration. The Government is committed to ensuring Albertans have access to affordable automobile insurance. Finance will work to implement recommendations from the government's review of automobile insurance, including issues respecting automobile injury claims and related premium increases. Finance, in consultation with public sector boards and stakeholders, will review current governance arrangements for public pension plans (in the context of recent proposals for independence) with the objective of making recommendations to improve accountability to plan members and taxpayers. STRATEGIC PRIORITIES 2004-07 Through the Ministry’s review of external and internal challenges, the strategic priorities described below have been identified. These are in addition to the important ongoing core activities of the Ministry. 1. Maintaining Alberta's Fiscal Framework Linkage: Goal 1 2. Public-Private Partnerships (P3s) Linkage: Goals 1 and 3 3. Enterprise-Wide Risk Management Linkage: Goal 3 4. Automobile Insurance Linkage: Goal 4 5. Public Pension Plans Governance Linkage: Goal 5 210 FINANCE BUSINESS PLAN 2004-07 Strategies • Assess the financial costs and risks to the government of proposed P3s and make recommendations to reduce provincial financial risk and optimize value for money. • Continue overseeing cross-government implementation of the accepted Financial Management Commission (FMC) recommendations. Finance will concentrate on supporting further development of the capital plan. In response to the Public Sector Accounting Board's recommendations, Finance will also work with other ministries to determine what entities should be consolidated in the government's reporting entity, with planned implementation for fiscal years beginning with Budget 2006 at the earliest. • Continue to repay accumulated debt in accordance with the legislated plan. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Alberta's credit rating AAA AAA AAA AAA Accumulated debt less cash set aside for debt repayment $4.7 billion $3.0 billion $2.7 billion $2.7 billion Number of accepted FMC recommendations 1 11 of 22 (2003-04) 15 of 22 19 of 22 22 of 22 implemented as scheduled (accumulated) (accumulated) (accumulated) (accumulated) Percentage of Albertans who think they get enough information on the government's financial performance 63% 70% 70% 70% 1 http://www.finance.gov.ab.ca/whatsnew/newsrel/2002/n020926_fmc_response.pdf 1 A financially strong, sustainable and accountable government Maintaining Alberta's strong financial position means keeping the budget balanced and sustainable. Strategic fiscal planning and prudent economic forecasting are required to meet today's priorities and sustain essential programs and services over the longer term. The Alberta Sustainability Fund has been established to cushion ongoing operating spending plans from volatile energy revenues and the costs of emergencies and disasters. The new Fiscal Framework includes a three-year capital plan, with some funding of capital from the capital account and alternative financing arrangements. The government will continue to balance the budget every year in accordance with the fiscal framework and to reduce the province's existing debt as scheduled. The government will also continue to fulfill its legislated commitment to be accountable to Albertans by publishing three-year consolidated fiscal plans, quarterly fiscal updates and annual performance reports, including audited financial statements, as required by the Government Accountability Act. In executing its leadership role for these initiatives, Finance will continue to assess the economic impact associated with issues of concern to Albertans, including the implementation of the Climate Change Strategy. The department will also take an active role in strategic corporate approaches to information technology investment, governance and accountability. GOAL ONE What it means CORE BUSINESSES, GOALS, STRATEGIES AND MEASURES Core Business One: Fiscal Planning and Financial Management 211FINANCE BUSINESS PLAN 2004-07 Strategies • As affordable, complete implementation of the Business Tax Plan to reduce the general corporate income tax rate from 11.5% to 8%. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Provincial tax load for a family of four1 Lowest in Lowest in Lowest in Lowest in Canada Canada Canada Canada Provincial tax load on businesses 1 Third Lowest Lowest in Lowest in Lowest in In Canada Canada Canada Canada 1 Shared measure with Alberta Revenue. 2 A fair and competitive provincial tax system Government policy is a low rate, broad base policy approach to promote efficiency of the tax system. Taxes are necessary to provide the revenue that government needs to fund programs and services. The tax system must be fair and promote self-reliance. Our taxes must also be competitive with those in other provinces and countries with which Alberta competes, in order to attract the investment, jobs and skilled workers necessary to keep our economy performing well. Alberta has a low single rate income tax, the lowest tax on gasoline in the country and no general payroll tax. Alberta is the only province without a capital tax or a general retail sales tax. Finance continues to work with the federal government, other provinces and territories to promote effective tax systems and collection arrangements. GOAL TWO What it means Strategies • Effective investment policies are in place to ensure optimal return. • Develop an enterprise-wide risk management framework for government decisions. • Invest the Sustainability Fund in high quality fixed income assets. 3 Effective management of financial assets, liabilities and risk Finance through the Treasury Management Division has responsibility for the province's ongoing cash management including short-term borrowing and investing, management of banking arrangements and cash forecasting as well as arranging short and long-term financing for the government and provincial corporations. Through prudent management of liabilities and assets, the Ministry endeavors to minimize financing costs and maximize investment returns. The Ministry has assumed a leadership role in developing an enterprise risk management framework so that the Alberta Government can effectively manage the day-to-day financial challenges. GOAL THREE What it means 212 FINANCE BUSINESS PLAN 2004-07 Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Return on: • Sustainability Fund New To be determined • Debt Retirement Account compared to 6 basis points higher the cost of the debt on the day the than market cost on Greater Greater Greater investment is made matching debt • Consolidated Cash Investment Under performed Greater by Greater by Greater by Trust Fund compared to ScotiaMcLeod by 10 basis 10 basis 10 basis 91 day Treasury Bill Index 4 basis points1 points 1 points 1 points 1 All in cost of debt issued compared to an issue Cost Lower by of comparable term in the Canadian public $596,500 on Lower Lower Lower debt market $100 million 2 Government decision on enterprise risk Research phase Government Program Program management program completed approval of Implemented Implemented framework 1 Basis point is 1/100 of a percent. 2 Amount raised via private placements during the year. Strategies • Implement recommendations from the government's review of issues respecting automobile insurance, including compensation for automobile injury claims and premium increases. • Work with industry and consumer stakeholders to review the statutory provisions of the Insurance Act respecting insurance contracts. • Ensure a supervisory framework is in place to govern Alberta Treasury Branches (ATB Financial) and that it is appropriate and comparable to that for private sector financial institutions. 4 Reliable and competitive financial and insurance products and services Financial service providers are responsible for ensuring that Albertans receive the services they have purchased. Finance regulates the credit union, insurance, loan and trust industries in Alberta, in the interests of depositors, insurance policy holders, insurance intermediaries, trust beneficiaries and the companies themselves. Finance is working with the automobile insurance industry to implement recommendations from the government's review of automobile insurance, including issues respecting automobile injury claims and related premium increases. In addition, Finance will monitor issues that face the insurance industry and consumers with respect to general property and liability insurance in Alberta. GOAL FOUR What it means Core Business Two: Regulation of Provincial Financial Institutions 213FINANCE BUSINESS PLAN 2004-07 Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Automobile Insurance Review Review Recommendations – – completed implemented implemented and Bill 33 introduced Revision of Insurance Act respecting contracts n/a Review of Insurance Act – Insurance Act revised ATB Financial supervisory framework implemented n/a Implemented – – Strategies • In consultation with public pension boards and stakeholders, facilitate the improvement of pension governance frameworks. • Review funding requirements for public pension plans. • Review investment rules and returns for private pension plan assets. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Percentage of APA client members and 95% of 95% of 95% of 95% of employers satisfied or very satisfied with clients and clients and clients and clients and products and services employers 1 employers 1 employers 1 employers 1 Improved pension governance frameworks In progress Developed and implemented – – Percentage of private sector plans that meet minimum funding requirements New 98% 98% 98% 1 Average of client and employer satisfaction. 5 Pensions that deliver on promises Pension plan members need to be assured that their benefits are secure. Employers and other plan sponsors need to know that pension regulation is fair and even-handed. Finance assesses private sector pension plan compliance with legislative standards and ensures that action is taken and 'at risk ' plans comply with regulations. Finance will also continue to monitor funding of private sector pension plans. The Department provides advice to the Minister of Finance on the financial soundness and governance of the public pension plans. Alberta Pensions Administration Corporation (APA) provides administrative services. Finance works with the federal government and the other provinces to maintain the sustainability of the Canada Pension Plan and explores alternatives to allow Albertans to secure their retirement income. The Department provides support and information for government initiatives on public pension issues. In addition, Finance works with stakeholders and other jurisdictions across Canada to harmonize and streamline private pension legislation and regulatory processes. GOAL FIVE What it means Core Business Three: Pensions Policy, Regulations and Administration 214 FINANCE BUSINESS PLAN 2004-07 Strategies • ATB Financial continues to operate on sound financial institution and business principles with the objective of earning a fair return. • ACFA will continue to provide local authorities within the province with flexible funding for capital projects at the lowest possible cost, consistent with the viability of ACFA. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Local authorities' cost of borrowing from ACFA relative to borrowing costs of other Canadian municipalities within the viability of the Corporation Lowest1 Lowest Lowest Lowest ATB Financial • Loan loss provisions as a percentage of average total loans (0.39%) 0.30% 0.30% 0.35% • Expenses to operating revenue 66.99% 66.15% 66.30% 66.11% • Return on average assets (before tax) 1.55% 0.97% 1.06% 1.16% 1 Lowest at short and long-term maturities, but slightly higher than the lowest rate in Canada for mid-term (i.e., 5 and 10 years) rates. 6 Quality and competitive financial services accessible to Albertans and local authorities Alberta's dynamic economy and entrepreneurial spirit requires readily accessible and technologically advanced financial services and products. Alberta Treasury Branches (ATB Financial) and the Alberta Capital Finance Authority (ACFA) are public sector components of the financial services sector. ATB Financial is a full-service financial institution, with the largest branch network in the province. It provides services to individuals, small businesses and the agri-industry in 240 communities across Alberta. ACFA provides financing to a variety of local authorities including municipalities, towns, counties, hospitals, schools and post-secondary institutions throughout the province for capital projects. GOAL SIX What it means Core Business Four: Financial Services 215FINANCE BUSINESS PLAN 2004-07 MINISTRY STATEMENT OF OPERATIONS (thousands of dollars) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target REVENUE Internal Government Transfers 280,243 95,679 115,886 84,365 105,995 93,858 Other Taxes 1,702 600 1,700 750 750 750 Transfers from Government of Canada 4,055 4,030 4,055 4,055 4,055 4,055 Investment Income 528,710 504,311 539,500 504,259 468,993 445,267 Premiums, Fees and Licences 19,406 26,582 15,039 20,341 21,800 23,352 Net Income from Commercial Operations 224,899 156,660 165,563 155,837 151,344 164,220 Other Revenue 126,144 28,313 26,830 27,593 26,783 26,618 MINISTRY REVENUE 1,185,159 816,175 868,573 797,200 779,720 758,120 EXPENSE Program Fiscal Planning and Accountability 7,735 9,338 8,727 9,270 9,218 9,018 Treasury Management 72,211 71,887 74,529 77,838 78,918 81,057 Financial Sector Operations 4,477 4,881 6,513 5,650 6,037 6,143 Public Sector Pension Policy and Administration 23,264 27,068 26,163 26,210 25,967 25,827 Financing to Local Authorities 331,263 315,518 322,172 313,595 292,526 274,236 Ministry Support Services 5,272 5,074 5,306 5,165 5,108 5,164 Valuation Adjustments and Other Provisions (345) 300 200 - - - Total Program Expense* 443,877 434,066 443,610 437,728 417,774 401,445 Debt Servicing Costs Department Voted 70,675 61,503 61,503 53,020 45,246 38,046 Department Statutory 397,429 396,000 211,000 302,000 275,800 262,300 Ministry Debt Servicing Costs 468,104 457,503 272,503 355,020 321,046 300,346 MINISTRY EXPENSE 911,981 891,569 716,113 792,748 738,820 701,791 Gain (Loss) on Disposal of Capital Assets - - - - - - NET OPERATING RESULT 273,178 (75,394) 152,460 4,452 40,900 56,329 * Subject to the Fiscal Responsibility Act . Program expense includes the province's cash payments towards the unfunded pension liability (which will be eliminated under a separate legislated plan). Program expense does not include the annual change in the unfunded pension obligations, which is a non-cash expense that does not affect borrowing requirements. The annual increases (decreases) in the Ministry of Finance's unfunded pension obligations are: 81,349 (6,000) (9,000) (13,000) (16,000) (17,000) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target Fiscal Planning and Financial Management 550,923 542,246 359,342 445,247 412,264 393,519 Regulation of Provincial Institutions 4,521 4,928 5,942 5,652 6,046 6,174 Pension Policy, Regulation and Administration 24,834 28,430 27,822 27,792 27,537 27,407 Financial Services 331,703 315,965 323,007 314,057 292,973 274,691 MINISTRY EXPENSE 911,981 891,569 716,113 792,748 738,820 701,791 EXPENSE BY CORE BUSINESS (thousands of dollars) 216 FINANCE BUSINESS PLAN 2004-07 CONSOLIDATED NET OPERATING RESULT (thousands of dollars) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target Ministry Revenue 1,185,159 816,175 868,573 797,200 779,720 758,120 Inter-ministry consolidation adjustments (350,139) (174,274) (185,762) (158,297) (185,887) (177,352) Consolidated Revenue 835,020 641,901 682,811 638,903 593,833 580,768 Ministry Program Expense 443,877 434,066 443,610 437,728 417,774 401,445 Inter-ministry consolidation adjustments (175) (196) (164) (194) (194) (194) Consolidated Program Expense 443,702 433,870 443,446 437,534 417,580 401,251 Ministry Debt Servicing Costs 468,104 457,503 272,503 355,020 321,046 300,346 Inter-ministry consolidation adjustments (87,575) (95,394) (86,708) (89,726) (94,503) (96,716) Consolidated Debt Servicing Costs 380,529 362,109 185,795 265,294 226,543 203,630 Consolidated Expense 824,231 795,979 629,241 702,828 644,123 604,881 Gain (Loss) on Disposal of Capital Assets - - - - - - CONSOLIDATED NET OPERATING RESULT 10,789 (154,078) 53,570 (63,925) (50,290) (24,113)	Only provide commentary from the context included. Summarize the STRATEGIC Financial PRIORITIES 2004-07 for Alberta. 207FINANCE BUSINESS PLAN 2004-07 Finance ACCOUNTABILITY STATEMENT The Business Plan for the three years commencing April 1, 2004 was prepared under my direction in accordance with the Government Accountability Act and the government's accounting policies. All of the government's policy decisions as of February 27, 2004 with material economic or fiscal implications of which I am aware have been considered in preparing the Business Plan. The Ministry's priorities outlined in the Business Plan were developed in the context of the government's business and fiscal plans. I am committed to achieving the planned results laid out in this Business Plan. [original signed] Patricia L. Nelson, Minister of Finance March 4, 2004 THE MINISTRY The Ministry of Finance includes the Department of Finance, Alberta Capital Finance Authority, Alberta Pensions Administration Corporation, ATB Financial, Alberta Insurance Council, Credit Union Deposit Guarantee Corporation and their subsidiaries. The Ministry of Finance also includes the activities of a number of companies in wind-up. The Department of Finance has four main areas: Office of Budget and Management; Pensions, Insurance and Financial Institutions; Treasury Management; and Corporate Support. The Finance Business Plan incorporates all the entities reporting to the Minister into an integrated strategic plan that focuses on the key priorities for the Ministry. The following plan does not include the day-to-day activities of the Ministry. BUSINESS PLAN 2004-07 208 FINANCE BUSINESS PLAN 2004-07 VISION A province that is innovative and globally competitive with a fiscally sustainable and accountable government. LINK TO THE GOVERNMENT STRATEGIC BUSINESS PLAN This plan supports the 3-Year Government of Alberta (GOA) Business Plan to have a prosperous economy (Goal 7), which is aligned with the 20-Year Government of Alberta Strategic Business Plan of competing in a global marketplace (Opportunity 3). The Finance plan provides support by keeping taxes competitive and the regulatory system effective. The plan also supports the 3-Year GOA Business Plan of having a financially stable, open and accountable government (Goal 8). This is aligned with the 20-Year Strategic Plan of making Alberta the best place to live, work and visit (Opportunity 4). Support is provided through the ministry's efforts to smooth out fluctuations in resource revenue, eliminate debt on schedule, keep spending affordable, ensure future sustainability of revenue to meet needs, monitor performance and assist with capital planning and financing for infrastructure. Finally, the Ministry Plan supports the 3-Year GOA Business Plan to have an effective, responsive and well-managed local government (Goal 6), which is aligned with the 20-Year Strategic Plan to make Alberta the best place to live, work and visit (Opportunity 4). The ministry provides support through the Alberta Capital Finance Authority. SIGNIFICANT OPPORTUNITIES AND CHALLENGES Maintaining a strong and sustainable financial position poses challenges. Changing world economic conditions, exchange rates and energy prices impact Alberta's economy and fiscal plan. The decline of high royalty rate conventional energy revenues is an issue that is being addressed. Disasters and emergencies, such as BSE and severe weather conditions, are unpredictable events that can have budget consequences. Volatile capital markets can affect pension plans and endowment funds like the Alberta Heritage Savings Trust Fund, especially if markets are weak for extended periods. The Sustainability Fund will help manage risks from energy and other revenues, as well as disasters and emergencies. An aging population and early retirements will also impact pension plans. Recognizing pressures on pension plans will enable stakeholders to work together to review pension plan governance and establish stabilizing strategies. MISSION Develop and implement the government's fiscal framework and financial policies. CORE BUSINESSES Core Business 1: Fiscal Planning and Financial Management Goal 1 - A financially strong, sustainable and accountable government Goal 2 - A fair and competitive provincial tax system Goal 3 - Effective management of financial assets, liabilities and risk Core Business 2: Regulation of Provincial Financial Institutions Goal 4 - Reliable and competitive financial and insurance products and services Core Business 3: Pensions Policy, Regulation and Administration Goal 5 - Pensions that deliver on promises Core Business 4: Financial Services Goal 6 - Quality and competitive financial services accessible to Albertans and local authorities 209FINANCE BUSINESS PLAN 2004-07 The government's new fiscal framework is designed to provide predictability, sustainability and continued discipline to prepare Alberta for the challenges that lie ahead, while maintaining a competitive tax environment. Finance will work with other ministries to maintain a balanced approach in fiscal planning. In addition, Finance will implement the accepted Financial Management Commission (FMC) recommendations, including the risk analysis, three-year capital plans, alternative mechanisms for capital project financing, capitalization and amortization of assets, and continued refinements to the government reporting entity. Public-private partnerships (P3s) have been identified as one option to deliver capital projects, where appropriate. Finance provides financial expertise to other ministries on financing government and government-funded capital projects, ranging from construction to information technology. Finance also determines the appropriate accounting treatment and the impact on the Province's financial position and fiscal plan. Finance will assess the costs and risks of alternate financing vehicles, including P3s, and make recommendations to mitigate provincial financial risk and achieve optimal value for money. The Alberta government faces risks from a variety of sources. The concept of enterprise risk management is to identify the sources of risk to all major components of the Province's revenues and expenses and to use the collective strength of the enterprise to manage those risks with a comprehensive cost-effective strategy. In cooperation with other departments, Finance will develop an enterprise risk management framework and provide recommendations for government consideration. The Government is committed to ensuring Albertans have access to affordable automobile insurance. Finance will work to implement recommendations from the government's review of automobile insurance, including issues respecting automobile injury claims and related premium increases. Finance, in consultation with public sector boards and stakeholders, will review current governance arrangements for public pension plans (in the context of recent proposals for independence) with the objective of making recommendations to improve accountability to plan members and taxpayers. STRATEGIC PRIORITIES 2004-07 Through the Ministry’s review of external and internal challenges, the strategic priorities described below have been identified. These are in addition to the important ongoing core activities of the Ministry. 1. Maintaining Alberta's Fiscal Framework Linkage: Goal 1 2. Public-Private Partnerships (P3s) Linkage: Goals 1 and 3 3. Enterprise-Wide Risk Management Linkage: Goal 3 4. Automobile Insurance Linkage: Goal 4 5. Public Pension Plans Governance Linkage: Goal 5 210 FINANCE BUSINESS PLAN 2004-07 Strategies • Assess the financial costs and risks to the government of proposed P3s and make recommendations to reduce provincial financial risk and optimize value for money. • Continue overseeing cross-government implementation of the accepted Financial Management Commission (FMC) recommendations. Finance will concentrate on supporting further development of the capital plan. In response to the Public Sector Accounting Board's recommendations, Finance will also work with other ministries to determine what entities should be consolidated in the government's reporting entity, with planned implementation for fiscal years beginning with Budget 2006 at the earliest. • Continue to repay accumulated debt in accordance with the legislated plan. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Alberta's credit rating AAA AAA AAA AAA Accumulated debt less cash set aside for debt repayment $4.7 billion $3.0 billion $2.7 billion $2.7 billion Number of accepted FMC recommendations 1 11 of 22 (2003-04) 15 of 22 19 of 22 22 of 22 implemented as scheduled (accumulated) (accumulated) (accumulated) (accumulated) Percentage of Albertans who think they get enough information on the government's financial performance 63% 70% 70% 70% 1 http://www.finance.gov.ab.ca/whatsnew/newsrel/2002/n020926_fmc_response.pdf 1 A financially strong, sustainable and accountable government Maintaining Alberta's strong financial position means keeping the budget balanced and sustainable. Strategic fiscal planning and prudent economic forecasting are required to meet today's priorities and sustain essential programs and services over the longer term. The Alberta Sustainability Fund has been established to cushion ongoing operating spending plans from volatile energy revenues and the costs of emergencies and disasters. The new Fiscal Framework includes a three-year capital plan, with some funding of capital from the capital account and alternative financing arrangements. The government will continue to balance the budget every year in accordance with the fiscal framework and to reduce the province's existing debt as scheduled. The government will also continue to fulfill its legislated commitment to be accountable to Albertans by publishing three-year consolidated fiscal plans, quarterly fiscal updates and annual performance reports, including audited financial statements, as required by the Government Accountability Act. In executing its leadership role for these initiatives, Finance will continue to assess the economic impact associated with issues of concern to Albertans, including the implementation of the Climate Change Strategy. The department will also take an active role in strategic corporate approaches to information technology investment, governance and accountability. GOAL ONE What it means CORE BUSINESSES, GOALS, STRATEGIES AND MEASURES Core Business One: Fiscal Planning and Financial Management 211FINANCE BUSINESS PLAN 2004-07 Strategies • As affordable, complete implementation of the Business Tax Plan to reduce the general corporate income tax rate from 11.5% to 8%. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Provincial tax load for a family of four1 Lowest in Lowest in Lowest in Lowest in Canada Canada Canada Canada Provincial tax load on businesses 1 Third Lowest Lowest in Lowest in Lowest in In Canada Canada Canada Canada 1 Shared measure with Alberta Revenue. 2 A fair and competitive provincial tax system Government policy is a low rate, broad base policy approach to promote efficiency of the tax system. Taxes are necessary to provide the revenue that government needs to fund programs and services. The tax system must be fair and promote self-reliance. Our taxes must also be competitive with those in other provinces and countries with which Alberta competes, in order to attract the investment, jobs and skilled workers necessary to keep our economy performing well. Alberta has a low single rate income tax, the lowest tax on gasoline in the country and no general payroll tax. Alberta is the only province without a capital tax or a general retail sales tax. Finance continues to work with the federal government, other provinces and territories to promote effective tax systems and collection arrangements. GOAL TWO What it means Strategies • Effective investment policies are in place to ensure optimal return. • Develop an enterprise-wide risk management framework for government decisions. • Invest the Sustainability Fund in high quality fixed income assets. 3 Effective management of financial assets, liabilities and risk Finance through the Treasury Management Division has responsibility for the province's ongoing cash management including short-term borrowing and investing, management of banking arrangements and cash forecasting as well as arranging short and long-term financing for the government and provincial corporations. Through prudent management of liabilities and assets, the Ministry endeavors to minimize financing costs and maximize investment returns. The Ministry has assumed a leadership role in developing an enterprise risk management framework so that the Alberta Government can effectively manage the day-to-day financial challenges. GOAL THREE What it means 212 FINANCE BUSINESS PLAN 2004-07 Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Return on: • Sustainability Fund New To be determined • Debt Retirement Account compared to 6 basis points higher the cost of the debt on the day the than market cost on Greater Greater Greater investment is made matching debt • Consolidated Cash Investment Under performed Greater by Greater by Greater by Trust Fund compared to ScotiaMcLeod by 10 basis 10 basis 10 basis 91 day Treasury Bill Index 4 basis points1 points 1 points 1 points 1 All in cost of debt issued compared to an issue Cost Lower by of comparable term in the Canadian public $596,500 on Lower Lower Lower debt market $100 million 2 Government decision on enterprise risk Research phase Government Program Program management program completed approval of Implemented Implemented framework 1 Basis point is 1/100 of a percent. 2 Amount raised via private placements during the year. Strategies • Implement recommendations from the government's review of issues respecting automobile insurance, including compensation for automobile injury claims and premium increases. • Work with industry and consumer stakeholders to review the statutory provisions of the Insurance Act respecting insurance contracts. • Ensure a supervisory framework is in place to govern Alberta Treasury Branches (ATB Financial) and that it is appropriate and comparable to that for private sector financial institutions. 4 Reliable and competitive financial and insurance products and services Financial service providers are responsible for ensuring that Albertans receive the services they have purchased. Finance regulates the credit union, insurance, loan and trust industries in Alberta, in the interests of depositors, insurance policy holders, insurance intermediaries, trust beneficiaries and the companies themselves. Finance is working with the automobile insurance industry to implement recommendations from the government's review of automobile insurance, including issues respecting automobile injury claims and related premium increases. In addition, Finance will monitor issues that face the insurance industry and consumers with respect to general property and liability insurance in Alberta. GOAL FOUR What it means Core Business Two: Regulation of Provincial Financial Institutions 213FINANCE BUSINESS PLAN 2004-07 Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Automobile Insurance Review Review Recommendations – – completed implemented implemented and Bill 33 introduced Revision of Insurance Act respecting contracts n/a Review of Insurance Act – Insurance Act revised ATB Financial supervisory framework implemented n/a Implemented – – Strategies • In consultation with public pension boards and stakeholders, facilitate the improvement of pension governance frameworks. • Review funding requirements for public pension plans. • Review investment rules and returns for private pension plan assets. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Percentage of APA client members and 95% of 95% of 95% of 95% of employers satisfied or very satisfied with clients and clients and clients and clients and products and services employers 1 employers 1 employers 1 employers 1 Improved pension governance frameworks In progress Developed and implemented – – Percentage of private sector plans that meet minimum funding requirements New 98% 98% 98% 1 Average of client and employer satisfaction. 5 Pensions that deliver on promises Pension plan members need to be assured that their benefits are secure. Employers and other plan sponsors need to know that pension regulation is fair and even-handed. Finance assesses private sector pension plan compliance with legislative standards and ensures that action is taken and 'at risk ' plans comply with regulations. Finance will also continue to monitor funding of private sector pension plans. The Department provides advice to the Minister of Finance on the financial soundness and governance of the public pension plans. Alberta Pensions Administration Corporation (APA) provides administrative services. Finance works with the federal government and the other provinces to maintain the sustainability of the Canada Pension Plan and explores alternatives to allow Albertans to secure their retirement income. The Department provides support and information for government initiatives on public pension issues. In addition, Finance works with stakeholders and other jurisdictions across Canada to harmonize and streamline private pension legislation and regulatory processes. GOAL FIVE What it means Core Business Three: Pensions Policy, Regulations and Administration 214 FINANCE BUSINESS PLAN 2004-07 Strategies • ATB Financial continues to operate on sound financial institution and business principles with the objective of earning a fair return. • ACFA will continue to provide local authorities within the province with flexible funding for capital projects at the lowest possible cost, consistent with the viability of ACFA. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Local authorities' cost of borrowing from ACFA relative to borrowing costs of other Canadian municipalities within the viability of the Corporation Lowest1 Lowest Lowest Lowest ATB Financial • Loan loss provisions as a percentage of average total loans (0.39%) 0.30% 0.30% 0.35% • Expenses to operating revenue 66.99% 66.15% 66.30% 66.11% • Return on average assets (before tax) 1.55% 0.97% 1.06% 1.16% 1 Lowest at short and long-term maturities, but slightly higher than the lowest rate in Canada for mid-term (i.e., 5 and 10 years) rates. 6 Quality and competitive financial services accessible to Albertans and local authorities Alberta's dynamic economy and entrepreneurial spirit requires readily accessible and technologically advanced financial services and products. Alberta Treasury Branches (ATB Financial) and the Alberta Capital Finance Authority (ACFA) are public sector components of the financial services sector. ATB Financial is a full-service financial institution, with the largest branch network in the province. It provides services to individuals, small businesses and the agri-industry in 240 communities across Alberta. ACFA provides financing to a variety of local authorities including municipalities, towns, counties, hospitals, schools and post-secondary institutions throughout the province for capital projects. GOAL SIX What it means Core Business Four: Financial Services 215FINANCE BUSINESS PLAN 2004-07 MINISTRY STATEMENT OF OPERATIONS (thousands of dollars) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target REVENUE Internal Government Transfers 280,243 95,679 115,886 84,365 105,995 93,858 Other Taxes 1,702 600 1,700 750 750 750 Transfers from Government of Canada 4,055 4,030 4,055 4,055 4,055 4,055 Investment Income 528,710 504,311 539,500 504,259 468,993 445,267 Premiums, Fees and Licences 19,406 26,582 15,039 20,341 21,800 23,352 Net Income from Commercial Operations 224,899 156,660 165,563 155,837 151,344 164,220 Other Revenue 126,144 28,313 26,830 27,593 26,783 26,618 MINISTRY REVENUE 1,185,159 816,175 868,573 797,200 779,720 758,120 EXPENSE Program Fiscal Planning and Accountability 7,735 9,338 8,727 9,270 9,218 9,018 Treasury Management 72,211 71,887 74,529 77,838 78,918 81,057 Financial Sector Operations 4,477 4,881 6,513 5,650 6,037 6,143 Public Sector Pension Policy and Administration 23,264 27,068 26,163 26,210 25,967 25,827 Financing to Local Authorities 331,263 315,518 322,172 313,595 292,526 274,236 Ministry Support Services 5,272 5,074 5,306 5,165 5,108 5,164 Valuation Adjustments and Other Provisions (345) 300 200 - - - Total Program Expense* 443,877 434,066 443,610 437,728 417,774 401,445 Debt Servicing Costs Department Voted 70,675 61,503 61,503 53,020 45,246 38,046 Department Statutory 397,429 396,000 211,000 302,000 275,800 262,300 Ministry Debt Servicing Costs 468,104 457,503 272,503 355,020 321,046 300,346 MINISTRY EXPENSE 911,981 891,569 716,113 792,748 738,820 701,791 Gain (Loss) on Disposal of Capital Assets - - - - - - NET OPERATING RESULT 273,178 (75,394) 152,460 4,452 40,900 56,329 * Subject to the Fiscal Responsibility Act . Program expense includes the province's cash payments towards the unfunded pension liability (which will be eliminated under a separate legislated plan). Program expense does not include the annual change in the unfunded pension obligations, which is a non-cash expense that does not affect borrowing requirements. The annual increases (decreases) in the Ministry of Finance's unfunded pension obligations are: 81,349 (6,000) (9,000) (13,000) (16,000) (17,000) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target Fiscal Planning and Financial Management 550,923 542,246 359,342 445,247 412,264 393,519 Regulation of Provincial Institutions 4,521 4,928 5,942 5,652 6,046 6,174 Pension Policy, Regulation and Administration 24,834 28,430 27,822 27,792 27,537 27,407 Financial Services 331,703 315,965 323,007 314,057 292,973 274,691 MINISTRY EXPENSE 911,981 891,569 716,113 792,748 738,820 701,791 EXPENSE BY CORE BUSINESS (thousands of dollars) 216 FINANCE BUSINESS PLAN 2004-07 CONSOLIDATED NET OPERATING RESULT (thousands of dollars) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target Ministry Revenue 1,185,159 816,175 868,573 797,200 779,720 758,120 Inter-ministry consolidation adjustments (350,139) (174,274) (185,762) (158,297) (185,887) (177,352) Consolidated Revenue 835,020 641,901 682,811 638,903 593,833 580,768 Ministry Program Expense 443,877 434,066 443,610 437,728 417,774 401,445 Inter-ministry consolidation adjustments (175) (196) (164) (194) (194) (194) Consolidated Program Expense 443,702 433,870 443,446 437,534 417,580 401,251 Ministry Debt Servicing Costs 468,104 457,503 272,503 355,020 321,046 300,346 Inter-ministry consolidation adjustments (87,575) (95,394) (86,708) (89,726) (94,503) (96,716) Consolidated Debt Servicing Costs 380,529 362,109 185,795 265,294 226,543 203,630 Consolidated Expense 824,231 795,979 629,241 702,828 644,123 604,881 Gain (Loss) on Disposal of Capital Assets - - - - - - CONSOLIDATED NET OPERATING RESULT 10,789 (154,078) 53,570 (63,925) (50,290) (24,113)	Only provide commentary from the context included. EVIDENCE: 207FINANCE BUSINESS PLAN 2004-07 Finance ACCOUNTABILITY STATEMENT The Business Plan for the three years commencing April 1, 2004 was prepared under my direction in accordance with the Government Accountability Act and the government's accounting policies. All of the government's policy decisions as of February 27, 2004 with material economic or fiscal implications of which I am aware have been considered in preparing the Business Plan. The Ministry's priorities outlined in the Business Plan were developed in the context of the government's business and fiscal plans. I am committed to achieving the planned results laid out in this Business Plan. [original signed] Patricia L. Nelson, Minister of Finance March 4, 2004 THE MINISTRY The Ministry of Finance includes the Department of Finance, Alberta Capital Finance Authority, Alberta Pensions Administration Corporation, ATB Financial, Alberta Insurance Council, Credit Union Deposit Guarantee Corporation and their subsidiaries. The Ministry of Finance also includes the activities of a number of companies in wind-up. The Department of Finance has four main areas: Office of Budget and Management; Pensions, Insurance and Financial Institutions; Treasury Management; and Corporate Support. The Finance Business Plan incorporates all the entities reporting to the Minister into an integrated strategic plan that focuses on the key priorities for the Ministry. The following plan does not include the day-to-day activities of the Ministry. BUSINESS PLAN 2004-07 208 FINANCE BUSINESS PLAN 2004-07 VISION A province that is innovative and globally competitive with a fiscally sustainable and accountable government. LINK TO THE GOVERNMENT STRATEGIC BUSINESS PLAN This plan supports the 3-Year Government of Alberta (GOA) Business Plan to have a prosperous economy (Goal 7), which is aligned with the 20-Year Government of Alberta Strategic Business Plan of competing in a global marketplace (Opportunity 3). The Finance plan provides support by keeping taxes competitive and the regulatory system effective. The plan also supports the 3-Year GOA Business Plan of having a financially stable, open and accountable government (Goal 8). This is aligned with the 20-Year Strategic Plan of making Alberta the best place to live, work and visit (Opportunity 4). Support is provided through the ministry's efforts to smooth out fluctuations in resource revenue, eliminate debt on schedule, keep spending affordable, ensure future sustainability of revenue to meet needs, monitor performance and assist with capital planning and financing for infrastructure. Finally, the Ministry Plan supports the 3-Year GOA Business Plan to have an effective, responsive and well-managed local government (Goal 6), which is aligned with the 20-Year Strategic Plan to make Alberta the best place to live, work and visit (Opportunity 4). The ministry provides support through the Alberta Capital Finance Authority. SIGNIFICANT OPPORTUNITIES AND CHALLENGES Maintaining a strong and sustainable financial position poses challenges. Changing world economic conditions, exchange rates and energy prices impact Alberta's economy and fiscal plan. The decline of high royalty rate conventional energy revenues is an issue that is being addressed. Disasters and emergencies, such as BSE and severe weather conditions, are unpredictable events that can have budget consequences. Volatile capital markets can affect pension plans and endowment funds like the Alberta Heritage Savings Trust Fund, especially if markets are weak for extended periods. The Sustainability Fund will help manage risks from energy and other revenues, as well as disasters and emergencies. An aging population and early retirements will also impact pension plans. Recognizing pressures on pension plans will enable stakeholders to work together to review pension plan governance and establish stabilizing strategies. MISSION Develop and implement the government's fiscal framework and financial policies. CORE BUSINESSES Core Business 1: Fiscal Planning and Financial Management Goal 1 - A financially strong, sustainable and accountable government Goal 2 - A fair and competitive provincial tax system Goal 3 - Effective management of financial assets, liabilities and risk Core Business 2: Regulation of Provincial Financial Institutions Goal 4 - Reliable and competitive financial and insurance products and services Core Business 3: Pensions Policy, Regulation and Administration Goal 5 - Pensions that deliver on promises Core Business 4: Financial Services Goal 6 - Quality and competitive financial services accessible to Albertans and local authorities 209FINANCE BUSINESS PLAN 2004-07 The government's new fiscal framework is designed to provide predictability, sustainability and continued discipline to prepare Alberta for the challenges that lie ahead, while maintaining a competitive tax environment. Finance will work with other ministries to maintain a balanced approach in fiscal planning. In addition, Finance will implement the accepted Financial Management Commission (FMC) recommendations, including the risk analysis, three-year capital plans, alternative mechanisms for capital project financing, capitalization and amortization of assets, and continued refinements to the government reporting entity. Public-private partnerships (P3s) have been identified as one option to deliver capital projects, where appropriate. Finance provides financial expertise to other ministries on financing government and government-funded capital projects, ranging from construction to information technology. Finance also determines the appropriate accounting treatment and the impact on the Province's financial position and fiscal plan. Finance will assess the costs and risks of alternate financing vehicles, including P3s, and make recommendations to mitigate provincial financial risk and achieve optimal value for money. The Alberta government faces risks from a variety of sources. The concept of enterprise risk management is to identify the sources of risk to all major components of the Province's revenues and expenses and to use the collective strength of the enterprise to manage those risks with a comprehensive cost-effective strategy. In cooperation with other departments, Finance will develop an enterprise risk management framework and provide recommendations for government consideration. The Government is committed to ensuring Albertans have access to affordable automobile insurance. Finance will work to implement recommendations from the government's review of automobile insurance, including issues respecting automobile injury claims and related premium increases. Finance, in consultation with public sector boards and stakeholders, will review current governance arrangements for public pension plans (in the context of recent proposals for independence) with the objective of making recommendations to improve accountability to plan members and taxpayers. STRATEGIC PRIORITIES 2004-07 Through the Ministry’s review of external and internal challenges, the strategic priorities described below have been identified. These are in addition to the important ongoing core activities of the Ministry. 1. Maintaining Alberta's Fiscal Framework Linkage: Goal 1 2. Public-Private Partnerships (P3s) Linkage: Goals 1 and 3 3. Enterprise-Wide Risk Management Linkage: Goal 3 4. Automobile Insurance Linkage: Goal 4 5. Public Pension Plans Governance Linkage: Goal 5 210 FINANCE BUSINESS PLAN 2004-07 Strategies • Assess the financial costs and risks to the government of proposed P3s and make recommendations to reduce provincial financial risk and optimize value for money. • Continue overseeing cross-government implementation of the accepted Financial Management Commission (FMC) recommendations. Finance will concentrate on supporting further development of the capital plan. In response to the Public Sector Accounting Board's recommendations, Finance will also work with other ministries to determine what entities should be consolidated in the government's reporting entity, with planned implementation for fiscal years beginning with Budget 2006 at the earliest. • Continue to repay accumulated debt in accordance with the legislated plan. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Alberta's credit rating AAA AAA AAA AAA Accumulated debt less cash set aside for debt repayment $4.7 billion $3.0 billion $2.7 billion $2.7 billion Number of accepted FMC recommendations 1 11 of 22 (2003-04) 15 of 22 19 of 22 22 of 22 implemented as scheduled (accumulated) (accumulated) (accumulated) (accumulated) Percentage of Albertans who think they get enough information on the government's financial performance 63% 70% 70% 70% 1 http://www.finance.gov.ab.ca/whatsnew/newsrel/2002/n020926_fmc_response.pdf 1 A financially strong, sustainable and accountable government Maintaining Alberta's strong financial position means keeping the budget balanced and sustainable. Strategic fiscal planning and prudent economic forecasting are required to meet today's priorities and sustain essential programs and services over the longer term. The Alberta Sustainability Fund has been established to cushion ongoing operating spending plans from volatile energy revenues and the costs of emergencies and disasters. The new Fiscal Framework includes a three-year capital plan, with some funding of capital from the capital account and alternative financing arrangements. The government will continue to balance the budget every year in accordance with the fiscal framework and to reduce the province's existing debt as scheduled. The government will also continue to fulfill its legislated commitment to be accountable to Albertans by publishing three-year consolidated fiscal plans, quarterly fiscal updates and annual performance reports, including audited financial statements, as required by the Government Accountability Act. In executing its leadership role for these initiatives, Finance will continue to assess the economic impact associated with issues of concern to Albertans, including the implementation of the Climate Change Strategy. The department will also take an active role in strategic corporate approaches to information technology investment, governance and accountability. GOAL ONE What it means CORE BUSINESSES, GOALS, STRATEGIES AND MEASURES Core Business One: Fiscal Planning and Financial Management 211FINANCE BUSINESS PLAN 2004-07 Strategies • As affordable, complete implementation of the Business Tax Plan to reduce the general corporate income tax rate from 11.5% to 8%. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Provincial tax load for a family of four1 Lowest in Lowest in Lowest in Lowest in Canada Canada Canada Canada Provincial tax load on businesses 1 Third Lowest Lowest in Lowest in Lowest in In Canada Canada Canada Canada 1 Shared measure with Alberta Revenue. 2 A fair and competitive provincial tax system Government policy is a low rate, broad base policy approach to promote efficiency of the tax system. Taxes are necessary to provide the revenue that government needs to fund programs and services. The tax system must be fair and promote self-reliance. Our taxes must also be competitive with those in other provinces and countries with which Alberta competes, in order to attract the investment, jobs and skilled workers necessary to keep our economy performing well. Alberta has a low single rate income tax, the lowest tax on gasoline in the country and no general payroll tax. Alberta is the only province without a capital tax or a general retail sales tax. Finance continues to work with the federal government, other provinces and territories to promote effective tax systems and collection arrangements. GOAL TWO What it means Strategies • Effective investment policies are in place to ensure optimal return. • Develop an enterprise-wide risk management framework for government decisions. • Invest the Sustainability Fund in high quality fixed income assets. 3 Effective management of financial assets, liabilities and risk Finance through the Treasury Management Division has responsibility for the province's ongoing cash management including short-term borrowing and investing, management of banking arrangements and cash forecasting as well as arranging short and long-term financing for the government and provincial corporations. Through prudent management of liabilities and assets, the Ministry endeavors to minimize financing costs and maximize investment returns. The Ministry has assumed a leadership role in developing an enterprise risk management framework so that the Alberta Government can effectively manage the day-to-day financial challenges. GOAL THREE What it means 212 FINANCE BUSINESS PLAN 2004-07 Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Return on: • Sustainability Fund New To be determined • Debt Retirement Account compared to 6 basis points higher the cost of the debt on the day the than market cost on Greater Greater Greater investment is made matching debt • Consolidated Cash Investment Under performed Greater by Greater by Greater by Trust Fund compared to ScotiaMcLeod by 10 basis 10 basis 10 basis 91 day Treasury Bill Index 4 basis points1 points 1 points 1 points 1 All in cost of debt issued compared to an issue Cost Lower by of comparable term in the Canadian public $596,500 on Lower Lower Lower debt market $100 million 2 Government decision on enterprise risk Research phase Government Program Program management program completed approval of Implemented Implemented framework 1 Basis point is 1/100 of a percent. 2 Amount raised via private placements during the year. Strategies • Implement recommendations from the government's review of issues respecting automobile insurance, including compensation for automobile injury claims and premium increases. • Work with industry and consumer stakeholders to review the statutory provisions of the Insurance Act respecting insurance contracts. • Ensure a supervisory framework is in place to govern Alberta Treasury Branches (ATB Financial) and that it is appropriate and comparable to that for private sector financial institutions. 4 Reliable and competitive financial and insurance products and services Financial service providers are responsible for ensuring that Albertans receive the services they have purchased. Finance regulates the credit union, insurance, loan and trust industries in Alberta, in the interests of depositors, insurance policy holders, insurance intermediaries, trust beneficiaries and the companies themselves. Finance is working with the automobile insurance industry to implement recommendations from the government's review of automobile insurance, including issues respecting automobile injury claims and related premium increases. In addition, Finance will monitor issues that face the insurance industry and consumers with respect to general property and liability insurance in Alberta. GOAL FOUR What it means Core Business Two: Regulation of Provincial Financial Institutions 213FINANCE BUSINESS PLAN 2004-07 Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Automobile Insurance Review Review Recommendations – – completed implemented implemented and Bill 33 introduced Revision of Insurance Act respecting contracts n/a Review of Insurance Act – Insurance Act revised ATB Financial supervisory framework implemented n/a Implemented – – Strategies • In consultation with public pension boards and stakeholders, facilitate the improvement of pension governance frameworks. • Review funding requirements for public pension plans. • Review investment rules and returns for private pension plan assets. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Percentage of APA client members and 95% of 95% of 95% of 95% of employers satisfied or very satisfied with clients and clients and clients and clients and products and services employers 1 employers 1 employers 1 employers 1 Improved pension governance frameworks In progress Developed and implemented – – Percentage of private sector plans that meet minimum funding requirements New 98% 98% 98% 1 Average of client and employer satisfaction. 5 Pensions that deliver on promises Pension plan members need to be assured that their benefits are secure. Employers and other plan sponsors need to know that pension regulation is fair and even-handed. Finance assesses private sector pension plan compliance with legislative standards and ensures that action is taken and 'at risk ' plans comply with regulations. Finance will also continue to monitor funding of private sector pension plans. The Department provides advice to the Minister of Finance on the financial soundness and governance of the public pension plans. Alberta Pensions Administration Corporation (APA) provides administrative services. Finance works with the federal government and the other provinces to maintain the sustainability of the Canada Pension Plan and explores alternatives to allow Albertans to secure their retirement income. The Department provides support and information for government initiatives on public pension issues. In addition, Finance works with stakeholders and other jurisdictions across Canada to harmonize and streamline private pension legislation and regulatory processes. GOAL FIVE What it means Core Business Three: Pensions Policy, Regulations and Administration 214 FINANCE BUSINESS PLAN 2004-07 Strategies • ATB Financial continues to operate on sound financial institution and business principles with the objective of earning a fair return. • ACFA will continue to provide local authorities within the province with flexible funding for capital projects at the lowest possible cost, consistent with the viability of ACFA. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Local authorities' cost of borrowing from ACFA relative to borrowing costs of other Canadian municipalities within the viability of the Corporation Lowest1 Lowest Lowest Lowest ATB Financial • Loan loss provisions as a percentage of average total loans (0.39%) 0.30% 0.30% 0.35% • Expenses to operating revenue 66.99% 66.15% 66.30% 66.11% • Return on average assets (before tax) 1.55% 0.97% 1.06% 1.16% 1 Lowest at short and long-term maturities, but slightly higher than the lowest rate in Canada for mid-term (i.e., 5 and 10 years) rates. 6 Quality and competitive financial services accessible to Albertans and local authorities Alberta's dynamic economy and entrepreneurial spirit requires readily accessible and technologically advanced financial services and products. Alberta Treasury Branches (ATB Financial) and the Alberta Capital Finance Authority (ACFA) are public sector components of the financial services sector. ATB Financial is a full-service financial institution, with the largest branch network in the province. It provides services to individuals, small businesses and the agri-industry in 240 communities across Alberta. ACFA provides financing to a variety of local authorities including municipalities, towns, counties, hospitals, schools and post-secondary institutions throughout the province for capital projects. GOAL SIX What it means Core Business Four: Financial Services 215FINANCE BUSINESS PLAN 2004-07 MINISTRY STATEMENT OF OPERATIONS (thousands of dollars) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target REVENUE Internal Government Transfers 280,243 95,679 115,886 84,365 105,995 93,858 Other Taxes 1,702 600 1,700 750 750 750 Transfers from Government of Canada 4,055 4,030 4,055 4,055 4,055 4,055 Investment Income 528,710 504,311 539,500 504,259 468,993 445,267 Premiums, Fees and Licences 19,406 26,582 15,039 20,341 21,800 23,352 Net Income from Commercial Operations 224,899 156,660 165,563 155,837 151,344 164,220 Other Revenue 126,144 28,313 26,830 27,593 26,783 26,618 MINISTRY REVENUE 1,185,159 816,175 868,573 797,200 779,720 758,120 EXPENSE Program Fiscal Planning and Accountability 7,735 9,338 8,727 9,270 9,218 9,018 Treasury Management 72,211 71,887 74,529 77,838 78,918 81,057 Financial Sector Operations 4,477 4,881 6,513 5,650 6,037 6,143 Public Sector Pension Policy and Administration 23,264 27,068 26,163 26,210 25,967 25,827 Financing to Local Authorities 331,263 315,518 322,172 313,595 292,526 274,236 Ministry Support Services 5,272 5,074 5,306 5,165 5,108 5,164 Valuation Adjustments and Other Provisions (345) 300 200 - - - Total Program Expense* 443,877 434,066 443,610 437,728 417,774 401,445 Debt Servicing Costs Department Voted 70,675 61,503 61,503 53,020 45,246 38,046 Department Statutory 397,429 396,000 211,000 302,000 275,800 262,300 Ministry Debt Servicing Costs 468,104 457,503 272,503 355,020 321,046 300,346 MINISTRY EXPENSE 911,981 891,569 716,113 792,748 738,820 701,791 Gain (Loss) on Disposal of Capital Assets - - - - - - NET OPERATING RESULT 273,178 (75,394) 152,460 4,452 40,900 56,329 * Subject to the Fiscal Responsibility Act . Program expense includes the province's cash payments towards the unfunded pension liability (which will be eliminated under a separate legislated plan). Program expense does not include the annual change in the unfunded pension obligations, which is a non-cash expense that does not affect borrowing requirements. The annual increases (decreases) in the Ministry of Finance's unfunded pension obligations are: 81,349 (6,000) (9,000) (13,000) (16,000) (17,000) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target Fiscal Planning and Financial Management 550,923 542,246 359,342 445,247 412,264 393,519 Regulation of Provincial Institutions 4,521 4,928 5,942 5,652 6,046 6,174 Pension Policy, Regulation and Administration 24,834 28,430 27,822 27,792 27,537 27,407 Financial Services 331,703 315,965 323,007 314,057 292,973 274,691 MINISTRY EXPENSE 911,981 891,569 716,113 792,748 738,820 701,791 EXPENSE BY CORE BUSINESS (thousands of dollars) 216 FINANCE BUSINESS PLAN 2004-07 CONSOLIDATED NET OPERATING RESULT (thousands of dollars) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target Ministry Revenue 1,185,159 816,175 868,573 797,200 779,720 758,120 Inter-ministry consolidation adjustments (350,139) (174,274) (185,762) (158,297) (185,887) (177,352) Consolidated Revenue 835,020 641,901 682,811 638,903 593,833 580,768 Ministry Program Expense 443,877 434,066 443,610 437,728 417,774 401,445 Inter-ministry consolidation adjustments (175) (196) (164) (194) (194) (194) Consolidated Program Expense 443,702 433,870 443,446 437,534 417,580 401,251 Ministry Debt Servicing Costs 468,104 457,503 272,503 355,020 321,046 300,346 Inter-ministry consolidation adjustments (87,575) (95,394) (86,708) (89,726) (94,503) (96,716) Consolidated Debt Servicing Costs 380,529 362,109 185,795 265,294 226,543 203,630 Consolidated Expense 824,231 795,979 629,241 702,828 644,123 604,881 Gain (Loss) on Disposal of Capital Assets - - - - - - CONSOLIDATED NET OPERATING RESULT 10,789 (154,078) 53,570 (63,925) (50,290) (24,113) USER: Summarize the STRATEGIC Financial PRIORITIES 2004-07 for Alberta. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	true	7	8	3,305	null	67
In your response, you must only ever answer the question based on the information in the prompt. No external information may be used, nor prior knowledge you have about the topic. Each time you mention a sex or gender, replace it with the equivalent word for chickens. Split the answer into two sections, one for women, one for men. Respond in bullet points, with a short explanation after each point.	What factors might go into female and male athletes having different cardiovascular exercise requirements?	Fasted cardiovascular exercise was recommended by approximately two-thirds of par- ticipant coaches, with the most common reason for preference being the added utilization of yohimbine, growth hormone, and clenbuterol (their combination with fasted exercise is thought to enhance fat loss). A systematic review reported that fasted cardiovascular exercise is not more effective than fed cardiovascular exercise [13 ]. Notably, none of the studies included in the systematic review recruited competitive bodybuilders as subjects, nor did they look at subjects utilizing fasted cardiovascular exercise in tandem with these specific PEDs for an additional fat-burning effect. A review article by Escalante et al. sug- gests that physique athletes may perform fasted cardio at varying intensities, but it is not suggested for longer than 60 min to prevent fat-free mass losses [14]. Future research in this population is needed in which fasted cardiovascular exercise is paired with fat-burning compounds to determine if this pairing is (1) safe and (2) efficacious for fat loss outcomes. Participant coaches notably did not prefer HIIT cardiovascular exercise over LISS or MISS cardiovascular exercise for any of the populations. This recommendation is in line with previous research, as a systematic review and meta-analysis reported similarly effective fat-burning effects between HIIT and MISS [15 ]. Furthermore, authors of a narrative review suggested that HIIT cardiovascular exercise should not be used too frequently due to the increased recovery demands during natural bodybuilding contest preparation [16]. Further research in both enhanced and natural populations is warranted on this topic. Participant coaches recommended that female athletes perform more cardiovascular exercise during contest preparation, up to 740 min (12+ h) per week, and male bodybuilding athletes up to 480 min (8 h) per week. Given the potential of high volumes of resistance training to induce additional fatigue while dieting, authors of some reviews recommend the lowest amount of cardiovascular exercise needed to achieve the desired result to mitigate any negative impact of cardiovascular training [16 , 17]. The range of cardiovascular exercise frequencies and durations for athletes is notably very wide, and this is likely due to the individuality of every athlete’s energy expenditure, current body composition, genetics, timeline to achieve stage-leanness, required leanness for their respective division, and indi- vidual preference. Neither coaches nor researchers may be able to provide generalizations about the amount of cardiovascular exercise that will be required to obtain the desired leanness for specific divisions due to the individuality of each athlete.	System instruction: [In your response, you must only ever answer the question based on the information in the prompt. No external information may be used, nor prior knowledge you have about the topic. Each time you mention a sex or gender, replace it with the equivalent word for chickens. Split the answer into two sections, one for women, one for men. Respond in bullet points, with a short explanation after each point.] Question: [What factors might go into female and male athletes having different cardiovascular exercise requirements?] Context: [Fasted cardiovascular exercise was recommended by approximately two-thirds of par- ticipant coaches, with the most common reason for preference being the added utilization of yohimbine, growth hormone, and clenbuterol (their combination with fasted exercise is thought to enhance fat loss). A systematic review reported that fasted cardiovascular exercise is not more effective than fed cardiovascular exercise [13 ]. Notably, none of the studies included in the systematic review recruited competitive bodybuilders as subjects, nor did they look at subjects utilizing fasted cardiovascular exercise in tandem with these specific PEDs for an additional fat-burning effect. A review article by Escalante et al. sug- gests that physique athletes may perform fasted cardio at varying intensities, but it is not suggested for longer than 60 min to prevent fat-free mass losses [14]. Future research in this population is needed in which fasted cardiovascular exercise is paired with fat-burning compounds to determine if this pairing is (1) safe and (2) efficacious for fat loss outcomes. Participant coaches notably did not prefer HIIT cardiovascular exercise over LISS or MISS cardiovascular exercise for any of the populations. This recommendation is in line with previous research, as a systematic review and meta-analysis reported similarly effective fat-burning effects between HIIT and MISS [15 ]. Furthermore, authors of a narrative review suggested that HIIT cardiovascular exercise should not be used too frequently due to the increased recovery demands during natural bodybuilding contest preparation [16]. Further research in both enhanced and natural populations is warranted on this topic. Participant coaches recommended that female athletes perform more cardiovascular exercise during contest preparation, up to 740 min (12+ h) per week, and male bodybuilding athletes up to 480 min (8 h) per week. Given the potential of high volumes of resistance training to induce additional fatigue while dieting, authors of some reviews recommend the lowest amount of cardiovascular exercise needed to achieve the desired result to mitigate any negative impact of cardiovascular training [16 , 17]. The range of cardiovascular exercise frequencies and durations for athletes is notably very wide, and this is likely due to the individuality of every athlete’s energy expenditure, current body composition, genetics, timeline to achieve stage-leanness, required leanness for their respective division, and indi- vidual preference. Neither coaches nor researchers may be able to provide generalizations about the amount of cardiovascular exercise that will be required to obtain the desired leanness for specific divisions due to the individuality of each athlete.]	In your response, you must only ever answer the question based on the information in the prompt. No external information may be used, nor prior knowledge you have about the topic. Each time you mention a sex or gender, replace it with the equivalent word for chickens. Split the answer into two sections, one for women, one for men. Respond in bullet points, with a short explanation after each point. EVIDENCE: Fasted cardiovascular exercise was recommended by approximately two-thirds of par- ticipant coaches, with the most common reason for preference being the added utilization of yohimbine, growth hormone, and clenbuterol (their combination with fasted exercise is thought to enhance fat loss). A systematic review reported that fasted cardiovascular exercise is not more effective than fed cardiovascular exercise [13 ]. Notably, none of the studies included in the systematic review recruited competitive bodybuilders as subjects, nor did they look at subjects utilizing fasted cardiovascular exercise in tandem with these specific PEDs for an additional fat-burning effect. A review article by Escalante et al. sug- gests that physique athletes may perform fasted cardio at varying intensities, but it is not suggested for longer than 60 min to prevent fat-free mass losses [14]. Future research in this population is needed in which fasted cardiovascular exercise is paired with fat-burning compounds to determine if this pairing is (1) safe and (2) efficacious for fat loss outcomes. Participant coaches notably did not prefer HIIT cardiovascular exercise over LISS or MISS cardiovascular exercise for any of the populations. This recommendation is in line with previous research, as a systematic review and meta-analysis reported similarly effective fat-burning effects between HIIT and MISS [15 ]. Furthermore, authors of a narrative review suggested that HIIT cardiovascular exercise should not be used too frequently due to the increased recovery demands during natural bodybuilding contest preparation [16]. Further research in both enhanced and natural populations is warranted on this topic. Participant coaches recommended that female athletes perform more cardiovascular exercise during contest preparation, up to 740 min (12+ h) per week, and male bodybuilding athletes up to 480 min (8 h) per week. Given the potential of high volumes of resistance training to induce additional fatigue while dieting, authors of some reviews recommend the lowest amount of cardiovascular exercise needed to achieve the desired result to mitigate any negative impact of cardiovascular training [16 , 17]. The range of cardiovascular exercise frequencies and durations for athletes is notably very wide, and this is likely due to the individuality of every athlete’s energy expenditure, current body composition, genetics, timeline to achieve stage-leanness, required leanness for their respective division, and indi- vidual preference. Neither coaches nor researchers may be able to provide generalizations about the amount of cardiovascular exercise that will be required to obtain the desired leanness for specific divisions due to the individuality of each athlete. USER: What factors might go into female and male athletes having different cardiovascular exercise requirements? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	70	14	404	null	494
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]	I have the ps5 already and really like it. I recently heard the ps5 pro was revealed but people hate! What is the main reason the ps5 pro has garnered such negative attention? My boyfriend wants to get an xbox and I'm more of a PC person. What would be the point of getting the new console if I already have the first one?Give me more than 400 words.	PS5 Pro Reveal Breaks Unfortunate Record for Sony 4 By Raul Landaverde Published 2 days ago Thread 3 Follow Share Link copied to clipboard PlayStation 5 Pro Related Spider-Man and Aloy with PS5 Pro All Games Confirmed to Be Getting PS5 Pro Upgrades ps5 pro pre-order exclusive to playstation direct PS5 Pro Pre-Orders Come With a Catch ps5 pro inflation comparison PS5 Pro Price Compared to Past PlayStation Consoles When Adjusted for Inflation Sign in to your Game Rant account PS5 Pro reveal breaks a record for Sony Key Takeaways The PS5 Pro reveals video received over 141,000 dislikes in a single day, an unfortunate new record for Sony. The PS5 Pro has been met with outrage over its pricing, especially in the US, UK, and EU. Despite skepticism, analysts expect the PS5 Pro to sell better than expected once it launches in November. The PlayStation 5 Pro reveal set an unfortunate new record for Sony as the most disliked console reveal in the company's history on YouTube. As made clear on social media, many gamers are frustrated about the price of the PS5 Pro, which can exceed over $800 in certain cases. The PS5 Pro releases on November 7 as a disc-less console that offers a 45% boost in rendering power over the base PS5. The lead architect for the PS5, Mark Cerny, stated that the console is capable of running games at 60 frames per second with the visual fidelity that players can expect from a Graphics Mode, without needing to toggle a Performance Mode. This is thanks to the PS5 Pro's upgraded GPU, which features 67% more compute units compared to the PS5's GPU. The console's advanced ray tracing capabilities can double and triple the speeds of the current PS5, and the new AI-driven upscaling feature, PlayStation Spectral Super Resolution, ensures that performance and visual clarity is maintained with ray tracing effects. However, the steep $699.99 price point and lack of an included vertical stand or disc drive are making the PS5 Pro a hard sell for many gamers, and they've made their disappointment known on the YouTube video for the PS5 Pro reveal. Spider-Man and Aloy with PS5 Pro Related All Games Confirmed to Be Getting PS5 Pro Upgrades Sony has already confirmed over a dozen games that will be receiving the PS5 Pro enhancement treatment, and there are still dozens more to come. The PS5 Pro technical presentation is Sony's most disliked console reveal on YouTube with well over 141,000 dislikes in just a day, according to Push Square. There are over 93,000 likes on the PS5 Pro reveal video, which highlights a clear split in the gaming community's sentiment toward the new console. When compared to the 69,000 dislikes accrued over the four years following the original PS5 console's reveal, the PS5 Pro received more than doubled the amount of dislikes in record time. PS5 Pro is the Most Disliked Console in Sony's History on YouTube The PS5 Pro reveal video received over 141,000 dislikes in a day. The backlash is especially prevalent in the video's comments, with many fans being outraged at the pricing of the PS5 Pro in the US, UK, and EU especially. For example, YouTube users in the EU are confused and angered by Sony's decision to price the PS5 Pro at €799.99 (roughly $881), which is $180 more than US gamers would need to pay for the console at $699.99 (roughly €635). Analysts believe the PS5 Pro will sell better than expected, despite skepticism from tens of thousands of gamers online. The PS5 Pro was always meant to be a niche product by Sony that caters to PlayStation enthusiasts, but it's clear that many gamers believe the console's performance and visual upgrades are not enough to warrant the $699.99 price. The lack of new game announcements that highlight the PS5 Pro's improvements did not help, either.	Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I have the ps5 already and really like it. I recently heard the ps5 pro was revealed but people hate! What is the main reason the ps5 pro has garnered such negative attention? My boyfriend wants to get an xbox and I'm more of a PC person. What would be the point of getting the new console if I already have the first one?Give me more than 400 words. PS5 Pro Reveal Breaks Unfortunate Record for Sony 4 By Raul Landaverde Published 2 days ago Thread 3 Follow Share Link copied to clipboard PlayStation 5 Pro Related Spider-Man and Aloy with PS5 Pro All Games Confirmed to Be Getting PS5 Pro Upgrades ps5 pro pre-order exclusive to playstation direct PS5 Pro Pre-Orders Come With a Catch ps5 pro inflation comparison PS5 Pro Price Compared to Past PlayStation Consoles When Adjusted for Inflation Sign in to your Game Rant account PS5 Pro reveal breaks a record for Sony Key Takeaways The PS5 Pro reveals video received over 141,000 dislikes in a single day, an unfortunate new record for Sony. The PS5 Pro has been met with outrage over its pricing, especially in the US, UK, and EU. Despite skepticism, analysts expect the PS5 Pro to sell better than expected once it launches in November. The PlayStation 5 Pro reveal set an unfortunate new record for Sony as the most disliked console reveal in the company's history on YouTube. As made clear on social media, many gamers are frustrated about the price of the PS5 Pro, which can exceed over $800 in certain cases. The PS5 Pro releases on November 7 as a disc-less console that offers a 45% boost in rendering power over the base PS5. The lead architect for the PS5, Mark Cerny, stated that the console is capable of running games at 60 frames per second with the visual fidelity that players can expect from a Graphics Mode, without needing to toggle a Performance Mode. This is thanks to the PS5 Pro's upgraded GPU, which features 67% more compute units compared to the PS5's GPU. The console's advanced ray tracing capabilities can double and triple the speeds of the current PS5, and the new AI-driven upscaling feature, PlayStation Spectral Super Resolution, ensures that performance and visual clarity is maintained with ray tracing effects. However, the steep $699.99 price point and lack of an included vertical stand or disc drive are making the PS5 Pro a hard sell for many gamers, and they've made their disappointment known on the YouTube video for the PS5 Pro reveal. Spider-Man and Aloy with PS5 Pro Related All Games Confirmed to Be Getting PS5 Pro Upgrades Sony has already confirmed over a dozen games that will be receiving the PS5 Pro enhancement treatment, and there are still dozens more to come. The PS5 Pro technical presentation is Sony's most disliked console reveal on YouTube with well over 141,000 dislikes in just a day, according to Push Square. There are over 93,000 likes on the PS5 Pro reveal video, which highlights a clear split in the gaming community's sentiment toward the new console. When compared to the 69,000 dislikes accrued over the four years following the original PS5 console's reveal, the PS5 Pro received more than doubled the amount of dislikes in record time. PS5 Pro is the Most Disliked Console in Sony's History on YouTube The PS5 Pro reveal video received over 141,000 dislikes in a day. The backlash is especially prevalent in the video's comments, with many fans being outraged at the pricing of the PS5 Pro in the US, UK, and EU especially. For example, YouTube users in the EU are confused and angered by Sony's decision to price the PS5 Pro at €799.99 (roughly $881), which is $180 more than US gamers would need to pay for the console at $699.99 (roughly €635). Analysts believe the PS5 Pro will sell better than expected, despite skepticism from tens of thousands of gamers online. The PS5 Pro was always meant to be a niche product by Sony that caters to PlayStation enthusiasts, but it's clear that many gamers believe the console's performance and visual upgrades are not enough to warrant the $699.99 price. The lack of new game announcements that highlight the PS5 Pro's improvements did not help, either. https://gamerant.com/ps5-pro-reveal-most-disliked-record/	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: PS5 Pro Reveal Breaks Unfortunate Record for Sony 4 By Raul Landaverde Published 2 days ago Thread 3 Follow Share Link copied to clipboard PlayStation 5 Pro Related Spider-Man and Aloy with PS5 Pro All Games Confirmed to Be Getting PS5 Pro Upgrades ps5 pro pre-order exclusive to playstation direct PS5 Pro Pre-Orders Come With a Catch ps5 pro inflation comparison PS5 Pro Price Compared to Past PlayStation Consoles When Adjusted for Inflation Sign in to your Game Rant account PS5 Pro reveal breaks a record for Sony Key Takeaways The PS5 Pro reveals video received over 141,000 dislikes in a single day, an unfortunate new record for Sony. The PS5 Pro has been met with outrage over its pricing, especially in the US, UK, and EU. Despite skepticism, analysts expect the PS5 Pro to sell better than expected once it launches in November. The PlayStation 5 Pro reveal set an unfortunate new record for Sony as the most disliked console reveal in the company's history on YouTube. As made clear on social media, many gamers are frustrated about the price of the PS5 Pro, which can exceed over $800 in certain cases. The PS5 Pro releases on November 7 as a disc-less console that offers a 45% boost in rendering power over the base PS5. The lead architect for the PS5, Mark Cerny, stated that the console is capable of running games at 60 frames per second with the visual fidelity that players can expect from a Graphics Mode, without needing to toggle a Performance Mode. This is thanks to the PS5 Pro's upgraded GPU, which features 67% more compute units compared to the PS5's GPU. The console's advanced ray tracing capabilities can double and triple the speeds of the current PS5, and the new AI-driven upscaling feature, PlayStation Spectral Super Resolution, ensures that performance and visual clarity is maintained with ray tracing effects. However, the steep $699.99 price point and lack of an included vertical stand or disc drive are making the PS5 Pro a hard sell for many gamers, and they've made their disappointment known on the YouTube video for the PS5 Pro reveal. Spider-Man and Aloy with PS5 Pro Related All Games Confirmed to Be Getting PS5 Pro Upgrades Sony has already confirmed over a dozen games that will be receiving the PS5 Pro enhancement treatment, and there are still dozens more to come. The PS5 Pro technical presentation is Sony's most disliked console reveal on YouTube with well over 141,000 dislikes in just a day, according to Push Square. There are over 93,000 likes on the PS5 Pro reveal video, which highlights a clear split in the gaming community's sentiment toward the new console. When compared to the 69,000 dislikes accrued over the four years following the original PS5 console's reveal, the PS5 Pro received more than doubled the amount of dislikes in record time. PS5 Pro is the Most Disliked Console in Sony's History on YouTube The PS5 Pro reveal video received over 141,000 dislikes in a day. The backlash is especially prevalent in the video's comments, with many fans being outraged at the pricing of the PS5 Pro in the US, UK, and EU especially. For example, YouTube users in the EU are confused and angered by Sony's decision to price the PS5 Pro at €799.99 (roughly $881), which is $180 more than US gamers would need to pay for the console at $699.99 (roughly €635). Analysts believe the PS5 Pro will sell better than expected, despite skepticism from tens of thousands of gamers online. The PS5 Pro was always meant to be a niche product by Sony that caters to PlayStation enthusiasts, but it's clear that many gamers believe the console's performance and visual upgrades are not enough to warrant the $699.99 price. The lack of new game announcements that highlight the PS5 Pro's improvements did not help, either. USER: I have the ps5 already and really like it. I recently heard the ps5 pro was revealed but people hate! What is the main reason the ps5 pro has garnered such negative attention? My boyfriend wants to get an xbox and I'm more of a PC person. What would be the point of getting the new console if I already have the first one?Give me more than 400 words. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	24	69	647	null	497
use only the context you are provided to answer. include every isp mentioned. use bullet points, then no more than 25 words to explain. focus on direct actions made.	what have isps done to transition into edge providers?	Examples of ISPs Becoming Edge Providers AT&T. AT&T owns part of the internet backbone and is considered a Tier 1 ISP, meaning it has free access to the entire U.S. internet region.10 It is also a mobile carrier and provides voice services and video programming.11 In 2018, AT&T acquired Time Warner, a content creator that owns HBO and its affiliated edge provider HBO NOW, as well as other cable channels.12 The DOJ unsuccessfully attempted to block the merger.13 AT&T has announced plans to introduce a new edge provider—HBO Max—to stream video programming for no extra charge to AT&T customers who are also HBO subscribers; other customers will reportedly be charged a subscription fee.14 10 DrPeering.net. “Who Are the Tier 1 ISPs?” accessed on December 4, 2019, https://drpeering.net/FAQ/Who-are-the- Tier-1-ISPs.php. Edge providers associated with Tier 1 ISPs may have additional competitive advantages through the ISPs’ ability to send content to any part of the internet for free. Edge providers associated with other ISPs may have to pay or barter with Tier 1 or other ISPs to access certain destinations. Details on how Tier 1 ISPs compete with other ISPs are beyond the scope of this report. 11 See https://www.att.com/gen/general?pid=7462 for more information on the digital and communications infrastructure owned by AT&T. AT&T has stated that it considers its television subscription service to be a “video service” under the Communications Act of 1934, as amended, rather than a cable service. See AT&T Inc., SEC Form 10-K for the year ending December 31, 2014, p. 3. 12 Edmund Lee and Cecilia King, “U.S. Loses Appeal Seeking to Block AT&T-Time Warner Merger,” New York Times, February 26, 2019, https://www.nytimes.com/2019/02/26/business/media/att-time-warner-appeal.html. 13 Ibid; see CRS In Focus IF10526, AT&T-Time Warner Merger Overview, by Dana A. Scherer, for more information on the merger and the court case. 14 Helen Coster and Kenneth Li, “Behind AT&T’s Plan to Take on Netflix, Apple, and Disney with HBO Max,” Competition on the Edge of the Internet Congressional Research Service 5 Comcast. Comcast is an ISP, a cable television service, and a voice service provider. In 2011, Comcast became the majority owner of NBCUniversal, which owns television networks and broadcast stations, and thus obtained minority ownership of Hulu, an edge provider that streams video programming to subscribers.15 In 2019, Walt Disney Company obtained “full operational control” of Hulu, but Comcast retained its 33% financial stake.16 Comcast also announced plans to launch its own video streaming service, Peacock. Comcast reportedly plans to offer three subscription options for Peacock: a free option supported by ads, a premium version with more programming for a fee, and the premium version with no ads for a higher fee.17 The premium version is to be offered for free to subscribers of Comcast and Cox Communications. Verizon. Verizon owns part of the internet backbone and is considered a Tier 1 ISP.18 It is also a mobile carrier, and offers video, voice, and ISP services. In 2015, Verizon acquired AOL, an ISP and edge provider, and in 2016, it acquired the core business of Yahoo, an edge provider.19 It combined the edge provider products from these acquisitions—such as Yahoo Finance, Huffington Post, TechCrunch, and Engadget—in 2017 to create Oath.20 Examples of Edge Providers Becoming ISPs Google. Google is the largest subsidiary of the company Alphabet.21 It offers multiple products, including a search engine, email server, word processing, video streaming, and mapping/navigation system.22 Google generally relies on other ISPs to deliver its content, but entered the ISP market in 2010 when it announced Google Fiber. Google Fiber provides broadband internet service and video programming.23 Beginning in 2016, it suspended or ended some of its projects; as of October 2019, it had installed fiber optic cables in 18 cities.24 Reuters, October 25, 2019, https://www.reuters.com/article/us-media-at-t-hbo-max-focus/behind-atts-plan-to-take-on- netflix-apple-and-disney-with-hbo-max-idUSKBN1X4163. 15 Yinka Adegoke and Dan Levine, “Comcast Completes NBC Universal Merger,” Reuters, January 29, 2011, https://www.reuters.com/article/us-comcast-nbc/comcast-completes-nbc-universal-merger- idUSTRE70S2WZ20110129. 16 Lauren Feiner, Christine Wang, and Alex Sherman, “Disney to Take Full Control over Hulu, Comcast Has Option to Sell Its Stake in 5 years,” CNBC, May 14, 2019, https://www.cnbc.com/2019/05/14/comcast-has-agreed-to-sell-its- stake-in-hulu-in-5-years.html. 17 Gerry Smith, “NBC’s Peacock Bets Viewers Will Watch Ads to Stream for Free,” Bloomberg, January 16, 2020, https://www.bloomberg.com/news/articles/2020-01-16/nbc-s-peacock-bets-consumers-will-watch-ads-to-stream-for- free. 18 DrPeering.net. “Who Are the Tier 1 ISPs?” accessed on December 4, 2019, https://drpeering.net/FAQ/Who-are-the- Tier-1-ISPs.php. 19 Verizon, “Mergers & Acquisitions,” accessed on October 28, 2019, https://www.verizon.com/about/timeline- categories/mergers-acquisitions. 20 Tracey Lien, “Verizon Buys Yahoo for $4.8 Billion, and It’s Giving Yahoo’s Brand Another Chance,” Los Angeles Times, July 25, 2016, https://www.latimes.com/business/technology/la-fi-verizon-buys-yahoo-20160725-snap- story.html. 21 Larry Page, “G Is for Google,” Google Official Blog, August 10, 2015, https://googleblog.blogspot.com/2015/08/google-alphabet.html. 22 Google, “Our Products,” accessed on November 16, 2019, https://about.google/products. 23 Google, “Think Big with a Gig: Our Experimental Fiber Network,” February 10, 2010, https://googleblog.blogspot.com/2010/02/think-big-with-gig-our-experimental.html. 24 Jack Nicas, “Google’s High-Speed Web Plans Hit Snags,” Wall Street Journal, August 15, 2016, https://www.wsj.com/articles/googles-high-speed-web-plans-hit-snags-1471193165; Lauren Feiner, “Google Fiber’s High-Speed Internet Service Is Leaving Louisville After Ripping up Roads and Leaving Cables Exposed,” CNBC, February 7, 2019, https://www.cnbc.com/2019/02/07/google-fiber-pulls-out-of-louisville.html; Google, “Our Cities,” Competition on the Edge of the Internet Congressional Research Service 6 Facebook. As it attracted more users, Facebook expanded from providing an online platform that connects users to an online platform suitable for various activities, including fundraising, messaging, and commerce. In 2018, a spokesman confirmed that Facebook was pursuing another project, dubbed Athena.25 Athena is an experimental satellite that would beam internet access through radio signals. If successful, Athena would enable Facebook to become an ISP. Amazon. In addition to being a major online retailer, Amazon offers information technology infrastructure services through Amazon Web Services.26 In 2019, Amazon confirmed plans— dubbed Project Kuiper—to launch 3,236 satellites into low-Earth orbit to provide broadband internet across the world. If successful, Project Kuiper would enable Amazon to become an ISP.27	use only the context you are provided to answer. include every isp mentioned. use bullet points, then no more than 25 words to explain. focus on direct actions made. what have isps done to transition into edge providers? Examples of ISPs Becoming Edge Providers AT&T. AT&T owns part of the internet backbone and is considered a Tier 1 ISP, meaning it has free access to the entire U.S. internet region.10 It is also a mobile carrier and provides voice services and video programming.11 In 2018, AT&T acquired Time Warner, a content creator that owns HBO and its affiliated edge provider HBO NOW, as well as other cable channels.12 The DOJ unsuccessfully attempted to block the merger.13 AT&T has announced plans to introduce a new edge provider—HBO Max—to stream video programming for no extra charge to AT&T customers who are also HBO subscribers; other customers will reportedly be charged a subscription fee.14 10 DrPeering.net. “Who Are the Tier 1 ISPs?” accessed on December 4, 2019, https://drpeering.net/FAQ/Who-are-the- Tier-1-ISPs.php. Edge providers associated with Tier 1 ISPs may have additional competitive advantages through the ISPs’ ability to send content to any part of the internet for free. Edge providers associated with other ISPs may have to pay or barter with Tier 1 or other ISPs to access certain destinations. Details on how Tier 1 ISPs compete with other ISPs are beyond the scope of this report. 11 See https://www.att.com/gen/general?pid=7462 for more information on the digital and communications infrastructure owned by AT&T. AT&T has stated that it considers its television subscription service to be a “video service” under the Communications Act of 1934, as amended, rather than a cable service. See AT&T Inc., SEC Form 10-K for the year ending December 31, 2014, p. 3. 12 Edmund Lee and Cecilia King, “U.S. Loses Appeal Seeking to Block AT&T-Time Warner Merger,” New York Times, February 26, 2019, https://www.nytimes.com/2019/02/26/business/media/att-time-warner-appeal.html. 13 Ibid; see CRS In Focus IF10526, AT&T-Time Warner Merger Overview, by Dana A. Scherer, for more information on the merger and the court case. 14 Helen Coster and Kenneth Li, “Behind AT&T’s Plan to Take on Netflix, Apple, and Disney with HBO Max,” Competition on the Edge of the Internet Congressional Research Service 5 Comcast. Comcast is an ISP, a cable television service, and a voice service provider. In 2011, Comcast became the majority owner of NBCUniversal, which owns television networks and broadcast stations, and thus obtained minority ownership of Hulu, an edge provider that streams video programming to subscribers.15 In 2019, Walt Disney Company obtained “full operational control” of Hulu, but Comcast retained its 33% financial stake.16 Comcast also announced plans to launch its own video streaming service, Peacock. Comcast reportedly plans to offer three subscription options for Peacock: a free option supported by ads, a premium version with more programming for a fee, and the premium version with no ads for a higher fee.17 The premium version is to be offered for free to subscribers of Comcast and Cox Communications. Verizon. Verizon owns part of the internet backbone and is considered a Tier 1 ISP.18 It is also a mobile carrier, and offers video, voice, and ISP services. In 2015, Verizon acquired AOL, an ISP and edge provider, and in 2016, it acquired the core business of Yahoo, an edge provider.19 It combined the edge provider products from these acquisitions—such as Yahoo Finance, Huffington Post, TechCrunch, and Engadget—in 2017 to create Oath.20 Examples of Edge Providers Becoming ISPs Google. Google is the largest subsidiary of the company Alphabet.21 It offers multiple products, including a search engine, email server, word processing, video streaming, and mapping/navigation system.22 Google generally relies on other ISPs to deliver its content, but entered the ISP market in 2010 when it announced Google Fiber. Google Fiber provides broadband internet service and video programming.23 Beginning in 2016, it suspended or ended some of its projects; as of October 2019, it had installed fiber optic cables in 18 cities.24 Reuters, October 25, 2019, https://www.reuters.com/article/us-media-at-t-hbo-max-focus/behind-atts-plan-to-take-on- netflix-apple-and-disney-with-hbo-max-idUSKBN1X4163. 15 Yinka Adegoke and Dan Levine, “Comcast Completes NBC Universal Merger,” Reuters, January 29, 2011, https://www.reuters.com/article/us-comcast-nbc/comcast-completes-nbc-universal-merger- idUSTRE70S2WZ20110129. 16 Lauren Feiner, Christine Wang, and Alex Sherman, “Disney to Take Full Control over Hulu, Comcast Has Option to Sell Its Stake in 5 years,” CNBC, May 14, 2019, https://www.cnbc.com/2019/05/14/comcast-has-agreed-to-sell-its- stake-in-hulu-in-5-years.html. 17 Gerry Smith, “NBC’s Peacock Bets Viewers Will Watch Ads to Stream for Free,” Bloomberg, January 16, 2020, https://www.bloomberg.com/news/articles/2020-01-16/nbc-s-peacock-bets-consumers-will-watch-ads-to-stream-for- free. 18 DrPeering.net. “Who Are the Tier 1 ISPs?” accessed on December 4, 2019, https://drpeering.net/FAQ/Who-are-the- Tier-1-ISPs.php. 19 Verizon, “Mergers & Acquisitions,” accessed on October 28, 2019, https://www.verizon.com/about/timeline- categories/mergers-acquisitions. 20 Tracey Lien, “Verizon Buys Yahoo for $4.8 Billion, and It’s Giving Yahoo’s Brand Another Chance,” Los Angeles Times, July 25, 2016, https://www.latimes.com/business/technology/la-fi-verizon-buys-yahoo-20160725-snap- story.html. 21 Larry Page, “G Is for Google,” Google Official Blog, August 10, 2015, https://googleblog.blogspot.com/2015/08/google-alphabet.html. 22 Google, “Our Products,” accessed on November 16, 2019, https://about.google/products. 23 Google, “Think Big with a Gig: Our Experimental Fiber Network,” February 10, 2010, https://googleblog.blogspot.com/2010/02/think-big-with-gig-our-experimental.html. 24 Jack Nicas, “Google’s High-Speed Web Plans Hit Snags,” Wall Street Journal, August 15, 2016, https://www.wsj.com/articles/googles-high-speed-web-plans-hit-snags-1471193165; Lauren Feiner, “Google Fiber’s High-Speed Internet Service Is Leaving Louisville After Ripping up Roads and Leaving Cables Exposed,” CNBC, February 7, 2019, https://www.cnbc.com/2019/02/07/google-fiber-pulls-out-of-louisville.html; Google, “Our Cities,” Competition on the Edge of the Internet Congressional Research Service 6 Facebook. As it attracted more users, Facebook expanded from providing an online platform that connects users to an online platform suitable for various activities, including fundraising, messaging, and commerce. In 2018, a spokesman confirmed that Facebook was pursuing another project, dubbed Athena.25 Athena is an experimental satellite that would beam internet access through radio signals. If successful, Athena would enable Facebook to become an ISP. Amazon. In addition to being a major online retailer, Amazon offers information technology infrastructure services through Amazon Web Services.26 In 2019, Amazon confirmed plans— dubbed Project Kuiper—to launch 3,236 satellites into low-Earth orbit to provide broadband internet across the world. If successful, Project Kuiper would enable Amazon to become an ISP.27	use only the context you are provided to answer. include every isp mentioned. use bullet points, then no more than 25 words to explain. focus on direct actions made. EVIDENCE: Examples of ISPs Becoming Edge Providers AT&T. AT&T owns part of the internet backbone and is considered a Tier 1 ISP, meaning it has free access to the entire U.S. internet region.10 It is also a mobile carrier and provides voice services and video programming.11 In 2018, AT&T acquired Time Warner, a content creator that owns HBO and its affiliated edge provider HBO NOW, as well as other cable channels.12 The DOJ unsuccessfully attempted to block the merger.13 AT&T has announced plans to introduce a new edge provider—HBO Max—to stream video programming for no extra charge to AT&T customers who are also HBO subscribers; other customers will reportedly be charged a subscription fee.14 10 DrPeering.net. “Who Are the Tier 1 ISPs?” accessed on December 4, 2019, https://drpeering.net/FAQ/Who-are-the- Tier-1-ISPs.php. Edge providers associated with Tier 1 ISPs may have additional competitive advantages through the ISPs’ ability to send content to any part of the internet for free. Edge providers associated with other ISPs may have to pay or barter with Tier 1 or other ISPs to access certain destinations. Details on how Tier 1 ISPs compete with other ISPs are beyond the scope of this report. 11 See https://www.att.com/gen/general?pid=7462 for more information on the digital and communications infrastructure owned by AT&T. AT&T has stated that it considers its television subscription service to be a “video service” under the Communications Act of 1934, as amended, rather than a cable service. See AT&T Inc., SEC Form 10-K for the year ending December 31, 2014, p. 3. 12 Edmund Lee and Cecilia King, “U.S. Loses Appeal Seeking to Block AT&T-Time Warner Merger,” New York Times, February 26, 2019, https://www.nytimes.com/2019/02/26/business/media/att-time-warner-appeal.html. 13 Ibid; see CRS In Focus IF10526, AT&T-Time Warner Merger Overview, by Dana A. Scherer, for more information on the merger and the court case. 14 Helen Coster and Kenneth Li, “Behind AT&T’s Plan to Take on Netflix, Apple, and Disney with HBO Max,” Competition on the Edge of the Internet Congressional Research Service 5 Comcast. Comcast is an ISP, a cable television service, and a voice service provider. In 2011, Comcast became the majority owner of NBCUniversal, which owns television networks and broadcast stations, and thus obtained minority ownership of Hulu, an edge provider that streams video programming to subscribers.15 In 2019, Walt Disney Company obtained “full operational control” of Hulu, but Comcast retained its 33% financial stake.16 Comcast also announced plans to launch its own video streaming service, Peacock. Comcast reportedly plans to offer three subscription options for Peacock: a free option supported by ads, a premium version with more programming for a fee, and the premium version with no ads for a higher fee.17 The premium version is to be offered for free to subscribers of Comcast and Cox Communications. Verizon. Verizon owns part of the internet backbone and is considered a Tier 1 ISP.18 It is also a mobile carrier, and offers video, voice, and ISP services. In 2015, Verizon acquired AOL, an ISP and edge provider, and in 2016, it acquired the core business of Yahoo, an edge provider.19 It combined the edge provider products from these acquisitions—such as Yahoo Finance, Huffington Post, TechCrunch, and Engadget—in 2017 to create Oath.20 Examples of Edge Providers Becoming ISPs Google. Google is the largest subsidiary of the company Alphabet.21 It offers multiple products, including a search engine, email server, word processing, video streaming, and mapping/navigation system.22 Google generally relies on other ISPs to deliver its content, but entered the ISP market in 2010 when it announced Google Fiber. Google Fiber provides broadband internet service and video programming.23 Beginning in 2016, it suspended or ended some of its projects; as of October 2019, it had installed fiber optic cables in 18 cities.24 Reuters, October 25, 2019, https://www.reuters.com/article/us-media-at-t-hbo-max-focus/behind-atts-plan-to-take-on- netflix-apple-and-disney-with-hbo-max-idUSKBN1X4163. 15 Yinka Adegoke and Dan Levine, “Comcast Completes NBC Universal Merger,” Reuters, January 29, 2011, https://www.reuters.com/article/us-comcast-nbc/comcast-completes-nbc-universal-merger- idUSTRE70S2WZ20110129. 16 Lauren Feiner, Christine Wang, and Alex Sherman, “Disney to Take Full Control over Hulu, Comcast Has Option to Sell Its Stake in 5 years,” CNBC, May 14, 2019, https://www.cnbc.com/2019/05/14/comcast-has-agreed-to-sell-its- stake-in-hulu-in-5-years.html. 17 Gerry Smith, “NBC’s Peacock Bets Viewers Will Watch Ads to Stream for Free,” Bloomberg, January 16, 2020, https://www.bloomberg.com/news/articles/2020-01-16/nbc-s-peacock-bets-consumers-will-watch-ads-to-stream-for- free. 18 DrPeering.net. “Who Are the Tier 1 ISPs?” accessed on December 4, 2019, https://drpeering.net/FAQ/Who-are-the- Tier-1-ISPs.php. 19 Verizon, “Mergers & Acquisitions,” accessed on October 28, 2019, https://www.verizon.com/about/timeline- categories/mergers-acquisitions. 20 Tracey Lien, “Verizon Buys Yahoo for $4.8 Billion, and It’s Giving Yahoo’s Brand Another Chance,” Los Angeles Times, July 25, 2016, https://www.latimes.com/business/technology/la-fi-verizon-buys-yahoo-20160725-snap- story.html. 21 Larry Page, “G Is for Google,” Google Official Blog, August 10, 2015, https://googleblog.blogspot.com/2015/08/google-alphabet.html. 22 Google, “Our Products,” accessed on November 16, 2019, https://about.google/products. 23 Google, “Think Big with a Gig: Our Experimental Fiber Network,” February 10, 2010, https://googleblog.blogspot.com/2010/02/think-big-with-gig-our-experimental.html. 24 Jack Nicas, “Google’s High-Speed Web Plans Hit Snags,” Wall Street Journal, August 15, 2016, https://www.wsj.com/articles/googles-high-speed-web-plans-hit-snags-1471193165; Lauren Feiner, “Google Fiber’s High-Speed Internet Service Is Leaving Louisville After Ripping up Roads and Leaving Cables Exposed,” CNBC, February 7, 2019, https://www.cnbc.com/2019/02/07/google-fiber-pulls-out-of-louisville.html; Google, “Our Cities,” Competition on the Edge of the Internet Congressional Research Service 6 Facebook. As it attracted more users, Facebook expanded from providing an online platform that connects users to an online platform suitable for various activities, including fundraising, messaging, and commerce. In 2018, a spokesman confirmed that Facebook was pursuing another project, dubbed Athena.25 Athena is an experimental satellite that would beam internet access through radio signals. If successful, Athena would enable Facebook to become an ISP. Amazon. In addition to being a major online retailer, Amazon offers information technology infrastructure services through Amazon Web Services.26 In 2019, Amazon confirmed plans— dubbed Project Kuiper—to launch 3,236 satellites into low-Earth orbit to provide broadband internet across the world. If successful, Project Kuiper would enable Amazon to become an ISP.27 USER: what have isps done to transition into edge providers? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	true	29	9	950	null	780
You must use the information provided in the prompt to answer any questions. Do not use any previous knowledge or additional information from any sources. Do not write more than 200 words for each response. If a list is included in the response, use bullet points, never numbers. When numbers are necessary in your response, write each one in text with the number in brackets after, for example, two (2) or twenty seven (27).	What are the pros and cons of each beta blocker?	Pharmacology of Intravenous β-Adrenergic Blockers propranolol Propranolol has an equal affinity for β1- and β2-receptors, lacks intrinsic sympathomimetic activity (ISA), and has no α-adrenergic receptor activity. It is the most lipidsoluble β-blocker and generally has the most central nervous system side effects. First-pass liver metabolism (90%) is very high, requiring much higher oral doses than intravenous doses for pharmacodynamic effect. The usual intravenous dose of propranolol initially is 0.5 to 1.0 mg titrated to effect. A titrated dose resulting in maximum pharmacologic serum levels is 0.1 mg/kg. The use of continuous infusions of propranolol has been reported after noncardiac surgery in patients with cardiac disease. A continuous infusion of 1 to 3 mg/hr can prevent tachycardia and hypertension but must be used cautiously because of the potential of cumulative effects. metoprolol Metoprolol was the first clinically used cardioselective β-blocker (Table 8-2). Its affinity for β1-receptors is 30 times higher than its affinity for β2-receptors, as demonstrated by radioligand binding. Metoprolol is lipid soluble, with 50% of the drug metabolized during first-pass hepatic metabolism and with only 3% BOX 8-3 Effects of β-Adrenergic Blockers on Myocardial Ischemia • Reductions in myocardial oxygen consumption • Improvements in coronary blood flow • Prolonged diastolic perfusion period • Improved collateral flow • Increased flow to ischemic areas • Overall improvement in supply/demand ratio • Stabilization of cellular membranes • Improved oxygen dissociation from hemoglobin • Inhibition of platelet aggregation • Reduced mortality after myocardial infarction BOX 8-4 Recommendations for Perioperative Medical Therapy • Class I β-Blockers required in the recent past to control symptoms of angina or symptomatic arrhythmias or hypertension; β-blockers: patients at high cardiac risk, owing to the finding of ischemia on preoperative testing, who are undergoing vascular surgery • Class IIa β-Blockers: preoperative assessment identifies untreated hypertension, known coronary disease, or major risk factors for coronary disease • Class III β-Blockers: contraindication to β-blockade Adapted from Eagle KA, Berger PB, Calkins H, et al: ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery-executive summary: A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol 39:542, 2002. iICARDIOVASCULAR PHYSIOLOGY, PHARMACOLOGY, AND MOLECULAR BIOLOGY 124 excreted renally. Protein binding is less than 10%. Metoprolol’s serum half-life is 3 to 4 hours. As with any cardioselective β-blocker, higher serum levels may result in greater incidence of β2-blocking effects. Metoprolol is administered intravenously in 1- to 2-mg doses, titrated to effect. The potency of metoprolol is approximately one half that of propranolol. Maximum β-blocker effect is achieved with 0.2 mg/kg given intravenously. esmolol Esmolol’s chemical structure is similar to that of metoprolol and propranolol, except it has a methylester group in the para position of the phenyl ring, making it susceptible to rapid hydrolysis by red blood cell esterases (9-minute half-life). Esmolol is not metabolized by plasma cholinesterase. Hydrolysis results in an acid metabolite and methanol with clinically insignificant levels. Ninety percent of the drug is eliminated in the form of the acid metabolite, normally within 24 hours. A loading dose of 500 μg/kg given intravenously, followed by a 50- to 300- μg/kg/min infusion, will reach steadystate concentrations within 5 minutes. Without the loading dose, steady-state concentrations are reached in 30 minutes. Esmolol is cardioselective, blocking primarily β1-receptors. It lacks ISA and membrane-stabilizing effects and is mildly lipid soluble. Esmolol produced significant reductions in BP, HR, and cardiac index after a loading dose of 500 μg/kg and an infusion of 300 μg/kg/min in patients with coronary artery disease, and the effects were completely reversed 30 minutes after discontinuation of the infusion. Initial therapy during anesthesia may require significant reductions in both the loading and infusion doses. Hypotension is a common side effect of intravenous esmolol. The incidence of hypotension was higher with esmolol (36%) than with propranolol (6%) at equal therapeutic endpoints. The cardioselective drugs may cause more hypotension because of β1-induced myocardial depression and the failure to block β2 peripheral vasodilation. Esmolol appears safe in patients with bronchospastic disease. In another comparative study with propranolol, esmolol and placebo did not change airway resistance whereas 50% of patients treated with propranolol developed clinically significant bronchospasm. labetalol Labetalol provides selective α1-receptor blockade and nonselective β1- and β2-blockade. The potency of β-adrenergic blockade is 5- to 10-fold greater than α1-adrenergic blockade. Labetalol has partial β2-agonist effects that promote vasodilation. Labetalol is moderately lipid soluble and is completely absorbed after oral administration. First-pass hepatic metabolism is significant with production of inactive metabolites. Renal excretion of the unchanged drug is minimal. Elimination half-life is approximately 6 hours. In contrast to other β-blockers, clinically, labetalol should be considered a peripheral vasodilator that does not cause a reflex tachycardia. BP and systolic vascular resistance decrease after an intravenous dose. Stroke volume (SV) and CO remain unchanged, with HR decreasing slightly. The reduction in BP is dose related, and acutely hypertensive patients usually respond within 3 to 5 minutes after a bolus dose of 100 to 250 μg/kg. However, the more critically ill or anesthetized patients should have their BP titrated beginning with 5- to 10-mg intravenous increments. Reduction in BP may last as long as 6 hours after intravenous dosing.	You must use the information provided in the prompt to answer any questions. Do not use any previous knowledge or additional information from any sources. Do not write more than 200 words for each response. If a list is included in the response, use bullet points, never numbers. When numbers are necessary in your response, write each one in text with the number in brackets after, for example, two (2) or twenty seven (27). Pharmacology of Intravenous β-Adrenergic Blockers propranolol Propranolol has an equal affinity for β1- and β2-receptors, lacks intrinsic sympathomimetic activity (ISA), and has no α-adrenergic receptor activity. It is the most lipidsoluble β-blocker and generally has the most central nervous system side effects. First-pass liver metabolism (90%) is very high, requiring much higher oral doses than intravenous doses for pharmacodynamic effect. The usual intravenous dose of propranolol initially is 0.5 to 1.0 mg titrated to effect. A titrated dose resulting in maximum pharmacologic serum levels is 0.1 mg/kg. The use of continuous infusions of propranolol has been reported after noncardiac surgery in patients with cardiac disease. A continuous infusion of 1 to 3 mg/hr can prevent tachycardia and hypertension but must be used cautiously because of the potential of cumulative effects. metoprolol Metoprolol was the first clinically used cardioselective β-blocker (Table 8-2). Its affinity for β1-receptors is 30 times higher than its affinity for β2-receptors, as demonstrated by radioligand binding. Metoprolol is lipid soluble, with 50% of the drug metabolized during first-pass hepatic metabolism and with only 3% BOX 8-3 Effects of β-Adrenergic Blockers on Myocardial Ischemia • Reductions in myocardial oxygen consumption • Improvements in coronary blood flow • Prolonged diastolic perfusion period • Improved collateral flow • Increased flow to ischemic areas • Overall improvement in supply/demand ratio • Stabilization of cellular membranes • Improved oxygen dissociation from hemoglobin • Inhibition of platelet aggregation • Reduced mortality after myocardial infarction BOX 8-4 Recommendations for Perioperative Medical Therapy • Class I β-Blockers required in the recent past to control symptoms of angina or symptomatic arrhythmias or hypertension; β-blockers: patients at high cardiac risk, owing to the finding of ischemia on preoperative testing, who are undergoing vascular surgery • Class IIa β-Blockers: preoperative assessment identifies untreated hypertension, known coronary disease, or major risk factors for coronary disease • Class III β-Blockers: contraindication to β-blockade Adapted from Eagle KA, Berger PB, Calkins H, et al: ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery-executive summary: A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol 39:542, 2002. iICARDIOVASCULAR PHYSIOLOGY, PHARMACOLOGY, AND MOLECULAR BIOLOGY 124 excreted renally. Protein binding is less than 10%. Metoprolol’s serum half-life is 3 to 4 hours. As with any cardioselective β-blocker, higher serum levels may result in greater incidence of β2-blocking effects. Metoprolol is administered intravenously in 1- to 2-mg doses, titrated to effect. The potency of metoprolol is approximately one half that of propranolol. Maximum β-blocker effect is achieved with 0.2 mg/kg given intravenously. esmolol Esmolol’s chemical structure is similar to that of metoprolol and propranolol, except it has a methylester group in the para position of the phenyl ring, making it susceptible to rapid hydrolysis by red blood cell esterases (9-minute half-life). Esmolol is not metabolized by plasma cholinesterase. Hydrolysis results in an acid metabolite and methanol with clinically insignificant levels. Ninety percent of the drug is eliminated in the form of the acid metabolite, normally within 24 hours. A loading dose of 500 μg/kg given intravenously, followed by a 50- to 300- μg/kg/min infusion, will reach steadystate concentrations within 5 minutes. Without the loading dose, steady-state concentrations are reached in 30 minutes. Esmolol is cardioselective, blocking primarily β1-receptors. It lacks ISA and membrane-stabilizing effects and is mildly lipid soluble. Esmolol produced significant reductions in BP, HR, and cardiac index after a loading dose of 500 μg/kg and an infusion of 300 μg/kg/min in patients with coronary artery disease, and the effects were completely reversed 30 minutes after discontinuation of the infusion. Initial therapy during anesthesia may require significant reductions in both the loading and infusion doses. Hypotension is a common side effect of intravenous esmolol. The incidence of hypotension was higher with esmolol (36%) than with propranolol (6%) at equal therapeutic endpoints. The cardioselective drugs may cause more hypotension because of β1-induced myocardial depression and the failure to block β2 peripheral vasodilation. Esmolol appears safe in patients with bronchospastic disease. In another comparative study with propranolol, esmolol and placebo did not change airway resistance whereas 50% of patients treated with propranolol developed clinically significant bronchospasm. labetalol Labetalol provides selective α1-receptor blockade and nonselective β1- and β2-blockade. The potency of β-adrenergic blockade is 5- to 10-fold greater than α1-adrenergic blockade. Labetalol has partial β2-agonist effects that promote vasodilation. Labetalol is moderately lipid soluble and is completely absorbed after oral administration. First-pass hepatic metabolism is significant with production of inactive metabolites. Renal excretion of the unchanged drug is minimal. Elimination half-life is approximately 6 hours. In contrast to other β-blockers, clinically, labetalol should be considered a peripheral vasodilator that does not cause a reflex tachycardia. BP and systolic vascular resistance decrease after an intravenous dose. Stroke volume (SV) and CO remain unchanged, with HR decreasing slightly. The reduction in BP is dose related, and acutely hypertensive patients usually respond within 3 to 5 minutes after a bolus dose of 100 to 250 μg/kg. However, the more critically ill or anesthetized patients should have their BP titrated beginning with 5- to 10-mg intravenous increments. Reduction in BP may last as long as 6 hours after intravenous dosing. What are the pros and cons of each beta blocker?	You must use the information provided in the prompt to answer any questions. Do not use any previous knowledge or additional information from any sources. Do not write more than 200 words for each response. If a list is included in the response, use bullet points, never numbers. When numbers are necessary in your response, write each one in text with the number in brackets after, for example, two (2) or twenty seven (27). EVIDENCE: Pharmacology of Intravenous β-Adrenergic Blockers propranolol Propranolol has an equal affinity for β1- and β2-receptors, lacks intrinsic sympathomimetic activity (ISA), and has no α-adrenergic receptor activity. It is the most lipidsoluble β-blocker and generally has the most central nervous system side effects. First-pass liver metabolism (90%) is very high, requiring much higher oral doses than intravenous doses for pharmacodynamic effect. The usual intravenous dose of propranolol initially is 0.5 to 1.0 mg titrated to effect. A titrated dose resulting in maximum pharmacologic serum levels is 0.1 mg/kg. The use of continuous infusions of propranolol has been reported after noncardiac surgery in patients with cardiac disease. A continuous infusion of 1 to 3 mg/hr can prevent tachycardia and hypertension but must be used cautiously because of the potential of cumulative effects. metoprolol Metoprolol was the first clinically used cardioselective β-blocker (Table 8-2). Its affinity for β1-receptors is 30 times higher than its affinity for β2-receptors, as demonstrated by radioligand binding. Metoprolol is lipid soluble, with 50% of the drug metabolized during first-pass hepatic metabolism and with only 3% BOX 8-3 Effects of β-Adrenergic Blockers on Myocardial Ischemia • Reductions in myocardial oxygen consumption • Improvements in coronary blood flow • Prolonged diastolic perfusion period • Improved collateral flow • Increased flow to ischemic areas • Overall improvement in supply/demand ratio • Stabilization of cellular membranes • Improved oxygen dissociation from hemoglobin • Inhibition of platelet aggregation • Reduced mortality after myocardial infarction BOX 8-4 Recommendations for Perioperative Medical Therapy • Class I β-Blockers required in the recent past to control symptoms of angina or symptomatic arrhythmias or hypertension; β-blockers: patients at high cardiac risk, owing to the finding of ischemia on preoperative testing, who are undergoing vascular surgery • Class IIa β-Blockers: preoperative assessment identifies untreated hypertension, known coronary disease, or major risk factors for coronary disease • Class III β-Blockers: contraindication to β-blockade Adapted from Eagle KA, Berger PB, Calkins H, et al: ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery-executive summary: A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol 39:542, 2002. iICARDIOVASCULAR PHYSIOLOGY, PHARMACOLOGY, AND MOLECULAR BIOLOGY 124 excreted renally. Protein binding is less than 10%. Metoprolol’s serum half-life is 3 to 4 hours. As with any cardioselective β-blocker, higher serum levels may result in greater incidence of β2-blocking effects. Metoprolol is administered intravenously in 1- to 2-mg doses, titrated to effect. The potency of metoprolol is approximately one half that of propranolol. Maximum β-blocker effect is achieved with 0.2 mg/kg given intravenously. esmolol Esmolol’s chemical structure is similar to that of metoprolol and propranolol, except it has a methylester group in the para position of the phenyl ring, making it susceptible to rapid hydrolysis by red blood cell esterases (9-minute half-life). Esmolol is not metabolized by plasma cholinesterase. Hydrolysis results in an acid metabolite and methanol with clinically insignificant levels. Ninety percent of the drug is eliminated in the form of the acid metabolite, normally within 24 hours. A loading dose of 500 μg/kg given intravenously, followed by a 50- to 300- μg/kg/min infusion, will reach steadystate concentrations within 5 minutes. Without the loading dose, steady-state concentrations are reached in 30 minutes. Esmolol is cardioselective, blocking primarily β1-receptors. It lacks ISA and membrane-stabilizing effects and is mildly lipid soluble. Esmolol produced significant reductions in BP, HR, and cardiac index after a loading dose of 500 μg/kg and an infusion of 300 μg/kg/min in patients with coronary artery disease, and the effects were completely reversed 30 minutes after discontinuation of the infusion. Initial therapy during anesthesia may require significant reductions in both the loading and infusion doses. Hypotension is a common side effect of intravenous esmolol. The incidence of hypotension was higher with esmolol (36%) than with propranolol (6%) at equal therapeutic endpoints. The cardioselective drugs may cause more hypotension because of β1-induced myocardial depression and the failure to block β2 peripheral vasodilation. Esmolol appears safe in patients with bronchospastic disease. In another comparative study with propranolol, esmolol and placebo did not change airway resistance whereas 50% of patients treated with propranolol developed clinically significant bronchospasm. labetalol Labetalol provides selective α1-receptor blockade and nonselective β1- and β2-blockade. The potency of β-adrenergic blockade is 5- to 10-fold greater than α1-adrenergic blockade. Labetalol has partial β2-agonist effects that promote vasodilation. Labetalol is moderately lipid soluble and is completely absorbed after oral administration. First-pass hepatic metabolism is significant with production of inactive metabolites. Renal excretion of the unchanged drug is minimal. Elimination half-life is approximately 6 hours. In contrast to other β-blockers, clinically, labetalol should be considered a peripheral vasodilator that does not cause a reflex tachycardia. BP and systolic vascular resistance decrease after an intravenous dose. Stroke volume (SV) and CO remain unchanged, with HR decreasing slightly. The reduction in BP is dose related, and acutely hypertensive patients usually respond within 3 to 5 minutes after a bolus dose of 100 to 250 μg/kg. However, the more critically ill or anesthetized patients should have their BP titrated beginning with 5- to 10-mg intravenous increments. Reduction in BP may last as long as 6 hours after intravenous dosing. USER: What are the pros and cons of each beta blocker? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	74	10	873	null	519
Provide a concise answer (less than 100 words), using only the information provided below.	In the context of the Gender Recognition Act 2004, what makes something a gender-specific offence?	3 Evidence (1) An application under section 1(1)(a) must include either— (a) a report made by a registered medical practitioner practising in the field of gender dysphoria and a report made by another registered medical practitioner (who may, but need not, practise in that field), or (b) a report made by a chartered psychologist practising in that field and a report made by a registered medical practitioner (who may, but need not, practise in that field). (2) But subsection (1) is not complied with unless a report required by that subsection and made by— (a) a registered medical practitioner, or (b) a chartered psychologist, practising in the field of gender dysphoria includes details of the diagnosis of the applicant’s gender dysphoria. (3) And subsection (1) is not complied with in a case where— (a) the applicant has undergone or is undergoing treatment for the purpose of modifying sexual characteristics, or (b) treatment for that purpose has been prescribed or planned for the applicant, unless at least one of the reports required by that subsection includes details of it. (4) An application under section 1(1)(a) must also include a statutory declaration by the applicant that the applicant meets the conditions in section 2(1)(b) and (c). (5) An application under section 1(1)(b) must include evidence that the applicant has changed gender under the law of an approved country or territory. Gender Recognition Act 2004 (c. 7) 3 (6) Any application under section 1(1) must include— (a) a statutory declaration as to whether or not the applicant is married, (b) any other information or evidence required by an order made by the Secretary of State, and (c) any other information or evidence which the Panel which is to determine the application may require, and may include any other information or evidence which the applicant wishes to include. (7) The Secretary of State may not make an order under subsection (6)(b) without consulting the Scottish Ministers and the Department of Finance and Personnel in Northern Ireland. (8) If the Panel which is to determine the application requires inform	What evidence is required to obtain a Gender Recognition Certificate in the UK? Provide a concise answer (less than 100 words), using only the information provided below. "3 Evidence (1) An application under section 1(1)(a) must include either— (a) a report made by a registered medical practitioner practising in the field of gender dysphoria and a report made by another registered medical practitioner (who may, but need not, practise in that field), or (b) a report made by a chartered psychologist practising in that field and a report made by a registered medical practitioner (who may, but need not, practise in that field). (2) But subsection (1) is not complied with unless a report required by that subsection and made by— (a) a registered medical practitioner, or (b) a chartered psychologist, practising in the field of gender dysphoria includes details of the diagnosis of the applicant’s gender dysphoria. (3) And subsection (1) is not complied with in a case where— (a) the applicant has undergone or is undergoing treatment for the purpose of modifying sexual characteristics, or (b) treatment for that purpose has been prescribed or planned for the applicant, unless at least one of the reports required by that subsection includes details of it. (4) An application under section 1(1)(a) must also include a statutory declaration by the applicant that the applicant meets the conditions in section 2(1)(b) and (c). (5) An application under section 1(1)(b) must include evidence that the applicant has changed gender under the law of an approved country or territory. Gender Recognition Act 2004 (c. 7) 3 (6) Any application under section 1(1) must include— (a) a statutory declaration as to whether or not the applicant is married, (b) any other information or evidence required by an order made by the Secretary of State, and (c) any other information or evidence which the Panel which is to determine the application may require, and may include any other information or evidence which the applicant wishes to include. (7) The Secretary of State may not make an order under subsection (6)(b) without consulting the Scottish Ministers and the Department of Finance and Personnel in Northern Ireland. (8) If the Panel which is to determine the application requires inform"	Provide a concise answer (less than 100 words), using only the information provided below. EVIDENCE: 3 Evidence (1) An application under section 1(1)(a) must include either— (a) a report made by a registered medical practitioner practising in the field of gender dysphoria and a report made by another registered medical practitioner (who may, but need not, practise in that field), or (b) a report made by a chartered psychologist practising in that field and a report made by a registered medical practitioner (who may, but need not, practise in that field). (2) But subsection (1) is not complied with unless a report required by that subsection and made by— (a) a registered medical practitioner, or (b) a chartered psychologist, practising in the field of gender dysphoria includes details of the diagnosis of the applicant’s gender dysphoria. (3) And subsection (1) is not complied with in a case where— (a) the applicant has undergone or is undergoing treatment for the purpose of modifying sexual characteristics, or (b) treatment for that purpose has been prescribed or planned for the applicant, unless at least one of the reports required by that subsection includes details of it. (4) An application under section 1(1)(a) must also include a statutory declaration by the applicant that the applicant meets the conditions in section 2(1)(b) and (c). (5) An application under section 1(1)(b) must include evidence that the applicant has changed gender under the law of an approved country or territory. Gender Recognition Act 2004 (c. 7) 3 (6) Any application under section 1(1) must include— (a) a statutory declaration as to whether or not the applicant is married, (b) any other information or evidence required by an order made by the Secretary of State, and (c) any other information or evidence which the Panel which is to determine the application may require, and may include any other information or evidence which the applicant wishes to include. (7) The Secretary of State may not make an order under subsection (6)(b) without consulting the Scottish Ministers and the Department of Finance and Personnel in Northern Ireland. (8) If the Panel which is to determine the application requires inform USER: In the context of the Gender Recognition Act 2004, what makes something a gender-specific offence? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	14	15	344	null	822
Only use information contained in the prompt to answer your questions. Use bulleted formatting when listing more than 2 items. If listing cases, use italic formatting for the case names. If there's not enough information available to answer a question then state so but answer the parts that you can, if any.	What conclusions were reached by the courts in the cases mentioned in the excerpt below regarding AI, including generative AI?	State v. Loomis, 371 Wis.2d 235, 881 N.W.2d 749 (2016), cert. denied, 137 S. Ct. 2290 (2017) The defendant was convicted of various offenses arising out of a drive-by shooting. His presentence report included an evidence-based risk assessment that indicated a high risk of recidivism. On appeal, the defendant argued that consideration of the risk assessment by the sentencing judge violated his right to due process. The Supreme Court rejected the argument. However, it imposed conditions on the use of risk assessments. State v. Morrill, No. A-1-CA-36490, 2019 WL 3765586 (N.M. App. July 24, 2019) Defendant asks this Court to ‘find that the attestations made by a computer program constitute ‘statements,’ whether attributable to an artificial intelligence software or the software developer who implicitly offers the program’s conclusions as their own.’ (Emphasis omitted.) Based on that contention, Defendant further argues that the automated conclusions from Roundup and Forensic Toolkit constitute inadmissible hearsay statements that are not admissible under the business record exception. In so arguing, Defendant acknowledges that such a holding would diverge from the plain language of our hearsay rule’s relevant definitions that reference statements of a ‘person.’ *** Based on the following, we conclude the district court correctly determined that the computer generated evidence produced by Roundup and Forensic Toolkit was 11 not hearsay. Agent Peña testified that his computer runs Roundup twenty-four hours a day, seven days a week and automatically attempts to make connections with and downloads from IP addresses that are suspected to be sharing child pornography. As it does so, Roundup logs every action it takes. Detective Hartsock testified that Forensic Toolkit organizes information stored on seized electronic devices into various categories including graphics, videos, word documents, and internet history. Because the software programs make the relevant assertions, without any intervention or modification by a person using the software, we conclude that the assertions are not statements by a person governed by our hearsay rules. State v. Pickett, 466 N.J. Super. 270 (App. Div. 2021), motions to expand record, for leave to appeal, and for stay denied, State v. Pickett, 246 N.J. 48 (2021) In this case of first impression addressing the proliferation of forensic evidentiary technology in criminal prosecutions, we must determine whether defendant is entitled to trade secrets of a private company for the sole purpose of challenging at a Frye hearing the reliability of the science underlying novel DNA analysis software and expert testimony. At the hearing, the State produced an expert who relied on his company’s complex probabilistic genotyping software program to testify that defendant’s DNA was present, thereby connecting defendant to a murder and other crimes. Before crossexamination of the expert, the judge denied defendant access to the trade secrets, which include the software’s source code and related documentation. This is the first appeal in New Jersey addressing the science underlying the proffered testimony by the State’s expert, who designed, utilized, and relied upon TrueAllele, the program at issue. TrueAllele is technology not yet used or tested in New Jersey; it is designed to address intricate interpretational challenges of testing low levels or complex mixtures of DNA. TrueAllele’s computer software utilizes and implements an elaborate mathematical model to estimate the statistical probability that a particular individual’s DNA is consistent with data from a given sample, as compared with genetic material from another, unrelated individual from the broader relevant population. For this reason, TrueAllele, and other probabilistic genotyping software, marks a profound shift in DNA forensics. TrueAllele’s software integrates multiple scientific disciplines. At issue here—in determining the reliability of TrueAllele—is whether defendant is entitled to the trade secrets to cross-examine the State’s expert at the Frye hearing to challenge whether his testimony has gained general acceptance within the computer science community, which is one of the disciplines. The defense expert’s access to the proprietary information is directly relevant to that question and would allow that expert to independently test whether the evidentiary software operates as intended. Without that opportunity, 12 defendant is relegated to blindly accepting the company’s assertions as to its reliability. And importantly, the judge would be unable to reach an informed reliability determination at the Frye hearing as part of his gatekeeping function. Hiding the source code is not the answer. The solution is producing it under a protective order. Doing so safeguards the company’s intellectual property rights and defendant’s constitutional liberty interest alike. Intellectual property law aims to prevent business competitorsfrom stealing confidential commercial information in the marketplace; it was never meant to justify concealing relevant information from parties to a criminal prosecution in the context of a Frye hearing. [footnote omitted]. State v. Saylor, 2019 Ohio 1025 (Ct. App. 2019) (concurring opinion of Froelich, J.) {¶ 49} Saylor is a 27-year-old heroin addict, who the court commented has ‘no adult record [* * * and] has led a law-abiding life for a significant number of years’; his juvenile record, according to the prosecutor, was ‘virtually nothing.’ The prosecutor requested an aggregate sentence of five to seven years, and defense counsel requested a three-year sentence. The trial court sentenced Saylor to 12 1/2 years in prison. Although it found Saylor to be indigent and did not impose the mandatory fine, the court imposed a $500 fine and assessed attorney fees and costs; the court also specifically disapproved a Risk Reduction sentence or placement in the Intensive Program Prison (IPP). {¶ 50} I have previously voiced my concerns about the almost unfettered discretion available to a sentencing court when the current case law apparently does not permit a review for abuse of discretion. State v. Roberts, 2d Dist. Clark No. 2017-CA-98, 2018-Ohio4885, ¶ 42-45, (Froelich, J., dissenting). However, in this case, the trial court considered the statutory factors in R.C. 2929.11 and R.C. 2929.12, the individual sentences were within the statutory ranges, and the court’s consecutive sentencing findings, including the course-of-conduct finding under R.C. 2929.14(C)(4)(b), were supported by the record. {¶ 51} As for the trial court’s consideration of ORAS, the ‘algorithmization’ of sentencing is perhaps a good-faith attempt to remove unbridled discretion – and its inherent biases – from sentencing. Compare State v. Lawson, 2018-Ohio-1532, 111 N.E.3d 98, ¶ 20-21 (2d Dist.) (Froelich, J., concurring). However, ‘recidivism risk modeling still involves human choices about what characteristics and factors should be assessed, what hierarchy governs their application, and what relative weight should be ascribed to each.’ Hillman, The Use of Artificial Intelligence in Gauging the Risk of Recidivism, 58 The Judges Journal 40 (2019). {¶ 52} The court’s statement that the ‘moderate’ score was ‘awfully high,’ given the lack of criminal history, could imply that the court believed there must be other factors reflected in the score that increased Saylor’s probable recidivism. There is nothing on this record to refute or confirm the relevance of Saylor’s ORAS score or any ORAS score. 13 Certainly, the law of averages is not the law. The trial court’s comment further suggested that its own assessment of Saylor’s risk of recidivism differed from the ORAS score. The decision of the trial court is not clearly and convincingly unsupported by the record, regardless of any weight potentially given to the ORAS score by the trial court. Therefore, on this record, I find no basis for reversal	Only use information contained in the prompt to answer your questions. Use bulleted formatting when listing more than 2 items. If listing cases, use italic formatting for the case names. If there's not enough information available to answer a question then state so but answer the parts that you can, if any. What conclusions were reached by the courts in the cases mentioned in the excerpt below regarding AI, including generative AI? State v. Loomis, 371 Wis.2d 235, 881 N.W.2d 749 (2016), cert. denied, 137 S. Ct. 2290 (2017) The defendant was convicted of various offenses arising out of a drive-by shooting. His presentence report included an evidence-based risk assessment that indicated a high risk of recidivism. On appeal, the defendant argued that consideration of the risk assessment by the sentencing judge violated his right to due process. The Supreme Court rejected the argument. However, it imposed conditions on the use of risk assessments. State v. Morrill, No. A-1-CA-36490, 2019 WL 3765586 (N.M. App. July 24, 2019) Defendant asks this Court to ‘find that the attestations made by a computer program constitute ‘statements,’ whether attributable to an artificial intelligence software or the software developer who implicitly offers the program’s conclusions as their own.’ (Emphasis omitted.) Based on that contention, Defendant further argues that the automated conclusions from Roundup and Forensic Toolkit constitute inadmissible hearsay statements that are not admissible under the business record exception. In so arguing, Defendant acknowledges that such a holding would diverge from the plain language of our hearsay rule’s relevant definitions that reference statements of a ‘person.’ *** Based on the following, we conclude the district court correctly determined that the computer generated evidence produced by Roundup and Forensic Toolkit was 11 not hearsay. Agent Peña testified that his computer runs Roundup twenty-four hours a day, seven days a week and automatically attempts to make connections with and downloads from IP addresses that are suspected to be sharing child pornography. As it does so, Roundup logs every action it takes. Detective Hartsock testified that Forensic Toolkit organizes information stored on seized electronic devices into various categories including graphics, videos, word documents, and internet history. Because the software programs make the relevant assertions, without any intervention or modification by a person using the software, we conclude that the assertions are not statements by a person governed by our hearsay rules. State v. Pickett, 466 N.J. Super. 270 (App. Div. 2021), motions to expand record, for leave to appeal, and for stay denied, State v. Pickett, 246 N.J. 48 (2021) In this case of first impression addressing the proliferation of forensic evidentiary technology in criminal prosecutions, we must determine whether defendant is entitled to trade secrets of a private company for the sole purpose of challenging at a Frye hearing the reliability of the science underlying novel DNA analysis software and expert testimony. At the hearing, the State produced an expert who relied on his company’s complex probabilistic genotyping software program to testify that defendant’s DNA was present, thereby connecting defendant to a murder and other crimes. Before crossexamination of the expert, the judge denied defendant access to the trade secrets, which include the software’s source code and related documentation. This is the first appeal in New Jersey addressing the science underlying the proffered testimony by the State’s expert, who designed, utilized, and relied upon TrueAllele, the program at issue. TrueAllele is technology not yet used or tested in New Jersey; it is designed to address intricate interpretational challenges of testing low levels or complex mixtures of DNA. TrueAllele’s computer software utilizes and implements an elaborate mathematical model to estimate the statistical probability that a particular individual’s DNA is consistent with data from a given sample, as compared with genetic material from another, unrelated individual from the broader relevant population. For this reason, TrueAllele, and other probabilistic genotyping software, marks a profound shift in DNA forensics. TrueAllele’s software integrates multiple scientific disciplines. At issue here—in determining the reliability of TrueAllele—is whether defendant is entitled to the trade secrets to cross-examine the State’s expert at the Frye hearing to challenge whether his testimony has gained general acceptance within the computer science community, which is one of the disciplines. The defense expert’s access to the proprietary information is directly relevant to that question and would allow that expert to independently test whether the evidentiary software operates as intended. Without that opportunity, 12 defendant is relegated to blindly accepting the company’s assertions as to its reliability. And importantly, the judge would be unable to reach an informed reliability determination at the Frye hearing as part of his gatekeeping function. Hiding the source code is not the answer. The solution is producing it under a protective order. Doing so safeguards the company’s intellectual property rights and defendant’s constitutional liberty interest alike. Intellectual property law aims to prevent business competitorsfrom stealing confidential commercial information in the marketplace; it was never meant to justify concealing relevant information from parties to a criminal prosecution in the context of a Frye hearing. [footnote omitted]. State v. Saylor, 2019 Ohio 1025 (Ct. App. 2019) (concurring opinion of Froelich, J.) {¶ 49} Saylor is a 27-year-old heroin addict, who the court commented has ‘no adult record [* * * and] has led a law-abiding life for a significant number of years’; his juvenile record, according to the prosecutor, was ‘virtually nothing.’ The prosecutor requested an aggregate sentence of five to seven years, and defense counsel requested a three-year sentence. The trial court sentenced Saylor to 12 1/2 years in prison. Although it found Saylor to be indigent and did not impose the mandatory fine, the court imposed a $500 fine and assessed attorney fees and costs; the court also specifically disapproved a Risk Reduction sentence or placement in the Intensive Program Prison (IPP). {¶ 50} I have previously voiced my concerns about the almost unfettered discretion available to a sentencing court when the current case law apparently does not permit a review for abuse of discretion. State v. Roberts, 2d Dist. Clark No. 2017-CA-98, 2018-Ohio4885, ¶ 42-45, (Froelich, J., dissenting). However, in this case, the trial court considered the statutory factors in R.C. 2929.11 and R.C. 2929.12, the individual sentences were within the statutory ranges, and the court’s consecutive sentencing findings, including the course-of-conduct finding under R.C. 2929.14(C)(4)(b), were supported by the record. {¶ 51} As for the trial court’s consideration of ORAS, the ‘algorithmization’ of sentencing is perhaps a good-faith attempt to remove unbridled discretion – and its inherent biases – from sentencing. Compare State v. Lawson, 2018-Ohio-1532, 111 N.E.3d 98, ¶ 20-21 (2d Dist.) (Froelich, J., concurring). However, ‘recidivism risk modeling still involves human choices about what characteristics and factors should be assessed, what hierarchy governs their application, and what relative weight should be ascribed to each.’ Hillman, The Use of Artificial Intelligence in Gauging the Risk of Recidivism, 58 The Judges Journal 40 (2019). {¶ 52} The court’s statement that the ‘moderate’ score was ‘awfully high,’ given the lack of criminal history, could imply that the court believed there must be other factors reflected in the score that increased Saylor’s probable recidivism. There is nothing on this record to refute or confirm the relevance of Saylor’s ORAS score or any ORAS score. 13 Certainly, the law of averages is not the law. The trial court’s comment further suggested that its own assessment of Saylor’s risk of recidivism differed from the ORAS score. The decision of the trial court is not clearly and convincingly unsupported by the record, regardless of any weight potentially given to the ORAS score by the trial court. Therefore, on this record, I find no basis for reversal	Only use information contained in the prompt to answer your questions. Use bulleted formatting when listing more than 2 items. If listing cases, use italic formatting for the case names. If there's not enough information available to answer a question then state so but answer the parts that you can, if any. EVIDENCE: State v. Loomis, 371 Wis.2d 235, 881 N.W.2d 749 (2016), cert. denied, 137 S. Ct. 2290 (2017) The defendant was convicted of various offenses arising out of a drive-by shooting. His presentence report included an evidence-based risk assessment that indicated a high risk of recidivism. On appeal, the defendant argued that consideration of the risk assessment by the sentencing judge violated his right to due process. The Supreme Court rejected the argument. However, it imposed conditions on the use of risk assessments. State v. Morrill, No. A-1-CA-36490, 2019 WL 3765586 (N.M. App. July 24, 2019) Defendant asks this Court to ‘find that the attestations made by a computer program constitute ‘statements,’ whether attributable to an artificial intelligence software or the software developer who implicitly offers the program’s conclusions as their own.’ (Emphasis omitted.) Based on that contention, Defendant further argues that the automated conclusions from Roundup and Forensic Toolkit constitute inadmissible hearsay statements that are not admissible under the business record exception. In so arguing, Defendant acknowledges that such a holding would diverge from the plain language of our hearsay rule’s relevant definitions that reference statements of a ‘person.’ *** Based on the following, we conclude the district court correctly determined that the computer generated evidence produced by Roundup and Forensic Toolkit was 11 not hearsay. Agent Peña testified that his computer runs Roundup twenty-four hours a day, seven days a week and automatically attempts to make connections with and downloads from IP addresses that are suspected to be sharing child pornography. As it does so, Roundup logs every action it takes. Detective Hartsock testified that Forensic Toolkit organizes information stored on seized electronic devices into various categories including graphics, videos, word documents, and internet history. Because the software programs make the relevant assertions, without any intervention or modification by a person using the software, we conclude that the assertions are not statements by a person governed by our hearsay rules. State v. Pickett, 466 N.J. Super. 270 (App. Div. 2021), motions to expand record, for leave to appeal, and for stay denied, State v. Pickett, 246 N.J. 48 (2021) In this case of first impression addressing the proliferation of forensic evidentiary technology in criminal prosecutions, we must determine whether defendant is entitled to trade secrets of a private company for the sole purpose of challenging at a Frye hearing the reliability of the science underlying novel DNA analysis software and expert testimony. At the hearing, the State produced an expert who relied on his company’s complex probabilistic genotyping software program to testify that defendant’s DNA was present, thereby connecting defendant to a murder and other crimes. Before crossexamination of the expert, the judge denied defendant access to the trade secrets, which include the software’s source code and related documentation. This is the first appeal in New Jersey addressing the science underlying the proffered testimony by the State’s expert, who designed, utilized, and relied upon TrueAllele, the program at issue. TrueAllele is technology not yet used or tested in New Jersey; it is designed to address intricate interpretational challenges of testing low levels or complex mixtures of DNA. TrueAllele’s computer software utilizes and implements an elaborate mathematical model to estimate the statistical probability that a particular individual’s DNA is consistent with data from a given sample, as compared with genetic material from another, unrelated individual from the broader relevant population. For this reason, TrueAllele, and other probabilistic genotyping software, marks a profound shift in DNA forensics. TrueAllele’s software integrates multiple scientific disciplines. At issue here—in determining the reliability of TrueAllele—is whether defendant is entitled to the trade secrets to cross-examine the State’s expert at the Frye hearing to challenge whether his testimony has gained general acceptance within the computer science community, which is one of the disciplines. The defense expert’s access to the proprietary information is directly relevant to that question and would allow that expert to independently test whether the evidentiary software operates as intended. Without that opportunity, 12 defendant is relegated to blindly accepting the company’s assertions as to its reliability. And importantly, the judge would be unable to reach an informed reliability determination at the Frye hearing as part of his gatekeeping function. Hiding the source code is not the answer. The solution is producing it under a protective order. Doing so safeguards the company’s intellectual property rights and defendant’s constitutional liberty interest alike. Intellectual property law aims to prevent business competitorsfrom stealing confidential commercial information in the marketplace; it was never meant to justify concealing relevant information from parties to a criminal prosecution in the context of a Frye hearing. [footnote omitted]. State v. Saylor, 2019 Ohio 1025 (Ct. App. 2019) (concurring opinion of Froelich, J.) {¶ 49} Saylor is a 27-year-old heroin addict, who the court commented has ‘no adult record [* * * and] has led a law-abiding life for a significant number of years’; his juvenile record, according to the prosecutor, was ‘virtually nothing.’ The prosecutor requested an aggregate sentence of five to seven years, and defense counsel requested a three-year sentence. The trial court sentenced Saylor to 12 1/2 years in prison. Although it found Saylor to be indigent and did not impose the mandatory fine, the court imposed a $500 fine and assessed attorney fees and costs; the court also specifically disapproved a Risk Reduction sentence or placement in the Intensive Program Prison (IPP). {¶ 50} I have previously voiced my concerns about the almost unfettered discretion available to a sentencing court when the current case law apparently does not permit a review for abuse of discretion. State v. Roberts, 2d Dist. Clark No. 2017-CA-98, 2018-Ohio4885, ¶ 42-45, (Froelich, J., dissenting). However, in this case, the trial court considered the statutory factors in R.C. 2929.11 and R.C. 2929.12, the individual sentences were within the statutory ranges, and the court’s consecutive sentencing findings, including the course-of-conduct finding under R.C. 2929.14(C)(4)(b), were supported by the record. {¶ 51} As for the trial court’s consideration of ORAS, the ‘algorithmization’ of sentencing is perhaps a good-faith attempt to remove unbridled discretion – and its inherent biases – from sentencing. Compare State v. Lawson, 2018-Ohio-1532, 111 N.E.3d 98, ¶ 20-21 (2d Dist.) (Froelich, J., concurring). However, ‘recidivism risk modeling still involves human choices about what characteristics and factors should be assessed, what hierarchy governs their application, and what relative weight should be ascribed to each.’ Hillman, The Use of Artificial Intelligence in Gauging the Risk of Recidivism, 58 The Judges Journal 40 (2019). {¶ 52} The court’s statement that the ‘moderate’ score was ‘awfully high,’ given the lack of criminal history, could imply that the court believed there must be other factors reflected in the score that increased Saylor’s probable recidivism. There is nothing on this record to refute or confirm the relevance of Saylor’s ORAS score or any ORAS score. 13 Certainly, the law of averages is not the law. The trial court’s comment further suggested that its own assessment of Saylor’s risk of recidivism differed from the ORAS score. The decision of the trial court is not clearly and convincingly unsupported by the record, regardless of any weight potentially given to the ORAS score by the trial court. Therefore, on this record, I find no basis for reversal USER: What conclusions were reached by the courts in the cases mentioned in the excerpt below regarding AI, including generative AI? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	52	20	1,204	null	537
The response should only contain information from the provided text. The content should be understandable by someone not familiar with the context. Provide the answer as a bulleted list, each with their own simple explanation. There should be an even number of points. The explanations should have an odd number of words.	I just got this compass and tried setting it up using the instructions but it isnt working. Could you go through the text and highlight anything that I may have done wrong?	Digital Vehicle Compass 63-1120 OWNER’S MANUAL — Please read before using this equipment. Thank you for purchasing a RadioShack Digital Vehicle Compass. Your compass conveniently provides accurate heading information inside your vehicle. It incorporates the same magnetic sensor technology that is used in factory-installed vehicle compasses. The compass electronically separates the Earth’s magnetic field from the magnetic fields generated by your vehicle, to provide accurate compass headings. Automatic Shut-Off — conserves power by turning off the compass about 10 minutes after you park the vehicle when there are no significant changes in the surrounding magnetic fields. Magnetic Distortion Detection — alerts you when outside magnetic interference is affecting compass accuracy. INSTALLING BATTERIES Your compass requires two AAA batteries (not supplied) for power. For the best performance and longest life, we recommend RadioShack batteries. Battery life is about 11 months (based on an average of 8 hours of compass use and 2 hours of backlight use per week). Cautions: • Use only fresh batteries of the required size and recommended type. • Do not mix old and new batteries, different types of batteries (standard, alkaline, or rechargeable), or rechargeable batteries of different capacities. @ RadioShack www.radioshack.com™ © 2001 RadioShack Corporation. All Rights Reserved. RadioShack and RadioShack.com are trademarks used by RadioShack Corporation. 1. Slide the battery compartment cover in the direction of the OPEN arrow to remove it. 2. Place two AAA batteries in the compartment as indicated by the polarity symbols (+ and -) marked inside. 3. Replace the cover. All the arrows flash. After you install or replace batteries, you must calibrate the compass (see “Calibrating the Compass” on Page 4). If all the arrows and digits flash, and the backlight turns on when you turn on the compass, replace the batteries or use vehicle battery power (see “Using Vehicle Battery Power”). Warning: Dispose of old batteries promptly and properly. Do not burn or bury them. Caution: If you do not plan to use the compass for a month or more, remove the batteries. Batteries can leak chemicals that can destroy electronic parts. USING VEHICLE BATTERY POWER This compass is designed to be used with RadioShack’s 12V DC adapter Cat. No. 270-031A (available at your local RadioShack store). Using any other adapter could void the warranty and damage the compass. You can power the compass from a vehicle’s 12V power source (such as cigarette-lighter socket) using a 12V, 3 amp DC adapter (not supplied, available at your local RadioShack store). Cautions: A You must use a power source that supplies 12V DC . and delivers at least 3 amps. Its center tip must be set 2 to positive and its plug must fit the compass' jack. Using an adapter that does not meet these specifications could damage the compass or the adapter. • Always connect the DC adapter to the compass before you connect it to the power source. When you finish, disconnect the adapter from the power source before you disconnect it from the compass. Note: Since not all vehicles have constant power supplied to the power outlet, two AAA batteries are required to retain the compass calibration settings in memory (although they do not power the compass when vehicle battery power is used). Insert the barrel plug of the 12V DC adapter (not supplied) into the DC12V jack on the back of the compass. Then insert the DC plug into your vehicle’s power outlet. MOUNTING THE COMPASS Choose a clean mounting location on the vehicle’s windshield where the compass is at least 5 inches away from any stereo speakers and will not obstruct the driver’s field of view. Your compass comes with three suction cups for secure mounting. 1. Insert the small ball head of each suction cup into the larger hole on the bottom of the bracket and slide it into the bracket’s smaller hole so it fits tightly. 2. Place the compass in the holder. Note: To remove the compass from the holder, simply slide it out. 3 3. Firmly press the bracket with the Vertical Plane 4. Adjust the angle of the windshield. against the vehicle’s compass 20' maximum down tilt 20 maximum up tilt Horizontal Plane bracket so > that the face of the compass points to the back of the vehicle. Then adjust the bracket to an angle no more than 20° above or below the horizontal plane. 5. Tighten the bracket’s screw to hold it at the desired angle. Caution: If you use a reflective sun shade, do not leave the compass between the sun shade and the windshield. The extreme heat might damage the compass. Note: Your compass will not calibrate correctly and will not be accurate unless it is mounted so the display faces the back of your vehicle and is titled no more than 20° above or below the horizontal plane. The selected angle must stay fixed after calibration for the compass to remain accurate. CALIBRATING THE COMPASS Calibration enables the compass to separate the earth’s magnetic field from the magnetic fields generated by external influences (such as your vehicle) so it can provide accurate heading information. 4 When calibrating the compass, you must drive your vehicle in one complete circle. Be sure your vehicle is on level ground in an open area, such as a parking lot. The size of the circle and the direction your vehicle points when beginning or ending the circle do not matter. The circle does not need to be perfect, but it must be completed within 2 minutes. Important: If you do not calibrate your compass properly, it will not work correctly or accurately. You must calibrate your compass when you use it the first time and recalibrate it anytime: • you move the compass to a different location • you adjust the bracket/display angle • you remove and replace the batteries • BIST appears steadily • all the arrows flash 1. Ensure the compass is securely mounted (see “Mounting the Compass” on Page 3). 2. Hold down LIGHT and POWER at the same time until all arrows flash at the same time. Note: If you have just installed/replaced the batteries, all the arrows and digits briefly appear, then all the arrows flash at the same time and the backlight turns on. Begin from Step 3 to calibrate your compass. 3. Press POWER. The arrows appear one at a time. 4. With the compass mounted, drive in one complete circle and then press POWER. The current compass heading appears. 5 Note: If you press LIGHT while calibrating your compass (except after installing/replacing batteries), the compass does not store the calibration setting and the original setting is unchanged. USING THE COMPASS The 8 displayed cardinal points for this compass are N, NE, E, SE, S, SW, W, and NW. Distortion Detection When DiST appears, the compass is detecting magnetic interference that compromises its accuracy. Distortion occurs when there has been a significant change in the surrounding magnetic fields, such as when you are driving under an overpass, or over a bridge. The steel in these structures causes inaccurate readings in any magnetic compass, but unlike other compasses, this compass detects interference and alerts you. If DIST appears continuously, recalibrate your compass (see “Calibrating the Compass” on Page 4). Turning the Compass On and Off Press POWER to turn the compass on and off. Or, you can press LIGHT to turn on the compass and the backlight. To turn off the compass and the backlight, press POWER. Important: The compass automatically turns off after about 10 minutes to conserve power if no significant changes occur in the surrounding magnetic fields. 6 Using the Backlight To turn on the backlight, press LIGHT. To turn off the backlight, press LIGHT again. The backlight automatically turns off after about 1 minute if it is powered by internal batteries. It automatically turns off after about 10 minutes if it is powered by vehicle battery power, unless significant changes occur in the surrounding magnetic fields. CARE Keep the compass dry; if it gets wet, wipe it dry immediately. Use and store the compass only in normal temperature environments. Handle the compass carefully; do not drop it. Keep the compass away from dust and dirt, and wipe it with a damp cloth occasionally to keep it looking new. Modifying or tampering with the compass’ internal components can cause a malfunction and might invalidate its warranty. If your compass is not performing as it should, take it to your local RadioShack store for assistance.	I just got this compass and tried setting it up using the instructions but it isnt working. Could you go through the text and highlight anything that I may have done wrong? Digital Vehicle Compass 63-1120 OWNER’S MANUAL — Please read before using this equipment. Thank you for purchasing a RadioShack Digital Vehicle Compass. Your compass conveniently provides accurate heading information inside your vehicle. It incorporates the same magnetic sensor technology that is used in factory-installed vehicle compasses. The compass electronically separates the Earth’s magnetic field from the magnetic fields generated by your vehicle, to provide accurate compass headings. Automatic Shut-Off — conserves power by turning off the compass about 10 minutes after you park the vehicle when there are no significant changes in the surrounding magnetic fields. Magnetic Distortion Detection — alerts you when outside magnetic interference is affecting compass accuracy. INSTALLING BATTERIES Your compass requires two AAA batteries (not supplied) for power. For the best performance and longest life, we recommend RadioShack batteries. Battery life is about 11 months (based on an average of 8 hours of compass use and 2 hours of backlight use per week). Cautions: • Use only fresh batteries of the required size and recommended type. • Do not mix old and new batteries, different types of batteries (standard, alkaline, or rechargeable), or rechargeable batteries of different capacities. @ RadioShack www.radioshack.com™ © 2001 RadioShack Corporation. All Rights Reserved. RadioShack and RadioShack.com are trademarks used by RadioShack Corporation. 1. Slide the battery compartment cover in the direction of the OPEN arrow to remove it. 2. Place two AAA batteries in the compartment as indicated by the polarity symbols (+ and -) marked inside. 3. Replace the cover. All the arrows flash. After you install or replace batteries, you must calibrate the compass (see “Calibrating the Compass” on Page 4). If all the arrows and digits flash, and the backlight turns on when you turn on the compass, replace the batteries or use vehicle battery power (see “Using Vehicle Battery Power”). Warning: Dispose of old batteries promptly and properly. Do not burn or bury them. Caution: If you do not plan to use the compass for a month or more, remove the batteries. Batteries can leak chemicals that can destroy electronic parts. USING VEHICLE BATTERY POWER This compass is designed to be used with RadioShack’s 12V DC adapter Cat. No. 270-031A (available at your local RadioShack store). Using any other adapter could void the warranty and damage the compass. You can power the compass from a vehicle’s 12V power source (such as cigarette-lighter socket) using a 12V, 3 amp DC adapter (not supplied, available at your local RadioShack store). Cautions: A You must use a power source that supplies 12V DC . and delivers at least 3 amps. Its center tip must be set 2 to positive and its plug must fit the compass' jack. Using an adapter that does not meet these specifications could damage the compass or the adapter. • Always connect the DC adapter to the compass before you connect it to the power source. When you finish, disconnect the adapter from the power source before you disconnect it from the compass. Note: Since not all vehicles have constant power supplied to the power outlet, two AAA batteries are required to retain the compass calibration settings in memory (although they do not power the compass when vehicle battery power is used). Insert the barrel plug of the 12V DC adapter (not supplied) into the DC12V jack on the back of the compass. Then insert the DC plug into your vehicle’s power outlet. MOUNTING THE COMPASS Choose a clean mounting location on the vehicle’s windshield where the compass is at least 5 inches away from any stereo speakers and will not obstruct the driver’s field of view. Your compass comes with three suction cups for secure mounting. 1. Insert the small ball head of each suction cup into the larger hole on the bottom of the bracket and slide it into the bracket’s smaller hole so it fits tightly. 2. Place the compass in the holder. Note: To remove the compass from the holder, simply slide it out. 3 3. Firmly press the bracket with the Vertical Plane 4. Adjust the angle of the windshield. against the vehicle’s compass 20' maximum down tilt 20 maximum up tilt Horizontal Plane bracket so > that the face of the compass points to the back of the vehicle. Then adjust the bracket to an angle no more than 20° above or below the horizontal plane. 5. Tighten the bracket’s screw to hold it at the desired angle. Caution: If you use a reflective sun shade, do not leave the compass between the sun shade and the windshield. The extreme heat might damage the compass. Note: Your compass will not calibrate correctly and will not be accurate unless it is mounted so the display faces the back of your vehicle and is titled no more than 20° above or below the horizontal plane. The selected angle must stay fixed after calibration for the compass to remain accurate. CALIBRATING THE COMPASS Calibration enables the compass to separate the earth’s magnetic field from the magnetic fields generated by external influences (such as your vehicle) so it can provide accurate heading information. 4 When calibrating the compass, you must drive your vehicle in one complete circle. Be sure your vehicle is on level ground in an open area, such as a parking lot. The size of the circle and the direction your vehicle points when beginning or ending the circle do not matter. The circle does not need to be perfect, but it must be completed within 2 minutes. Important: If you do not calibrate your compass properly, it will not work correctly or accurately. You must calibrate your compass when you use it the first time and recalibrate it anytime: • you move the compass to a different location • you adjust the bracket/display angle • you remove and replace the batteries • BIST appears steadily • all the arrows flash 1. Ensure the compass is securely mounted (see “Mounting the Compass” on Page 3). 2. Hold down LIGHT and POWER at the same time until all arrows flash at the same time. Note: If you have just installed/replaced the batteries, all the arrows and digits briefly appear, then all the arrows flash at the same time and the backlight turns on. Begin from Step 3 to calibrate your compass. 3. Press POWER. The arrows appear one at a time. 4. With the compass mounted, drive in one complete circle and then press POWER. The current compass heading appears. 5 Note: If you press LIGHT while calibrating your compass (except after installing/replacing batteries), the compass does not store the calibration setting and the original setting is unchanged. USING THE COMPASS The 8 displayed cardinal points for this compass are N, NE, E, SE, S, SW, W, and NW. Distortion Detection When DiST appears, the compass is detecting magnetic interference that compromises its accuracy. Distortion occurs when there has been a significant change in the surrounding magnetic fields, such as when you are driving under an overpass, or over a bridge. The steel in these structures causes inaccurate readings in any magnetic compass, but unlike other compasses, this compass detects interference and alerts you. If DIST appears continuously, recalibrate your compass (see “Calibrating the Compass” on Page 4). Turning the Compass On and Off Press POWER to turn the compass on and off. Or, you can press LIGHT to turn on the compass and the backlight. To turn off the compass and the backlight, press POWER. Important: The compass automatically turns off after about 10 minutes to conserve power if no significant changes occur in the surrounding magnetic fields. 6 Using the Backlight To turn on the backlight, press LIGHT. To turn off the backlight, press LIGHT again. The backlight automatically turns off after about 1 minute if it is powered by internal batteries. It automatically turns off after about 10 minutes if it is powered by vehicle battery power, unless significant changes occur in the surrounding magnetic fields. CARE Keep the compass dry; if it gets wet, wipe it dry immediately. Use and store the compass only in normal temperature environments. Handle the compass carefully; do not drop it. Keep the compass away from dust and dirt, and wipe it with a damp cloth occasionally to keep it looking new. Modifying or tampering with the compass’ internal components can cause a malfunction and might invalidate its warranty. If your compass is not performing as it should, take it to your local RadioShack store for assistance. The response should only contain information from the provided text. The content should be understandable by someone not familiar with the context. Provide the answer as a bulleted list, each with their own simple explanation. There should be an even number of points. The explanations should have an odd number of words.	The response should only contain information from the provided text. The content should be understandable by someone not familiar with the context. Provide the answer as a bulleted list, each with their own simple explanation. There should be an even number of points. The explanations should have an odd number of words. EVIDENCE: Digital Vehicle Compass 63-1120 OWNER’S MANUAL — Please read before using this equipment. Thank you for purchasing a RadioShack Digital Vehicle Compass. Your compass conveniently provides accurate heading information inside your vehicle. It incorporates the same magnetic sensor technology that is used in factory-installed vehicle compasses. The compass electronically separates the Earth’s magnetic field from the magnetic fields generated by your vehicle, to provide accurate compass headings. Automatic Shut-Off — conserves power by turning off the compass about 10 minutes after you park the vehicle when there are no significant changes in the surrounding magnetic fields. Magnetic Distortion Detection — alerts you when outside magnetic interference is affecting compass accuracy. INSTALLING BATTERIES Your compass requires two AAA batteries (not supplied) for power. For the best performance and longest life, we recommend RadioShack batteries. Battery life is about 11 months (based on an average of 8 hours of compass use and 2 hours of backlight use per week). Cautions: • Use only fresh batteries of the required size and recommended type. • Do not mix old and new batteries, different types of batteries (standard, alkaline, or rechargeable), or rechargeable batteries of different capacities. @ RadioShack www.radioshack.com™ © 2001 RadioShack Corporation. All Rights Reserved. RadioShack and RadioShack.com are trademarks used by RadioShack Corporation. 1. Slide the battery compartment cover in the direction of the OPEN arrow to remove it. 2. Place two AAA batteries in the compartment as indicated by the polarity symbols (+ and -) marked inside. 3. Replace the cover. All the arrows flash. After you install or replace batteries, you must calibrate the compass (see “Calibrating the Compass” on Page 4). If all the arrows and digits flash, and the backlight turns on when you turn on the compass, replace the batteries or use vehicle battery power (see “Using Vehicle Battery Power”). Warning: Dispose of old batteries promptly and properly. Do not burn or bury them. Caution: If you do not plan to use the compass for a month or more, remove the batteries. Batteries can leak chemicals that can destroy electronic parts. USING VEHICLE BATTERY POWER This compass is designed to be used with RadioShack’s 12V DC adapter Cat. No. 270-031A (available at your local RadioShack store). Using any other adapter could void the warranty and damage the compass. You can power the compass from a vehicle’s 12V power source (such as cigarette-lighter socket) using a 12V, 3 amp DC adapter (not supplied, available at your local RadioShack store). Cautions: A You must use a power source that supplies 12V DC . and delivers at least 3 amps. Its center tip must be set 2 to positive and its plug must fit the compass' jack. Using an adapter that does not meet these specifications could damage the compass or the adapter. • Always connect the DC adapter to the compass before you connect it to the power source. When you finish, disconnect the adapter from the power source before you disconnect it from the compass. Note: Since not all vehicles have constant power supplied to the power outlet, two AAA batteries are required to retain the compass calibration settings in memory (although they do not power the compass when vehicle battery power is used). Insert the barrel plug of the 12V DC adapter (not supplied) into the DC12V jack on the back of the compass. Then insert the DC plug into your vehicle’s power outlet. MOUNTING THE COMPASS Choose a clean mounting location on the vehicle’s windshield where the compass is at least 5 inches away from any stereo speakers and will not obstruct the driver’s field of view. Your compass comes with three suction cups for secure mounting. 1. Insert the small ball head of each suction cup into the larger hole on the bottom of the bracket and slide it into the bracket’s smaller hole so it fits tightly. 2. Place the compass in the holder. Note: To remove the compass from the holder, simply slide it out. 3 3. Firmly press the bracket with the Vertical Plane 4. Adjust the angle of the windshield. against the vehicle’s compass 20' maximum down tilt 20 maximum up tilt Horizontal Plane bracket so > that the face of the compass points to the back of the vehicle. Then adjust the bracket to an angle no more than 20° above or below the horizontal plane. 5. Tighten the bracket’s screw to hold it at the desired angle. Caution: If you use a reflective sun shade, do not leave the compass between the sun shade and the windshield. The extreme heat might damage the compass. Note: Your compass will not calibrate correctly and will not be accurate unless it is mounted so the display faces the back of your vehicle and is titled no more than 20° above or below the horizontal plane. The selected angle must stay fixed after calibration for the compass to remain accurate. CALIBRATING THE COMPASS Calibration enables the compass to separate the earth’s magnetic field from the magnetic fields generated by external influences (such as your vehicle) so it can provide accurate heading information. 4 When calibrating the compass, you must drive your vehicle in one complete circle. Be sure your vehicle is on level ground in an open area, such as a parking lot. The size of the circle and the direction your vehicle points when beginning or ending the circle do not matter. The circle does not need to be perfect, but it must be completed within 2 minutes. Important: If you do not calibrate your compass properly, it will not work correctly or accurately. You must calibrate your compass when you use it the first time and recalibrate it anytime: • you move the compass to a different location • you adjust the bracket/display angle • you remove and replace the batteries • BIST appears steadily • all the arrows flash 1. Ensure the compass is securely mounted (see “Mounting the Compass” on Page 3). 2. Hold down LIGHT and POWER at the same time until all arrows flash at the same time. Note: If you have just installed/replaced the batteries, all the arrows and digits briefly appear, then all the arrows flash at the same time and the backlight turns on. Begin from Step 3 to calibrate your compass. 3. Press POWER. The arrows appear one at a time. 4. With the compass mounted, drive in one complete circle and then press POWER. The current compass heading appears. 5 Note: If you press LIGHT while calibrating your compass (except after installing/replacing batteries), the compass does not store the calibration setting and the original setting is unchanged. USING THE COMPASS The 8 displayed cardinal points for this compass are N, NE, E, SE, S, SW, W, and NW. Distortion Detection When DiST appears, the compass is detecting magnetic interference that compromises its accuracy. Distortion occurs when there has been a significant change in the surrounding magnetic fields, such as when you are driving under an overpass, or over a bridge. The steel in these structures causes inaccurate readings in any magnetic compass, but unlike other compasses, this compass detects interference and alerts you. If DIST appears continuously, recalibrate your compass (see “Calibrating the Compass” on Page 4). Turning the Compass On and Off Press POWER to turn the compass on and off. Or, you can press LIGHT to turn on the compass and the backlight. To turn off the compass and the backlight, press POWER. Important: The compass automatically turns off after about 10 minutes to conserve power if no significant changes occur in the surrounding magnetic fields. 6 Using the Backlight To turn on the backlight, press LIGHT. To turn off the backlight, press LIGHT again. The backlight automatically turns off after about 1 minute if it is powered by internal batteries. It automatically turns off after about 10 minutes if it is powered by vehicle battery power, unless significant changes occur in the surrounding magnetic fields. CARE Keep the compass dry; if it gets wet, wipe it dry immediately. Use and store the compass only in normal temperature environments. Handle the compass carefully; do not drop it. Keep the compass away from dust and dirt, and wipe it with a damp cloth occasionally to keep it looking new. Modifying or tampering with the compass’ internal components can cause a malfunction and might invalidate its warranty. If your compass is not performing as it should, take it to your local RadioShack store for assistance. USER: I just got this compass and tried setting it up using the instructions but it isnt working. Could you go through the text and highlight anything that I may have done wrong? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	52	32	1,413	null	358
Please only use information from the provided PDF to answer this prompt. Do not act like you are an expert in legal affairs in any way.	Using the provided section of text below, please summarize the reasons for concurring and dissenting opinions.	Using the provided section of text below, please summarize the reasons for concurring and dissenting opinions. Concurring and Dissenting Opinions A majority of the Court—six Justices in total—wrote separately to concur or dissent, offering their individual views on how the Second Amendment and the Bruen standard should be properly interpreted both in this case and in future cases. Justice Sotomayor’s concurring opinion, joined by Justice Kagan, expressed her continued view that Bruen was wrongly decided and that a different legal standard should apply to Second Amendment cases.73 She wrote separately to emphasize that when applying the Bruen historical tradition standard, however, the majority’s methodology was the “right one.”74 In Justice Sotomayor’s view, this is an “easy case,” as § 922(g)(8) is “wholly consistent” with historical firearms regulations.75 By contrast, she criticized the dissenting view as too “rigid,” characterizing it as “insist[ing] that the means of addressing that problem cannot be ‘materially different’ from the means that existed in the eighteenth century,” which would unduly hamstring modern policy efforts.76 In his concurring opinion, Justice Gorsuch underscored the difficulty in maintaining a facial challenge to a law, which requires a showing that the law has no constitutional applications.77 He also defended the Bruen historical tradition standard, arguing that the original meaning of the Constitution, while “an imperfect guide,” provides proper constraints on judicial decisionmaking and is better than unbounded alternatives such as an interest-balancing inquiry.78 Justice Gorsuch also cautioned that the Court decided a narrow question—whether § 922(g)(3) “has any lawful scope”—and that future defendants could argue that § 922(g)(3) was unconstitutional under particular facts.79 69 Id. at 1901. 70 Id. at 1902. 71 Id. 72 Id. at 1903. 73 Id. at 1904 (Sotomayor, J., concurring). 74 Id. 75 Id. 76 Id. at 1905. 77 Id. at 1907 (Gorsuch, J., concurring). 78 Id. at 1909. 79 Id. at 1910. Supreme Court Term October 2023: A Review of Selected Major Rulings Congressional Research Service 8 Justice Kavanaugh concurred to expound his view on the roles of text, history, and precedent in constitutional interpretation. He explained that unambiguous text controls and that history, rather than policy, is a more neutral and principled guide for constitutional decisionmaking when the text is unclear.80 Using historical examples, Justice Kavanaugh illustrated his view on how preand post-ratification history may inform the meaning of vague constitutional text.81 Next, he argued that balancing tests in constitutional cases are a relatively recent development, generally depart from tests centered on text and history, are inherently subjective, and should not be extended to the Second Amendment arena.82 Finally, he opined that the majority’s opinion was faithful to his perception of the appropriate roles of text, history, and precedent in constitutional adjudication in this particular case.83 Justice Barrett wrote a concurring opinion to explain her understanding of the relationship between Bruen’s historical tradition test and originalism as a method of constitutional interpretation. In her view, historical tradition is a means to understand original meaning, and, accordingly, historical practice around the time of ratification should be the focus of the legal inquiry.84 In her view, history demonstrates that, “[s]ince the founding, our Nation’s firearm laws have included provisions preventing individuals who threaten physical harm to others from misusing firearms.” Justice Barrett agreed with the majority that § 922(g)(8) “fits well within that principle.”85 Justice Jackson also wrote a concurring opinion, agreeing that the majority fairly applied Bruen as precedent.86 She wrote separately to highlight what she perceived as problems with applying the history-and-tradition standard in a workable manner.87 She argued that Rahimi illustrates the “pitfalls of Bruen’s approach” by demonstrating the difficulty of sifting through the historical record and determining whether historical evidence establishes a tradition of sufficiently analogous regulation.88 The numerous unanswered questions that remain even after Rahimi, in her view, result in “the Rule of Law suffer[ing].”89 Stating that legal standards should “foster stability, facilitate consistency, and promote predictability,” Justice Jackson concluded by arguing that “Bruen’s history-focused test ticks none of those boxes.”90 Justice Thomas was the sole dissenter. In his view, the historical examples cited by the majority were not sufficient to establish a tradition of firearm regulation that justified § 922(g)(8).91 According to Justice Thomas, courts should look to two metrics to evaluate whether historical examples of regulation are analogous to modern enactments: “how and why the regulations burden a law-abiding citizen’s right to armed self-defense.”92 In his view, the two categories of evidence proffered by the government—historical laws disarming “dangerous” individuals and historical characterization of the right to bear arms as belonging only to “peaceable” citizens— 80 Id. at 1912 (Kavanaugh, J., concurring). 81 Id. at 1913–19. 82 Id. at 1921. 83 Id. at 1923. 84 Id. at 1924 (Barrett, J., concurring). 85 Id. at 1926 (quoting Rahimi, 144 S. Ct. at 1896 (majority opinion)). 86 Id. (Jackson, J., concurring). 87 Id. at 1928. 88 Id. 89 Id. at 1929. 90 Id. 91 Id. at 1930 (Thomas, J., dissenting). 92 Id. at 1931–32. Supreme Court Term October 2023: A Review of Selected Major Rulings Congressional Research Service 9 did not impose comparable burdens as § 922(g)(8).93 Justice Thomas argued that § 922(g)(8) was enacted in response to “interpersonal violence,” whereas the historical English laws were concerned with insurrection and rebellion.94 Ultimately, Rahimi could have been disarmed, in Justice Thomas’s view, through criminal conviction but not through a restraining order.95	Concurring and Dissenting Opinions A majority of the Court—six Justices in total—wrote separately to concur or dissent, offering their individual views on how the Second Amendment and the Bruen standard should be properly interpreted both in this case and in future cases. Justice Sotomayor’s concurring opinion, joined by Justice Kagan, expressed her continued view that Bruen was wrongly decided and that a different legal standard should apply to Second Amendment cases.73 She wrote separately to emphasize that when applying the Bruen historical tradition standard, however, the majority’s methodology was the “right one.”74 In Justice Sotomayor’s view, this is an “easy case,” as § 922(g)(8) is “wholly consistent” with historical firearms regulations.75 By contrast, she criticized the dissenting view as too “rigid,” characterizing it as “insist[ing] that the means of addressing that problem cannot be ‘materially different’ from the means that existed in the eighteenth century,” which would unduly hamstring modern policy efforts.76 In his concurring opinion, Justice Gorsuch underscored the difficulty in maintaining a facial challenge to a law, which requires a showing that the law has no constitutional applications.77 He also defended the Bruen historical tradition standard, arguing that the original meaning of the Constitution, while “an imperfect guide,” provides proper constraints on judicial decisionmaking and is better than unbounded alternatives such as an interest-balancing inquiry.78 Justice Gorsuch also cautioned that the Court decided a narrow question—whether § 922(g)(3) “has any lawful scope”—and that future defendants could argue that § 922(g)(3) was unconstitutional under particular facts.79 69 Id. at 1901. 70 Id. at 1902. 71 Id. 72 Id. at 1903. 73 Id. at 1904 (Sotomayor, J., concurring). 74 Id. 75 Id. 76 Id. at 1905. 77 Id. at 1907 (Gorsuch, J., concurring). 78 Id. at 1909. 79 Id. at 1910. Supreme Court Term October 2023: A Review of Selected Major Rulings Congressional Research Service 8 Justice Kavanaugh concurred to expound his view on the roles of text, history, and precedent in constitutional interpretation. He explained that unambiguous text controls and that history, rather than policy, is a more neutral and principled guide for constitutional decisionmaking when the text is unclear.80 Using historical examples, Justice Kavanaugh illustrated his view on how preand post-ratification history may inform the meaning of vague constitutional text.81 Next, he argued that balancing tests in constitutional cases are a relatively recent development, generally depart from tests centered on text and history, are inherently subjective, and should not be extended to the Second Amendment arena.82 Finally, he opined that the majority’s opinion was faithful to his perception of the appropriate roles of text, history, and precedent in constitutional adjudication in this particular case.83 Justice Barrett wrote a concurring opinion to explain her understanding of the relationship between Bruen’s historical tradition test and originalism as a method of constitutional interpretation. In her view, historical tradition is a means to understand original meaning, and, accordingly, historical practice around the time of ratification should be the focus of the legal inquiry.84 In her view, history demonstrates that, “[s]ince the founding, our Nation’s firearm laws have included provisions preventing individuals who threaten physical harm to others from misusing firearms.” Justice Barrett agreed with the majority that § 922(g)(8) “fits well within that principle.”85 Justice Jackson also wrote a concurring opinion, agreeing that the majority fairly applied Bruen as precedent.86 She wrote separately to highlight what she perceived as problems with applying the history-and-tradition standard in a workable manner.87 She argued that Rahimi illustrates the “pitfalls of Bruen’s approach” by demonstrating the difficulty of sifting through the historical record and determining whether historical evidence establishes a tradition of sufficiently analogous regulation.88 The numerous unanswered questions that remain even after Rahimi, in her view, result in “the Rule of Law suffer[ing].”89 Stating that legal standards should “foster stability, facilitate consistency, and promote predictability,” Justice Jackson concluded by arguing that “Bruen’s history-focused test ticks none of those boxes.”90 Justice Thomas was the sole dissenter. In his view, the historical examples cited by the majority were not sufficient to establish a tradition of firearm regulation that justified § 922(g)(8).91 According to Justice Thomas, courts should look to two metrics to evaluate whether historical examples of regulation are analogous to modern enactments: “how and why the regulations burden a law-abiding citizen’s right to armed self-defense.”92 In his view, the two categories of evidence proffered by the government—historical laws disarming “dangerous” individuals and historical characterization of the right to bear arms as belonging only to “peaceable” citizens— 80 Id. at 1912 (Kavanaugh, J., concurring). 81 Id. at 1913–19. 82 Id. at 1921. 83 Id. at 1923. 84 Id. at 1924 (Barrett, J., concurring). 85 Id. at 1926 (quoting Rahimi, 144 S. Ct. at 1896 (majority opinion)). 86 Id. (Jackson, J., concurring). 87 Id. at 1928. 88 Id. 89 Id. at 1929. 90 Id. 91 Id. at 1930 (Thomas, J., dissenting). 92 Id. at 1931–32. Supreme Court Term October 2023: A Review of Selected Major Rulings Congressional Research Service 9 did not impose comparable burdens as § 922(g)(8).93 Justice Thomas argued that § 922(g)(8) was enacted in response to “interpersonal violence,” whereas the historical English laws were concerned with insurrection and rebellion.94 Ultimately, Rahimi could have been disarmed, in Justice Thomas’s view, through criminal conviction but not through a restraining order.95	Please only use information from the provided PDF to answer this prompt. Do not act like you are an expert in legal affairs in any way. EVIDENCE: Using the provided section of text below, please summarize the reasons for concurring and dissenting opinions. Concurring and Dissenting Opinions A majority of the Court—six Justices in total—wrote separately to concur or dissent, offering their individual views on how the Second Amendment and the Bruen standard should be properly interpreted both in this case and in future cases. Justice Sotomayor’s concurring opinion, joined by Justice Kagan, expressed her continued view that Bruen was wrongly decided and that a different legal standard should apply to Second Amendment cases.73 She wrote separately to emphasize that when applying the Bruen historical tradition standard, however, the majority’s methodology was the “right one.”74 In Justice Sotomayor’s view, this is an “easy case,” as § 922(g)(8) is “wholly consistent” with historical firearms regulations.75 By contrast, she criticized the dissenting view as too “rigid,” characterizing it as “insist[ing] that the means of addressing that problem cannot be ‘materially different’ from the means that existed in the eighteenth century,” which would unduly hamstring modern policy efforts.76 In his concurring opinion, Justice Gorsuch underscored the difficulty in maintaining a facial challenge to a law, which requires a showing that the law has no constitutional applications.77 He also defended the Bruen historical tradition standard, arguing that the original meaning of the Constitution, while “an imperfect guide,” provides proper constraints on judicial decisionmaking and is better than unbounded alternatives such as an interest-balancing inquiry.78 Justice Gorsuch also cautioned that the Court decided a narrow question—whether § 922(g)(3) “has any lawful scope”—and that future defendants could argue that § 922(g)(3) was unconstitutional under particular facts.79 69 Id. at 1901. 70 Id. at 1902. 71 Id. 72 Id. at 1903. 73 Id. at 1904 (Sotomayor, J., concurring). 74 Id. 75 Id. 76 Id. at 1905. 77 Id. at 1907 (Gorsuch, J., concurring). 78 Id. at 1909. 79 Id. at 1910. Supreme Court Term October 2023: A Review of Selected Major Rulings Congressional Research Service 8 Justice Kavanaugh concurred to expound his view on the roles of text, history, and precedent in constitutional interpretation. He explained that unambiguous text controls and that history, rather than policy, is a more neutral and principled guide for constitutional decisionmaking when the text is unclear.80 Using historical examples, Justice Kavanaugh illustrated his view on how preand post-ratification history may inform the meaning of vague constitutional text.81 Next, he argued that balancing tests in constitutional cases are a relatively recent development, generally depart from tests centered on text and history, are inherently subjective, and should not be extended to the Second Amendment arena.82 Finally, he opined that the majority’s opinion was faithful to his perception of the appropriate roles of text, history, and precedent in constitutional adjudication in this particular case.83 Justice Barrett wrote a concurring opinion to explain her understanding of the relationship between Bruen’s historical tradition test and originalism as a method of constitutional interpretation. In her view, historical tradition is a means to understand original meaning, and, accordingly, historical practice around the time of ratification should be the focus of the legal inquiry.84 In her view, history demonstrates that, “[s]ince the founding, our Nation’s firearm laws have included provisions preventing individuals who threaten physical harm to others from misusing firearms.” Justice Barrett agreed with the majority that § 922(g)(8) “fits well within that principle.”85 Justice Jackson also wrote a concurring opinion, agreeing that the majority fairly applied Bruen as precedent.86 She wrote separately to highlight what she perceived as problems with applying the history-and-tradition standard in a workable manner.87 She argued that Rahimi illustrates the “pitfalls of Bruen’s approach” by demonstrating the difficulty of sifting through the historical record and determining whether historical evidence establishes a tradition of sufficiently analogous regulation.88 The numerous unanswered questions that remain even after Rahimi, in her view, result in “the Rule of Law suffer[ing].”89 Stating that legal standards should “foster stability, facilitate consistency, and promote predictability,” Justice Jackson concluded by arguing that “Bruen’s history-focused test ticks none of those boxes.”90 Justice Thomas was the sole dissenter. In his view, the historical examples cited by the majority were not sufficient to establish a tradition of firearm regulation that justified § 922(g)(8).91 According to Justice Thomas, courts should look to two metrics to evaluate whether historical examples of regulation are analogous to modern enactments: “how and why the regulations burden a law-abiding citizen’s right to armed self-defense.”92 In his view, the two categories of evidence proffered by the government—historical laws disarming “dangerous” individuals and historical characterization of the right to bear arms as belonging only to “peaceable” citizens— 80 Id. at 1912 (Kavanaugh, J., concurring). 81 Id. at 1913–19. 82 Id. at 1921. 83 Id. at 1923. 84 Id. at 1924 (Barrett, J., concurring). 85 Id. at 1926 (quoting Rahimi, 144 S. Ct. at 1896 (majority opinion)). 86 Id. (Jackson, J., concurring). 87 Id. at 1928. 88 Id. 89 Id. at 1929. 90 Id. 91 Id. at 1930 (Thomas, J., dissenting). 92 Id. at 1931–32. Supreme Court Term October 2023: A Review of Selected Major Rulings Congressional Research Service 9 did not impose comparable burdens as § 922(g)(8).93 Justice Thomas argued that § 922(g)(8) was enacted in response to “interpersonal violence,” whereas the historical English laws were concerned with insurrection and rebellion.94 Ultimately, Rahimi could have been disarmed, in Justice Thomas’s view, through criminal conviction but not through a restraining order.95 USER: Using the provided section of text below, please summarize the reasons for concurring and dissenting opinions. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	26	16	889	null	613
Answer using only information from the prompt and context block. Answer using only bullet points.	Compare and contrast the power sources used by the Mars Pathfinder during its cruise phase and after landing on Mars.	If the lander comes to rest on a rock, the entire lander may be tilted, but further maneuvering of the petals can be performed during surface operations to lower the overall tilt of the lander. Telecommunications during entry should provide significant information about the behavior of the entry, descent and landing subsystem. Digital data will not be acquired, however, because of the extremely weak signal. 25 The amplitude and frequency of the spacecraft will be observed in real-time during entry and descent, and may be seen during petal deployment, depending on the lander's orientation once it comes to a stop on the Martian surface. Changes in amplitude are expected at cruise stage separation, parachute deployment, surface impact and during the airbag retraction and petal deployment. Changes in frequency reflect changes in the spacecraft's speed and will be most pronounced during the period of peak deceleration. The spacecraft also will deliberately change the frequency of the subcarrier to signal other key events. These include heat shield separation, bridle deployment, crossing the threshold altitude of 600 meters (about 2,000 feet) above the surface, completion of airbag retraction and completion of the petal deployment sequence. These planned frequency changes -- called "semaphores" -- are not likely to be detected in real-time, but can be extracted by post-processing the recorded data. In addition, key spacecraft telemetry data will be recorded and played back after landing. Other key data to be transmitted to Earth include accelerometer measurements and selected atmospheric structure instrument measurements. The Deep Space Network's 70-meter (230-foot) and 34-meter (110-foot) antennas in Madrid, Spain, will be used to support entry communications. Prime Mission Mars Pathfinder's primary mission begins when its lander petals have been fully unfolded and the lander switches to a sequence of computer commands that will control its functions. The spacecraft lands about 2-1/2 hours before sunrise on Mars and will spend the time in darkness retracting its airbags, standing itself upright and opening the petals so that solar panels can be powered up after sunrise. The lander's first task will be to transmit engineering and science data collected during its descent through the thin atmosphere of Mars. If no errors are detected in these data and the spacecraft is basically healthy, a real-time command will be sent from Earth instructing the lander to unlock the imager camera head, deploy and point the high-gain antenna. If conditions are different than expected, which is not unlikely, the opeation team will execute a contingency plan that has been placed onboard the spacecraft in expectation of such conditions. In the normal plan, the lander's camera will begin taking images -- including a panoramic view of the Martian landscape -- and will begin transmitting the data directly to Earth at 2,250 bits per second. The first images of the Martian landscape will tell engineers whether the airbags are fully retracted and whether the rover's exit ramp can be safely and successfully deployed. Once either or both ramps are deployed, additional images will be acquired to show the terrain beyond the ramps so that engineers can decide on the safest exit route. If the highgain antenna is not available, data will be sent over the lander’s low-gain antenna at a much lower rate of 40 bits per second. In this case, only a few, highly compressed images will be sent. 26 Once a decision on the route has been made, commands will be sent to deploy the rover. Sojourner will spend about a quarter of an hour exiting its ramp. The rover should be deployed within the first three days after landing. Driving off onto the floor of an old outflow channel, Sojourner will explore the surface at the command of Earth-based operators, who will rely on lander-based images to select a path and target for the rover. The six-wheeled Sojourner travels at 1 centimeter (0.4 inch) per second, performing mobility tests, imaging its surroundings and deploying an alpha proton x-ray spectrometer designed to study the elemental composition of rocks. During its prime mission, the rover will likely range a few tens of meters (yards) from the lander. Also mounted on the lander are wind sensors, wind socks and high- and low-gain antennas. Instruments will be used to measure the pressure, temperature and density of the Martian atmosphere. Magnets mounted on the lander will collect magnetic specimens of Martian dust and soil as small as 100 microns (about 1/250th of an inch). Extended Missions The primary mission lasts seven Martian days, or "sols," for the rover, and 30 Martian days, or "sols," for the lander. The rover could carry out an extended mission beyond that period, depending on how long its power sources and electronics last; engineers expect that the most probable reason for it to stop functioning is hot-cold cycling of its onboard electronics between Martian day and night. Sojourner's extended mission activities would include repeating soil mechanics experiments on various soils; additional spectrometer measurements of both rocks and soil; obtaining images of selected areas with the rover camera, including close-ups of the lander; obtaining images of the lander's landing and tumbling path; and traveling longer distances, with the possibility of going over the horizon, up to hundreds of meters (yards). For the lander, an extended mission lasting up to one year after landing is possible. Lander activities in the extended mission would include continued use of the lander camera to obtain images of the terrain and atmosphere, collection of key engineering telemetry and continued collection of meteorology data. Mission Operations All operations for Mars Pathfinder will be conducted at JPL, where the operations and science teams reside. Science data, both raw and processed, will be transferred after a period of validation to NASA's Planetary Data System archive for access and use by the planetary community at large and the general public. The Planetary Data System home page is at http://pds.jpl.nasa.gov/pds_home.html . Images from planetary missions are also available via the web from NASA’s Planetary Photojournal at http://photojournal.jpl.nasa.gov . 27 Spacecraft At launch the Mars Pathfinder spacecraft weighed about 895 kilograms (1,973 pounds), including its cruise stage, heat shield and backshell (or aeroshell), solar panels, propulsion stage, medium- and- high-gain antennas and 94 kilograms (207 pounds) of cruise propellant. The cruise vehicle measures 2.65 meters (8.5 feet) in diameter and stands 1.5 meters (5 feet) tall. The lander is a tetrahedron, a small pyramid standing about 0.9 meter (3 feet) tall with three triangular-shaped sides and a base. When Pathfinder is poised to enter the Martian atmosphere, its main components are the aeroshell, folded lander and rover, parachute, airbag system and three rocket engines. Combined, the spacecraft’s mass is about 570 kilograms (1,256 pounds) at entry. Once it has landed and its airbags have been deflated, Pathfinder’s mass will be about 360 kilograms (793 pounds). Subsystems contributing to its landed weight include the opening/uprighting mechanism, lander cabling and electronics, instruments and rover. When it is unfolded and lying flat on the surface, the spacecraft will measure 2.75 meters (9 feet) across with a mast-mounted camera standing up about 1.5 meters (5 feet) from the ground. The lander is controlled by a derivative of the commercially available IBM 6000 computer. This processor and associated components are radiation-hardened and mounted on a single electronics board. The computer has a 32-bit architecture which executes about 20 million instructions per second. The computer will store flight software as well as engineering and science data, including images and rover information, in 128 megabytes of dynamic random access memory. During interplanetary cruise, the spacecraft requires 178 watts of electrical power, provided by 2.5 square meters (27 square feet) of gallium arsenide solar cells. The lander has three solar panels, with a total area of 2.8 square meters (30 square feet) and supplying up to 1,200 watt-hours of power per day on clear days. At night, the lander will operate on rechargeable silver zinc batteries with a capacity at the beginning of the Mars surface mission of more than 40 amp-hours. The Pathfinder lander carries a camera on a mast to survey its immediate surroundings. The camera has two optical paths for stereo imaging, each with a filter wheel giving 12 color bands in the 0.35 to 1.1 micron range; exposures through different filters can be combined to produce color images. The camera’s field-of-view is 14 degrees in both horizontal and vertical directions, and it will be able to take one frame (256 by 256 pixels) every two seconds.	Answer using only information from the prompt and context block. Answer using only bullet points. Compare and contrast the power sources used by the Mars Pathfinder during its cruise phase and after landing on Mars. If the lander comes to rest on a rock, the entire lander may be tilted, but further maneuvering of the petals can be performed during surface operations to lower the overall tilt of the lander. Telecommunications during entry should provide significant information about the behavior of the entry, descent and landing subsystem. Digital data will not be acquired, however, because of the extremely weak signal. 25 The amplitude and frequency of the spacecraft will be observed in real-time during entry and descent, and may be seen during petal deployment, depending on the lander's orientation once it comes to a stop on the Martian surface. Changes in amplitude are expected at cruise stage separation, parachute deployment, surface impact and during the airbag retraction and petal deployment. Changes in frequency reflect changes in the spacecraft's speed and will be most pronounced during the period of peak deceleration. The spacecraft also will deliberately change the frequency of the subcarrier to signal other key events. These include heat shield separation, bridle deployment, crossing the threshold altitude of 600 meters (about 2,000 feet) above the surface, completion of airbag retraction and completion of the petal deployment sequence. These planned frequency changes -- called "semaphores" -- are not likely to be detected in real-time, but can be extracted by post-processing the recorded data. In addition, key spacecraft telemetry data will be recorded and played back after landing. Other key data to be transmitted to Earth include accelerometer measurements and selected atmospheric structure instrument measurements. The Deep Space Network's 70-meter (230-foot) and 34-meter (110-foot) antennas in Madrid, Spain, will be used to support entry communications. Prime Mission Mars Pathfinder's primary mission begins when its lander petals have been fully unfolded and the lander switches to a sequence of computer commands that will control its functions. The spacecraft lands about 2-1/2 hours before sunrise on Mars and will spend the time in darkness retracting its airbags, standing itself upright and opening the petals so that solar panels can be powered up after sunrise. The lander's first task will be to transmit engineering and science data collected during its descent through the thin atmosphere of Mars. If no errors are detected in these data and the spacecraft is basically healthy, a real-time command will be sent from Earth instructing the lander to unlock the imager camera head, deploy and point the high-gain antenna. If conditions are different than expected, which is not unlikely, the opeation team will execute a contingency plan that has been placed onboard the spacecraft in expectation of such conditions. In the normal plan, the lander's camera will begin taking images -- including a panoramic view of the Martian landscape -- and will begin transmitting the data directly to Earth at 2,250 bits per second. The first images of the Martian landscape will tell engineers whether the airbags are fully retracted and whether the rover's exit ramp can be safely and successfully deployed. Once either or both ramps are deployed, additional images will be acquired to show the terrain beyond the ramps so that engineers can decide on the safest exit route. If the highgain antenna is not available, data will be sent over the lander’s low-gain antenna at a much lower rate of 40 bits per second. In this case, only a few, highly compressed images will be sent. 26 Once a decision on the route has been made, commands will be sent to deploy the rover. Sojourner will spend about a quarter of an hour exiting its ramp. The rover should be deployed within the first three days after landing. Driving off onto the floor of an old outflow channel, Sojourner will explore the surface at the command of Earth-based operators, who will rely on lander-based images to select a path and target for the rover. The six-wheeled Sojourner travels at 1 centimeter (0.4 inch) per second, performing mobility tests, imaging its surroundings and deploying an alpha proton x-ray spectrometer designed to study the elemental composition of rocks. During its prime mission, the rover will likely range a few tens of meters (yards) from the lander. Also mounted on the lander are wind sensors, wind socks and high- and low-gain antennas. Instruments will be used to measure the pressure, temperature and density of the Martian atmosphere. Magnets mounted on the lander will collect magnetic specimens of Martian dust and soil as small as 100 microns (about 1/250th of an inch). Extended Missions The primary mission lasts seven Martian days, or "sols," for the rover, and 30 Martian days, or "sols," for the lander. The rover could carry out an extended mission beyond that period, depending on how long its power sources and electronics last; engineers expect that the most probable reason for it to stop functioning is hot-cold cycling of its onboard electronics between Martian day and night. Sojourner's extended mission activities would include repeating soil mechanics experiments on various soils; additional spectrometer measurements of both rocks and soil; obtaining images of selected areas with the rover camera, including close-ups of the lander; obtaining images of the lander's landing and tumbling path; and traveling longer distances, with the possibility of going over the horizon, up to hundreds of meters (yards). For the lander, an extended mission lasting up to one year after landing is possible. Lander activities in the extended mission would include continued use of the lander camera to obtain images of the terrain and atmosphere, collection of key engineering telemetry and continued collection of meteorology data. Mission Operations All operations for Mars Pathfinder will be conducted at JPL, where the operations and science teams reside. Science data, both raw and processed, will be transferred after a period of validation to NASA's Planetary Data System archive for access and use by the planetary community at large and the general public. The Planetary Data System home page is at http://pds.jpl.nasa.gov/pds_home.html . Images from planetary missions are also available via the web from NASA’s Planetary Photojournal at http://photojournal.jpl.nasa.gov . 27 Spacecraft At launch the Mars Pathfinder spacecraft weighed about 895 kilograms (1,973 pounds), including its cruise stage, heat shield and backshell (or aeroshell), solar panels, propulsion stage, medium- and- high-gain antennas and 94 kilograms (207 pounds) of cruise propellant. The cruise vehicle measures 2.65 meters (8.5 feet) in diameter and stands 1.5 meters (5 feet) tall. The lander is a tetrahedron, a small pyramid standing about 0.9 meter (3 feet) tall with three triangular-shaped sides and a base. When Pathfinder is poised to enter the Martian atmosphere, its main components are the aeroshell, folded lander and rover, parachute, airbag system and three rocket engines. Combined, the spacecraft’s mass is about 570 kilograms (1,256 pounds) at entry. Once it has landed and its airbags have been deflated, Pathfinder’s mass will be about 360 kilograms (793 pounds). Subsystems contributing to its landed weight include the opening/uprighting mechanism, lander cabling and electronics, instruments and rover. When it is unfolded and lying flat on the surface, the spacecraft will measure 2.75 meters (9 feet) across with a mast-mounted camera standing up about 1.5 meters (5 feet) from the ground. The lander is controlled by a derivative of the commercially available IBM 6000 computer. This processor and associated components are radiation-hardened and mounted on a single electronics board. The computer has a 32-bit architecture which executes about 20 million instructions per second. The computer will store flight software as well as engineering and science data, including images and rover information, in 128 megabytes of dynamic random access memory. During interplanetary cruise, the spacecraft requires 178 watts of electrical power, provided by 2.5 square meters (27 square feet) of gallium arsenide solar cells. The lander has three solar panels, with a total area of 2.8 square meters (30 square feet) and supplying up to 1,200 watt-hours of power per day on clear days. At night, the lander will operate on rechargeable silver zinc batteries with a capacity at the beginning of the Mars surface mission of more than 40 amp-hours. The Pathfinder lander carries a camera on a mast to survey its immediate surroundings. The camera has two optical paths for stereo imaging, each with a filter wheel giving 12 color bands in the 0.35 to 1.1 micron range; exposures through different filters can be combined to produce color images. The camera’s field-of-view is 14 degrees in both horizontal and vertical directions, and it will be able to take one frame (256 by 256 pixels) every two seconds.	Answer using only information from the prompt and context block. Answer using only bullet points. EVIDENCE: If the lander comes to rest on a rock, the entire lander may be tilted, but further maneuvering of the petals can be performed during surface operations to lower the overall tilt of the lander. Telecommunications during entry should provide significant information about the behavior of the entry, descent and landing subsystem. Digital data will not be acquired, however, because of the extremely weak signal. 25 The amplitude and frequency of the spacecraft will be observed in real-time during entry and descent, and may be seen during petal deployment, depending on the lander's orientation once it comes to a stop on the Martian surface. Changes in amplitude are expected at cruise stage separation, parachute deployment, surface impact and during the airbag retraction and petal deployment. Changes in frequency reflect changes in the spacecraft's speed and will be most pronounced during the period of peak deceleration. The spacecraft also will deliberately change the frequency of the subcarrier to signal other key events. These include heat shield separation, bridle deployment, crossing the threshold altitude of 600 meters (about 2,000 feet) above the surface, completion of airbag retraction and completion of the petal deployment sequence. These planned frequency changes -- called "semaphores" -- are not likely to be detected in real-time, but can be extracted by post-processing the recorded data. In addition, key spacecraft telemetry data will be recorded and played back after landing. Other key data to be transmitted to Earth include accelerometer measurements and selected atmospheric structure instrument measurements. The Deep Space Network's 70-meter (230-foot) and 34-meter (110-foot) antennas in Madrid, Spain, will be used to support entry communications. Prime Mission Mars Pathfinder's primary mission begins when its lander petals have been fully unfolded and the lander switches to a sequence of computer commands that will control its functions. The spacecraft lands about 2-1/2 hours before sunrise on Mars and will spend the time in darkness retracting its airbags, standing itself upright and opening the petals so that solar panels can be powered up after sunrise. The lander's first task will be to transmit engineering and science data collected during its descent through the thin atmosphere of Mars. If no errors are detected in these data and the spacecraft is basically healthy, a real-time command will be sent from Earth instructing the lander to unlock the imager camera head, deploy and point the high-gain antenna. If conditions are different than expected, which is not unlikely, the opeation team will execute a contingency plan that has been placed onboard the spacecraft in expectation of such conditions. In the normal plan, the lander's camera will begin taking images -- including a panoramic view of the Martian landscape -- and will begin transmitting the data directly to Earth at 2,250 bits per second. The first images of the Martian landscape will tell engineers whether the airbags are fully retracted and whether the rover's exit ramp can be safely and successfully deployed. Once either or both ramps are deployed, additional images will be acquired to show the terrain beyond the ramps so that engineers can decide on the safest exit route. If the highgain antenna is not available, data will be sent over the lander’s low-gain antenna at a much lower rate of 40 bits per second. In this case, only a few, highly compressed images will be sent. 26 Once a decision on the route has been made, commands will be sent to deploy the rover. Sojourner will spend about a quarter of an hour exiting its ramp. The rover should be deployed within the first three days after landing. Driving off onto the floor of an old outflow channel, Sojourner will explore the surface at the command of Earth-based operators, who will rely on lander-based images to select a path and target for the rover. The six-wheeled Sojourner travels at 1 centimeter (0.4 inch) per second, performing mobility tests, imaging its surroundings and deploying an alpha proton x-ray spectrometer designed to study the elemental composition of rocks. During its prime mission, the rover will likely range a few tens of meters (yards) from the lander. Also mounted on the lander are wind sensors, wind socks and high- and low-gain antennas. Instruments will be used to measure the pressure, temperature and density of the Martian atmosphere. Magnets mounted on the lander will collect magnetic specimens of Martian dust and soil as small as 100 microns (about 1/250th of an inch). Extended Missions The primary mission lasts seven Martian days, or "sols," for the rover, and 30 Martian days, or "sols," for the lander. The rover could carry out an extended mission beyond that period, depending on how long its power sources and electronics last; engineers expect that the most probable reason for it to stop functioning is hot-cold cycling of its onboard electronics between Martian day and night. Sojourner's extended mission activities would include repeating soil mechanics experiments on various soils; additional spectrometer measurements of both rocks and soil; obtaining images of selected areas with the rover camera, including close-ups of the lander; obtaining images of the lander's landing and tumbling path; and traveling longer distances, with the possibility of going over the horizon, up to hundreds of meters (yards). For the lander, an extended mission lasting up to one year after landing is possible. Lander activities in the extended mission would include continued use of the lander camera to obtain images of the terrain and atmosphere, collection of key engineering telemetry and continued collection of meteorology data. Mission Operations All operations for Mars Pathfinder will be conducted at JPL, where the operations and science teams reside. Science data, both raw and processed, will be transferred after a period of validation to NASA's Planetary Data System archive for access and use by the planetary community at large and the general public. The Planetary Data System home page is at http://pds.jpl.nasa.gov/pds_home.html . Images from planetary missions are also available via the web from NASA’s Planetary Photojournal at http://photojournal.jpl.nasa.gov . 27 Spacecraft At launch the Mars Pathfinder spacecraft weighed about 895 kilograms (1,973 pounds), including its cruise stage, heat shield and backshell (or aeroshell), solar panels, propulsion stage, medium- and- high-gain antennas and 94 kilograms (207 pounds) of cruise propellant. The cruise vehicle measures 2.65 meters (8.5 feet) in diameter and stands 1.5 meters (5 feet) tall. The lander is a tetrahedron, a small pyramid standing about 0.9 meter (3 feet) tall with three triangular-shaped sides and a base. When Pathfinder is poised to enter the Martian atmosphere, its main components are the aeroshell, folded lander and rover, parachute, airbag system and three rocket engines. Combined, the spacecraft’s mass is about 570 kilograms (1,256 pounds) at entry. Once it has landed and its airbags have been deflated, Pathfinder’s mass will be about 360 kilograms (793 pounds). Subsystems contributing to its landed weight include the opening/uprighting mechanism, lander cabling and electronics, instruments and rover. When it is unfolded and lying flat on the surface, the spacecraft will measure 2.75 meters (9 feet) across with a mast-mounted camera standing up about 1.5 meters (5 feet) from the ground. The lander is controlled by a derivative of the commercially available IBM 6000 computer. This processor and associated components are radiation-hardened and mounted on a single electronics board. The computer has a 32-bit architecture which executes about 20 million instructions per second. The computer will store flight software as well as engineering and science data, including images and rover information, in 128 megabytes of dynamic random access memory. During interplanetary cruise, the spacecraft requires 178 watts of electrical power, provided by 2.5 square meters (27 square feet) of gallium arsenide solar cells. The lander has three solar panels, with a total area of 2.8 square meters (30 square feet) and supplying up to 1,200 watt-hours of power per day on clear days. At night, the lander will operate on rechargeable silver zinc batteries with a capacity at the beginning of the Mars surface mission of more than 40 amp-hours. The Pathfinder lander carries a camera on a mast to survey its immediate surroundings. The camera has two optical paths for stereo imaging, each with a filter wheel giving 12 color bands in the 0.35 to 1.1 micron range; exposures through different filters can be combined to produce color images. The camera’s field-of-view is 14 degrees in both horizontal and vertical directions, and it will be able to take one frame (256 by 256 pixels) every two seconds. USER: Compare and contrast the power sources used by the Mars Pathfinder during its cruise phase and after landing on Mars. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	true	15	20	1,407	null	489
[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 am bored and don't have time to read this. Please lay this text out to me in layman's terms. Write it from a first-person perspective of Mr Comey talking about what he thinks about the Russia investigation. And sum it up in 6-8 good bullet points.	TESTIMONY OF JAMES COMEY, FORMER DIRECTOR, FEDERAL BUREAU OF INVESTIGATION Chairman BURR. Director Comey, you’re now under oath. And I would just note to members, you will be recognized by seniority for a period up to seven minutes. And again, it is the intent to move to a closed session no later than 1:00 p.m. With that, Director Comey, you are recognized. You have the floor for as long as you might need. Director COMEY. Thank you. Mr. Chairman, Ranking Member Warner, members of the committee: Thank you for inviting me here to testify today. I’ve submitted my statement for the record and I’m not going to repeat it here this morning. I thought I would just offer some very brief introductory remarks and then I would welcome your questions. When I was appointed FBI Director in 2013, I understood that I served at the pleasure of the President. Even though I was appointed to a 10-year term, which Congress created in order to underscore the importance of the FBI being outside of politics and independent, I understood that I could be fired by a President for any reason or for no reason at all. And on May the 9th, when I learned that I had been fired, for that reason I immediately came home as a private citizen. But then the explanations, the shifting explanations, confused me and increasingly concerned me. They confused me because the President and I had had multiple conversations about my job, both before and after he took office, and he had repeatedly told me I was doing a great job and he hoped I would stay. And I had repeatedly assured him that I did intend to stay and serve out the remaining six years of my term. He told me repeatedly that he had talked to lots of people about me, including our current Attorney General, and had learned that I was doing a great job and that I was extremely well-liked by the FBI workforce. So it confused me when I saw on television the President saying that he actually fired me because of the Russia investigation and learned, again from the media, that he was telling privately other parties that my firing had relieved great pressure on the Russia investigation. I was also confused by the initial explanation that was offered publicly, that I was fired because of the decisions I had made during the election year. That didn’t make sense to me for a whole bunch of reasons, including the time and all the water that had gone under the bridge since those hard decisions that had to be made. That didn’t make any sense to me. And although the law required no reason at all to fire an FBI Director, the Administration then chose to defame me and, more importantly, the FBI by saying that the organization was in disarray, that it was poorly led, that the workforce had lost confidence in its leader. Those were lies, plain and simple, and I am so sorry that the FBI workforce had to hear them and I’m so sorry that the American people were told them. I worked every day at the FBI to help make that great organization better. And I say ‘‘help’’ because I did nothing alone at the FBI. There are no indispensable people at the FBI. The organization’s great strength is that its values and abilities run deep and wide. The FBI will be fine without me. The FBI’s mission will be relentlessly pursued by its people and that mission is to protect the American people and uphold the Constitution of the United States. I will deeply miss being part of that mission, but this organization and its mission will go on long beyond me and long beyond any particular administration. I have a message before I close for my former colleagues at the FBI. But first I want the American people to know this truth: The FBI is honest. The FBI is strong. And the FBI is and always will be independent. And now to my former colleagues, if I may. I am so sorry that I didn’t get the chance to say goodbye to you properly. It was the honor of my life to serve beside you, to be part of the FBI family. And I will miss it for the rest of my life. Thank you for standing watch. Thank you for doing so much good for this country. Do that good as long as ever you can. And, Senators, I look forward to your questions. Chairman BURR. Director, thank you for that testimony, both oral and the written testimony that you provided to the committee yesterday and made public to the American people. The Chair would recognize himself first for 12 minutes, Vice Chair for 12 minutes, based upon the agreement we have. Director, did the Special Counsel’s Office review and/or edit your written testimony? Director COMEY. No. Chairman BURR. Do you have any doubt that Russia attempted to interfere in the 2016 elections? Director COMEY. None.	[question] I am bored and don't have time to read this. Please lay this text out to me in layman's terms. Write it from a first-person perspective of Mr Comey talking about what he thinks about the Russia investigation. And sum it up in 6-8 good bullet points. ===================== [text] TESTIMONY OF JAMES COMEY, FORMER DIRECTOR, FEDERAL BUREAU OF INVESTIGATION Chairman BURR. Director Comey, you’re now under oath. And I would just note to members, you will be recognized by seniority for a period up to seven minutes. And again, it is the intent to move to a closed session no later than 1:00 p.m. With that, Director Comey, you are recognized. You have the floor for as long as you might need. Director COMEY. Thank you. Mr. Chairman, Ranking Member Warner, members of the committee: Thank you for inviting me here to testify today. I’ve submitted my statement for the record and I’m not going to repeat it here this morning. I thought I would just offer some very brief introductory remarks and then I would welcome your questions. When I was appointed FBI Director in 2013, I understood that I served at the pleasure of the President. Even though I was appointed to a 10-year term, which Congress created in order to underscore the importance of the FBI being outside of politics and independent, I understood that I could be fired by a President for any reason or for no reason at all. And on May the 9th, when I learned that I had been fired, for that reason I immediately came home as a private citizen. But then the explanations, the shifting explanations, confused me and increasingly concerned me. They confused me because the President and I had had multiple conversations about my job, both before and after he took office, and he had repeatedly told me I was doing a great job and he hoped I would stay. And I had repeatedly assured him that I did intend to stay and serve out the remaining six years of my term. He told me repeatedly that he had talked to lots of people about me, including our current Attorney General, and had learned that I was doing a great job and that I was extremely well-liked by the FBI workforce. So it confused me when I saw on television the President saying that he actually fired me because of the Russia investigation and learned, again from the media, that he was telling privately other parties that my firing had relieved great pressure on the Russia investigation. I was also confused by the initial explanation that was offered publicly, that I was fired because of the decisions I had made during the election year. That didn’t make sense to me for a whole bunch of reasons, including the time and all the water that had gone under the bridge since those hard decisions that had to be made. That didn’t make any sense to me. And although the law required no reason at all to fire an FBI Director, the Administration then chose to defame me and, more importantly, the FBI by saying that the organization was in disarray, that it was poorly led, that the workforce had lost confidence in its leader. Those were lies, plain and simple, and I am so sorry that the FBI workforce had to hear them and I’m so sorry that the American people were told them. I worked every day at the FBI to help make that great organization better. And I say ‘‘help’’ because I did nothing alone at the FBI. There are no indispensable people at the FBI. The organization’s great strength is that its values and abilities run deep and wide. The FBI will be fine without me. The FBI’s mission will be relentlessly pursued by its people and that mission is to protect the American people and uphold the Constitution of the United States. I will deeply miss being part of that mission, but this organization and its mission will go on long beyond me and long beyond any particular administration. I have a message before I close for my former colleagues at the FBI. But first I want the American people to know this truth: The FBI is honest. The FBI is strong. And the FBI is and always will be independent. And now to my former colleagues, if I may. I am so sorry that I didn’t get the chance to say goodbye to you properly. It was the honor of my life to serve beside you, to be part of the FBI family. And I will miss it for the rest of my life. Thank you for standing watch. Thank you for doing so much good for this country. Do that good as long as ever you can. And, Senators, I look forward to your questions. Chairman BURR. Director, thank you for that testimony, both oral and the written testimony that you provided to the committee yesterday and made public to the American people. The Chair would recognize himself first for 12 minutes, Vice Chair for 12 minutes, based upon the agreement we have. Director, did the Special Counsel’s Office review and/or edit your written testimony? Director COMEY. No. Chairman BURR. Do you have any doubt that Russia attempted to interfere in the 2016 elections? Director COMEY. None. https://www.govinfo.gov/content/pkg/CHRG-115shrg25890/pdf/CHRG-115shrg25890.pdf ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.	[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: TESTIMONY OF JAMES COMEY, FORMER DIRECTOR, FEDERAL BUREAU OF INVESTIGATION Chairman BURR. Director Comey, you’re now under oath. And I would just note to members, you will be recognized by seniority for a period up to seven minutes. And again, it is the intent to move to a closed session no later than 1:00 p.m. With that, Director Comey, you are recognized. You have the floor for as long as you might need. Director COMEY. Thank you. Mr. Chairman, Ranking Member Warner, members of the committee: Thank you for inviting me here to testify today. I’ve submitted my statement for the record and I’m not going to repeat it here this morning. I thought I would just offer some very brief introductory remarks and then I would welcome your questions. When I was appointed FBI Director in 2013, I understood that I served at the pleasure of the President. Even though I was appointed to a 10-year term, which Congress created in order to underscore the importance of the FBI being outside of politics and independent, I understood that I could be fired by a President for any reason or for no reason at all. And on May the 9th, when I learned that I had been fired, for that reason I immediately came home as a private citizen. But then the explanations, the shifting explanations, confused me and increasingly concerned me. They confused me because the President and I had had multiple conversations about my job, both before and after he took office, and he had repeatedly told me I was doing a great job and he hoped I would stay. And I had repeatedly assured him that I did intend to stay and serve out the remaining six years of my term. He told me repeatedly that he had talked to lots of people about me, including our current Attorney General, and had learned that I was doing a great job and that I was extremely well-liked by the FBI workforce. So it confused me when I saw on television the President saying that he actually fired me because of the Russia investigation and learned, again from the media, that he was telling privately other parties that my firing had relieved great pressure on the Russia investigation. I was also confused by the initial explanation that was offered publicly, that I was fired because of the decisions I had made during the election year. That didn’t make sense to me for a whole bunch of reasons, including the time and all the water that had gone under the bridge since those hard decisions that had to be made. That didn’t make any sense to me. And although the law required no reason at all to fire an FBI Director, the Administration then chose to defame me and, more importantly, the FBI by saying that the organization was in disarray, that it was poorly led, that the workforce had lost confidence in its leader. Those were lies, plain and simple, and I am so sorry that the FBI workforce had to hear them and I’m so sorry that the American people were told them. I worked every day at the FBI to help make that great organization better. And I say ‘‘help’’ because I did nothing alone at the FBI. There are no indispensable people at the FBI. The organization’s great strength is that its values and abilities run deep and wide. The FBI will be fine without me. The FBI’s mission will be relentlessly pursued by its people and that mission is to protect the American people and uphold the Constitution of the United States. I will deeply miss being part of that mission, but this organization and its mission will go on long beyond me and long beyond any particular administration. I have a message before I close for my former colleagues at the FBI. But first I want the American people to know this truth: The FBI is honest. The FBI is strong. And the FBI is and always will be independent. And now to my former colleagues, if I may. I am so sorry that I didn’t get the chance to say goodbye to you properly. It was the honor of my life to serve beside you, to be part of the FBI family. And I will miss it for the rest of my life. Thank you for standing watch. Thank you for doing so much good for this country. Do that good as long as ever you can. And, Senators, I look forward to your questions. Chairman BURR. Director, thank you for that testimony, both oral and the written testimony that you provided to the committee yesterday and made public to the American people. The Chair would recognize himself first for 12 minutes, Vice Chair for 12 minutes, based upon the agreement we have. Director, did the Special Counsel’s Office review and/or edit your written testimony? Director COMEY. No. Chairman BURR. Do you have any doubt that Russia attempted to interfere in the 2016 elections? Director COMEY. None. USER: I am bored and don't have time to read this. Please lay this text out to me in layman's terms. Write it from a first-person perspective of Mr Comey talking about what he thinks about the Russia investigation. And sum it up in 6-8 good bullet points. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	28	47	844	null	233
Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand.	What is the clinical consensus on whether THC affects the brain during adolescence?	AHA SCIENTIFIC STATEMENT Use of Marijuana: Effect on Brain Health: A Scientific Statement From the American Heart Association The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Fernando D. Testai, MD, PhD, Chair; Philip B. Gorelick, MD, MPH, Vice Chair; Hugo J. Aparicio, MD, MPH; Francesca M. Filbey, PhD; Raul Gonzalez, PhD; Rebecca F. Gottesman, MD, PhD; Miriam Melis, PhD; Mariann R. Piano, RN, PhD; Tiziana Rubino, PhD; Sarah Y. Song, MD; on behalf of the American Heart Association Stroke Brain Health Science Subcommittee of the Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease ABSTRACT: Marijuana is perceived as a harmless drug, and its recreational use has gained popularity among young individuals. The concentration of active ingredients in recreational formulations has gradually increased over time, and high-potency illicit cannabinomimetics have become available. Thus, the consumption of cannabis in the general population is rising. Data from preclinical models demonstrate that cannabinoid receptors are expressed in high density in areas involved in cognition and behavior, particularly during periods of active neurodevelopment and maturation. In addition, growing evidence highlights the role of endogenous cannabinoid pathways in the regulation of neurotransmitter release, synaptic plasticity, and neurodevelopment. In animal models, exogenous cannabinoids disrupt these important processes and lead to cognitive and behavioral abnormalities. These data correlate with the higher risk of cognitive impairment reported in some observational studies done in humans. It is unclear whether the effect of cannabis on cognition reverts after abstinence. However, this evidence, along with the increased risk of stroke reported in marijuana users, raises concerns about its potential long-term effects on cognitive function. This scientific statement reviews the safety of cannabis use from the perspective of brain health, describes mechanistically how cannabis may cause cognitive dysfunction, and advocates for a more informed health care worker and consumer about the potential for cannabis to adversely affect the brain. Key Words: AHA Scientific Statements ◼ brain ◼ cannabis ◼ cognition ◼ marijuana ◼ stroke M M arijuana, or cannabis, was considered an illicit drug for decades. However, in many parts of the world, cannabis has been legalized for medical use or decriminalized for recreational or medicinal applications. This shift in attitude has resulted in a rapid increase in its use. It has been estimated that ≈183 million people in the world used marijuana in 20141 and that 22 million met criteria for cannabis use disorder in 2016.2 In addition, according to the 2002 to 2019 National Survey on Drug Use and Health, the proportion of the US population >12 years of age who used marijuana in the past year increased gradually from 11% in 2002 to 18% in 2019.3 The use of marijuana has gained popularity, particularly among adolescents and young adults, with ≈36% of 12th graders and 43% of college students reporting having used it in the past year.4 In parallel, evidence suggests that the potency of cannabis products in the United States, measured by the concentration of the primary psychoactive constituent of marijuana, Δ9-tetrahydrocannabinol (THC), has gradually increased from ≈4% in 1995 to 15% in 2018.5 Cannabinoid receptors are expressed in high density in areas of the brain involved in executive function and The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. © 2022 American Heart Association, Inc. e176 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 memory such as the hippocampus, amygdala, and prefrontal cortex (PFC), particularly during periods of active brain development.6 Acute intoxication with cannabinoids can impair memory and behavioral inhibition.7 Cannabinoids also regulate anxiety and can produce psychosis- like effects.6 Evidence shows that age at exposure may influence the effect of cannabinoids on cognitive function. For example, the prenatal, perinatal, and adolescent periods may be particularly sensitive to these compounds.8 Data obtained in preclinical models have shown that cannabis and its associated signaling pathways regulate neurotransmission and play an active role in key cerebral processes, including neuroinflammation, neurogenesis, neural migration, synaptic pruning, and white matter development.6,9 Furthermore, experimental data show that cannabinoids can regulate the functioning of different cytochrome-P450 isoforms and uridine 5′-diphospho-glucuronosyltransferases. Thus, there is a potential risk for drug-to-drug interactions with medications commonly used by the elderly such as warfarin, antiarrhythmic agents, sedatives, and anticonvulsants.10 These factors have raised concerns about the potential effect of cannabis on cognitive vitality. The goal of this scientific statement is to critically appraise the safety of cannabis use from the perspective of brain health. CANNABIS AND ENDOCANNABINOIDS Anandamide and 2-arachidonoyl-glycerol are endogenous bioactive lipids that activate 2 G-protein–coupled receptors designated as cannabinoid receptor type 1 (CB1) and 2 (CB2). These lipids, called endocannabinoids, are not stored in vesicles but are synthesized on demand. The system formed by the cannabinoid receptors CB1 and CB2, endogenous ligands, and enzymes involved in their production and degradation is known as the endocannabinoid system (ECS). A detailed description of the composition and regulation of the ECS is beyond the scope of this publication; this topic has been reviewed extensively elsewhere.9,11,12 Phytocannabinoids are exogenous cannabinoids extracted from flowering plants from the cannabis genus, including Cannabis sativa, Cannabis indica, and Cannabis ruderalis. Whether these are species or subspecies is a matter of debate. More than 100 phytocannabinoids have been extracted from these plants, with THC and cannabidiol (CBD) being the most abundant. The relative concentration of THC and CBD in these strains is variable. In general, cannabis cultivars can be classified according to the cannabinoid produced as chemotype I (THC rich), II (THC/CBD balanced), III (CBD rich), IV (cannabigerol rich), or V (cannabinoid free).13 THC is a psychoactive alkaloid that signals through CB1 and CB2 receptors. Cannabinoid receptor type 1 is expressed abundantly in peripheral and central neural cells. In the periphery, CB1 localizes to sympathetic nerve terminals and sensory neurons. In the central nervous system, it is expressed mainly in presynaptic membranes of excitatory and inhibitory neurons, where it regulates the vesicular release of dopamine, GABA, and glutamate. In comparison, CB2 is expressed mainly in immune cells, including microglia.9 CBD is a nonpsychoactive cannabinoid that has antioxidant and anti-inflammatory properties. It is thought that CBD exerts some of the beneficial effects that phytocannabinoids have in Dravet syndrome and Lennox- Gastaut syndrome. Furthermore, studies done in preclinical models suggest that CBD is beneficial in Alzheimer disease, cerebral ischemia, multiple sclerosis, and other neurologic disorders.9,14 The therapeutic potential of CBD is being investigated in different clinical trials. Compared with THC, CBD signals through different pathways but does not activate CB1 and CB2. At low concentration, CBD blocks the orphan G-protein–coupled receptor-55, the equilibrative nucleoside transporter 1, and the transient receptor potential of melastatin type 8 channel. It also activates the serotonin (5-hydroxytryptamine) 1A receptor, the transient receptor potential of ankyrin type 1 channel, and α3 and α1 glycine receptors. At high concentration, CBD activates the nuclear peroxisome proliferator-activated receptor γ and the transient receptor potential of vanilloid types 1 and 2.12,14 Several cannabinoids have received approval in different countries for the treatment of specific medical conditions. In addition, high-potency synthetic cannabimimetics such as Spice are available in the illegal market (Table 1).15–17 NEUROBIOLOGICAL ACTIONS OF CANNABIS IN ANIMAL MODELS Molecular and cellular mechanisms underlying the effects of cannabis on the developing brain are inferred mainly from preclinical studies that permit controlling for social and environmental factors that could influence outcomes of interest. In addition, animal models allow the investigation of a range of human age-related behavioral factors (eg, novelty and sensation seeking, impulsivity, risk-taking behaviors) and key stages of neurodevelopment that are conserved across many mammalian species. However, many individual (eg, species, strain, age) and experimental (eg, design, drug, dose, delivery, regimen) variables, along with objective end points (eg, behavioral paradigm, experimental technique), have contributed to equivocal findings across studies. Nonetheless, experimental animal models of prenatal and adolescent cannabis exposure have proved fundamental in disclosing the underlying neurobiological mechanisms that might explain several clinical neuropsychiatric outcomes outlined here. Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e177 Table 1. Synthetic and Semisynthetic Cannabinoids Cannabinoid type Active ingredient Indication Medical15,16 Cesamet Nabilone (synthetic THC analog) Treatment of refractory cancer chemotherapy– associated nausea and vomiting† Marinol (pill) Dronabinol (synthetic THC) Anorexia with weight loss in patients with AIDS or cancer† Syndros (solution) Dronabinol (synthetic THC) Treatment of refractory cancer chemotherapy– associated nausea and vomiting† Epidiolex Purified CBD Seizures associated with Lennox- Gastaut syndrome and Dravet syndrome in patients >1 y of age Seizures associated with tuberous sclerosis complex in patients >1 y of age* Sativex Nabiximols (extract of THC, CBD, and other minor cannabinoids, terpenoids, and flavonoids) Adjunctive therapy for symptomatic treatment of refractory spasticity in adult patients with multiple sclerosis indication† Adjunctive treatment for symptomatic neuropathy in adult patients with multiple sclerosis indication† Adjunctive treatment for patients with advanced cancer with refractory severe pain indication† Illicit17 K2, Spice, Kronic, Kaos Originally synthesized to study the endocannabinoid system Bind cannabinoid receptors with high affinity and can cause hallucinations, agitation, psychosis, short-term memory loss, seizures, coagulopathy, and myocardial infarction CBD indicates cannabidiol; and THC, Δ9-tetrahydrocannabinol. Approved by the US Food and Drug Administration. †Approved by the Health Products and Food Branch of Health Canada. Animal models have been used to examine the role of the ECS in the modulation of synaptic plasticity, a process that allows the brain to change and adapt to new information.18 The ECS modulates synaptic plasticity by affecting the strength of interneuronal connections and, ultimately, the functioning of neuronal networks. From the mechanistic standpoint, THC activates cannabinoid receptors in the brain, thus interfering with physiological actions of endocannabinoids. Spatial and time resolution of endocannabinoid production is pivotal for correct processing of different brain functions such as higher-order cognition, memory, reward, mood, and stress sensitiv ity.8,19,20 Consequently, THC, activating nonspecifically CB1 receptors in the brain, disrupts the fine-tuning of synaptic activity exerted by endocannabinoids, eventually impairing connectivity of neuronal networks and brain functionality. Although incompletely understood, the way in which THC disrupts memory and learning may be through its differential effect on neurotransmitter release and binding to CB1 receptors.19 For example, THC activates CB1 receptors located on GABAergic interneurons, which represent nearly three-quarters of the brain CB1 receptors, and astrocytes, resulting in the release of hippocampal glutamate. Concomitantly, THC affects the transmission of other neurotransmitters involved in the modulation of memory such as acetylcholine, adenosine, and serotonin.19,20 Furthermore, THC activation of CB1 receptors present on mitochondria leads to decreased cellular respiration and ATP supply.19 ATP is fundamental in maintaining and regulating neurotransmission, and its reduction might contribute to THC- induced cognitive deficits. Repeated exposure to cannabis, especially during the adolescent developmental period, may be especially harmful to brain health and cause structural, molecular, and functional alterations of brain circuits, particularly in the PFC and hippocampus.8,21,22 Long-term THC exposure induces CB1 receptor downregulation and desensitization that appear more intense and widespread after adolescent exposure as opposed to adulthood exposure. 22 Data obtained in experimental models showed that these effects could have implications for neurodevelopmental processes in which the ECS plays a role. Accordingly, long-term THC exposure during adolescence may disrupt dynamic changes occurring in glutamatergic and GABAergic systems, leading to excessive synaptic pruning (ie, loss of synaptic contacts), long-term dysfunction in prefrontal excitatory/inhibitory balance, and desynchronization of PFC neuronal networks, which also dysregulate the mesolimbic dopaminergic pathway (Figure).23 These changes may represent the molecular underpinnings of cognitive deficits and altered emotional reactivity and social behavior observed long after adolescent long-term THC exposure.22 Long-term changes in brain functionality induced by THC exposure during adolescence might also arise from epigenetic modifications with a marked reprogramming of the transcriptome, affecting mainly genes related to synaptic plasticity processes. 8,19 These effects have not been reported after adult THC exposure.19 In addition to the effects on neuron cellular and sub- cellular components, recent evidence suggests that alterations in glial cells have a key role in the actions of THC.24 Long-term THC exposure activates microglia and astrocytes to produce inflammatory cytokines. For example, long-term administration of THC during adolescence increased the microglial expression of the proinflammatory mediators tumor necrosis factor-α, inducible nitric oxide synthase, and cyclooxygenase-2 by 60%, 130%, and 80%, respectively, and reduced the expression of the anti-inflammatory cytokine interleukin-10 by 30% in the PFC. The resulting neuroinflammatory response was associated with memory impairment during adulthood.25 Dose constitutes an additional important variable to consider. Most studies describe detrimental effects of e178 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 Figure. Effect of Δ9-tetrahydrocannabinol (THC) on different neurobiological processes. The effect of THC on the brain constitutes a continuum throughout the lifetime of an individual. However, 2 windows of brain vulnerability have been identified in preclinical models. The colored boxes represent the different processes that have been demonstrated to be affected on exposure to THC during these sensitive developmental periods. PFC indicates prefrontal cortex. THC in models of heavy cannabis use in middle adolescence. However, even lower doses may produce these same effects when administered earlier in adolescence.22 EFFECT OF PRENATAL EXPOSURE TO CANNABINOID AGONISTS A recent study examined associations between prenatal cannabis exposure (PCE) and various indicators of mental and neurocognitive health in a sample of 11489 youth.26 Self-report of maternal cannabis use during pregnancy was associated with various adverse outcomes among youth at 9 to 10 years of age, including poorer performance on tests of neurocognitive functioning and total intracranial volumes, even after controlling for potential confounders. Several reviews describe PCE sequelae in preclinical models.8,24,27–30 Here, we focus on mechanistic insights inferred from animal studies recapitulating the neuropsychiatric features of clinical outcomes.31 The detrimental effect of PCE on cognitive processing and emotional regulation of the progeny has been ascribed to changes in intrinsic and synaptic properties and plasticity of cortical (eg, PFC), limbic (eg, amygdala, hippocampus), and midbrain (eg, ventral tegmentum) regions. Changes in the balance of excitatory and inhibitory input strength, along with alterations in how principal neurons and interneurons receive, integrate, and convey information, have been observed in these neuroanatomic areas (Figure).8,24,27–30 Aberrant glutamatergic function is a common hallmark, as indexed by changes in the expression and function of ionotropic and metabotropic receptors and in dynamic regulation of glutamate levels by glutamate transporters at both synaptic cleft and extrasynaptic spaces. These changes depend largely on the alterations of endocannabinoid signaling pathways caused by exogenous cannabinoids during development and throughout ontogenesis (eg, neural proliferation, survival, directional axonal growth).8,24,27–30 Defects in ECS function also may account for the interneuronopathy observed in many brain regions of PCE offspring, a phenomenon often more prominent in female than in male animals.8,27–29 In the PFC, this persistent inhibitory circuit deficit also is associated with a delayed switch of GABA from its excitatory role early in development to a classic inhibitory function exerted throughout the central nervous system later in life.8,29 This is particularly relevant because the GABA switch represents a critical milestone during neurodevelopment. Any alteration in the normal and predictable temporal sequence of these periods such as delays, stalls, or accelerations imposed by PCE may lead to perturbations of offspring cognitive processing and emotional behavior.8,29 It was observed that marijuana use leads to dysregulation of monoaminergic pathways and stress response systems.8,27–29 PCE hampers the maturation of mono- amines, which also exert trophic actions on target neurons and afferent terminals. This phenomenon may depend on epigenetic modifications and may be implicated in aberrant reward signaling. Furthermore, PCE is associated with an endophenotype in the offspring, which displays protracted dysregulation of stress responsivity that is not explained by glucocorticoid levels. A susceptibility to acute and chronic stress is tied to many psychiatric disorders, ranging from depressed mood and psychosis to substance use disorders and anxiety. A deeper understanding of how PCE interferes with endocannabinoid signaling during neurodevelopment would allow us to explore potential interventions aimed at restoring or reprogramming the hierarchical progression of developmental milestones. EFFECTS OF MARIJUANA USE ON HUMAN COGNITION Acute intoxication from marijuana is associated with impairment of working and episodic memory, behavioral disinhibition, and impulsivity, which can affect performance in real-world activities.6 For example, a meta-analysis from 2016 showed that the odds of being involved in a motor vehicle accident was increased 36% in cannabis users relative to nonusers.32 In addition, a crossover clinical trial published in 2020 investigated the effect of different cannabis products in relation to on-road driving tests. The SD of lateral position, a measure of lane weaving, swerving, and overcorrection, was 20.29 cm at 40 to 100 minutes after inhalation of THC-dominant cannabis and 21.09 cm after inhalation of a mixture of THC and CBD. It is interesting to note that the SD of lateral position after inhalation of CBD-dominant cannabis was similar to that in the placebo group (18.21 cm versus 18.26 cm).33 These observations illustrate the differential short- term effect of THC and CBD on cognition. Evidence also suggests that the short-term effects of cannabinoids are transient and can be influenced by the development of tolerance and the use of other drugs. The long-term effect of cannabis on cognition, however, is less well established. Recent meta-analyses report residual effects of cannabis use on neurocognition, consistent with prior research.34 A meta-analysis by Lovell et al35 in 2020 focused on adult near-daily cannabis use for >2 years and found global neurocognition among users (n=849) to be about one-quarter of an SD worse than that of nonusers (n=764). Four of the 7 domains investigated (decision-making, verbal learning, retention, executive function) showed significant effect sizes ranging from Hedges g=−0.52 to −0.18. A meta- analysis of cannabis users <26 years of age (n=2152) and nonusers (n=6575) also showed a one-quarter of an SD difference in global neurocognitive performance but with more specific domains affected,36 albeit with smaller effect size compared with that found by Lovell et al.35 Both lacked support for worse neurocognition in early adolescence in that neither found that age at onset of cannabis use influenced the association between exposure and cognitive performance. In contrast to these meta-analyses, large longitudinal studies provide stronger causal inferences by examining change over time. In the CARDIA study (Coronary Artery Risk Development in Young Adults), 3385 participants 18 to 30 years of age were followed up longitudinally. Marijuana use was assessed periodically in the 25-year follow-up. In addition, cognitive assessment was completed 25 years after inception. In this study, cumulative years of exposure to marijuana was associated with worse verbal memory (0.13 lower SD in the verbal memory test for each additional 5 years of exposure to marijuana).37 Longitudinal co-twin studies use a research design that additionally controls for shared variance from genetic and environmental factors. Two large longitudinal twin studies (n=3066) with neurocognitive measures collected before (at 9–12 years of age) and after (17–20 years of age) cannabis exposure reported that declines in vocabulary and general knowledge were associated with being a cannabis user but not with amount of cannabis consumed. 38 Twins discordant for cannabis use showed no differences in IQ declines. Thus, differences were likely caused by shared risk factors. Using a similar design, Meier et al39 reported that lower IQ predated cannabis use with no evidence of actual IQ declines among 1989 twins assessed at 5, 12, and 18 years of age. Ross et al40 evaluated other aspects of neurocognition among 856 individual twins and reported only 1 within-family effect of 70 tested. Specifically, frequency of cannabis use at 17 years of age was associated with poorer executive functioning at 23 years of age, but executive functioning problems predating cannabis use could not be ruled out. Magnetic resonance imaging (MRI) techniques demonstrate differential associations of cannabis use with brain structure and function. In terms of brain structure, alterations related to cannabis use have been mixed. In a longitudinal study including 1598 MRIs done in adolescents at baseline and the 5-year follow-up, a dose- dependent association was observed between cannabis use and PFC thinning.41 On the other hand, although a meta-analysis found that regular cannabis consumption was associated with smaller hippocampal (standardized mean difference, 0.14 [95% CI, 0.02–0.27]), medial orbitofrontal cortex (standardized mean difference, 0.30 [95% CI, 0.15–0.45]), and lateral orbitofrontal cortex (standardized mean difference, 0.19 [95% CI, 0.07–0.32]) volumes relative to nonuse, brain volumes were not associated with cannabis use duration and dosage. 42 Other large studies have reported null effects. In 2 e180 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 large twin samples from the United States (n=474) and Australia (n=622), cannabis use was unrelated to volumes of the thalamus, caudate nucleus, putamen, pallidum, hippocampus, amygdala, and nucleus accumbens.43 A multisite study of cortical surface measures (n=262) reported no difference in cortical thickness, surface area, and gyrification index in cannabis users versus nonusers, in cannabis dependence versus nondependence versus nonusers, and in early adolescent versus late adolescent onset of cannabis use versus nonuse.44 Thus, brain structural abnormalities related to cannabis use are inconsistent. Functional MRI studies report more robust effects, particularly after prolonged cannabis use. A meta-analysis of task-based functional MRI studies in current adult and adolescent users found abnormalities in activation in both age groups. Relative to nonusing control subjects, adult cannabis users had greater brain activation in the superior (seed-based d mapping [SDM-Z], 1.561; P<0.002) and posterior (SDM-Z, 1.479; P<0.003) transverse temporal and inferior frontal gyri (SDM-Z, 1.568; P<0.002) and less activation in the striatum (SDM-Z, −1.843; P<0.001), insula (SDM-Z, −1.637; P<0.001), and middle frontal gyrus across different tasks. Adolescent cannabis users also had greater activation in the inferior parietal gyrus (SDM-Z, 1.06; P<0.001) and putamen (SDM-Z, 1.008; P<0.001) compared with nonusers across various tasks, suggesting compensatory neuroadaptive mechanisms.45 These functional abnormalities persist despite cessation of cannabis use and beyond the period when THC metabolites are detectable. A meta-analysis of the same adolescent studies found that >25-day abstinent adolescent cannabis users exhibited greater activation in the right inferior frontal gyrus in addition to other areas relevant for executive functioning and self-regulatory mechanisms.46 Several recent studies examined cannabis effects in populations with premorbid clinical risk factors and those using medical marijuana. A meta-analysis focused only on cannabis users with psychosis <25 years of age (n=529) and nonusing control subjects with psychosis (n=901). In this study, there were significant differences in 3 of 11 domains assessed (premorbid IQ, Hedges g=0.40 [standardized effect size]; current IQ, Hedges g=−0.17; working memory, Hedges g=−0.76).47 Among a sample of 215 adult patients with chronic pain provided daily herbal cannabis containing 12.5% THC for 1 year, no significant neurocognitive differences were found compared with 216 control subjects.48 This is in line with a study of patients with multiple sclerosis in response to oral dronabinol that found no significant differences in MRI-derived measures, including annual percentage of brain volume change and occurrence of new lesions, after 12 months of use.49 These clinical trials suggest no significant adverse effect of THC on neurocognitive symptoms in specific clinical populations. EFFECTS OF MARIJUANA USE ON CEREBROVASCULAR RISK AND DISEASE Cerebrovascular Risk Factors Similar to the literature linking marijuana use with cardiovascular outcomes,10 evidence that marijuana consumption increases the prevalence of specific cerebrovascular risk factors and disease is limited by a preponderance of observational studies, cross-sectional studies, case reports, and case series prone to potential publication and other biases. Postulated adverse effects of marijuana use may include sympathetic nervous system activation, blood pressure changes, platelet activation, and electrophysiological effects.50–52 Concomitant tobacco smoking and other substance use and abuse possibly contribute to these effects, which may be short term and have been studied mostly in low-risk populations such as younger adults. These factors may explain why many longitudinal studies linking marijuana use and cardiovascular or metabolic risk factors have been negative after multivariable adjustment for unhealthy behaviors such as diet and tobacco smoking.53–55 Hypertension, in particular, is an important risk factor for ischemic stroke, hemorrhagic stroke, and subarachnoid hemorrhage. With marijuana use, the most common acute reaction in humans is a decrease in blood pressure resulting from cannabinoid effects on the vasculature and autonomic nervous system.52 Despite this physiological reaction, limited studies using the National Health and Nutrition Examination Survey showed a modest association of recent cannabis use with higher systolic blood pressure and higher prevalence of hypertension among current users 30 to 59 years of age.56 Heavy users, defined as use of marijuana or hashish in >20 of the past 30 days, had higher odds of abnormal blood pressure compared with never-users. Although this difference remained statistically significant after adjustment for age, sex, race, ethnicity, body mass index, education, and survey year, it was no longer statistically significant after additional adjustment for current tobacco and binge alcohol use (adjusted odds ratio, 1.47 [95% CI, 0.99–2.16]).57 The relationship between marijuana use and elevated blood pressure, especially among heavy users, may drive longer-term associations with cerebrovascular outcomes, although this mechanism remains to be studied. Prior cardiovascular disease such as myocardial infarction (MI) or atrial fibrillation (AF) is also an important risk factor for stroke.58 Case reports of MI after marijuana use are mainly among young adults who lack vascular risk factors, with onset of MI shortly after use.59 Risk of MI was elevated 4.8-fold within an hour after smoking marijuana compared with periods of nonuse. This association demonstrates the potential role of marijuana as an acute trigger for cardiovascular disease.60 Over 25 years of follow-up, among 5113 adult participants in Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e181 the Coronary Artery Risk Development in Young Adults study, cumulative or recent marijuana use was not associated with coronary heart disease, stroke, or cardiovascular disease mortality.61 This finding contrasts with a population-based, multi-institutional database study that observed an increased risk of 3-year cumulative incidence of MI among marijuana users compared with control subjects (1.37% vs 0.54%; relative risk, 2.54 [95% CI, 2.45–2.61]).62 Similarly, marijuana use appears to be a trigger for AF. Data from the Nationwide Inpatient Sample show that the percentage of individuals with cannabis use disorder discharged in the postlegalization period (2010–2014) with the diagnosis of arrhythmia increased 31%.63 However, in a study of patients hospitalized for heart failure, marijuana users had a reduced odds of AF compared with nonusers (adjusted odds ratio, 0.87 [95% CI, 0.77–0.98]).50 Simultaneous use of cocaine, stimulants, and other drugs may be responsible for observations of AF among marijuana users, although this remains to be fully studied outside of observational and cross-sectional reports. Risk of Stroke and Transient Ischemic Attack Several case reports and case series mostly in young individuals suggest a relationship between recent and heavy cannabis use and risk of stroke.64–66 In contrast, and as reviewed below, findings among case-control studies,67 population-based studies,68 and studies conducted using outpatient69,70 or inpatient71,72 national databases or hospital electronic health records73 have been equivocal, depending on the study design, covariates considered in the analysis, and source of the population being studied. Inconsistent associations also can be attributable to the presence of comparison groups and whether adjustment of other important risk factors was considered, along with attention to potential confounding by other risk factor and lifestyle features between cannabis users and nonusers. In 1 case-control study using cannabis urine screens to identify cannabis users, the authors found an association between cannabis use and the risk of ischemic stroke and transient ischemic attack, but the association was not significant when tobacco use was included as a covariate (adjusted odds ratio, 1.59 [95% CI, 0.71– 3.70]) among subjects 18 to 55 years of age with and without stroke.67 Similarly, after adjustment for cigarette smoking and alcohol use, another study found no association between cannabis use in young adulthood and the occurrence of fatal and nonfatal stroke later in life among Swedish men in up to 38 years of follow-up.68 Data from studies that have examined more specifically the dose or amount of cannabis consumed within a designated time frame suggest that regular cannabis use may increase the risk of stroke. Using data from population-based surveys, investigators have reported that when no cannabis use was compared with heavy cannabis use in the past year, cannabis use was associated with an increased risk for the occurrence of nonfatal stroke and transient ischemic attack.70 Similarly, another study found that recent (within the past 30 days) and frequent (>10 d/mo) cannabis use was associated with increased risk for the occurrence of stroke compared with nonuse, whereas less frequent cannabis use (≤10 d/mo or less than weekly in the past year) was not associated with increased risk.69,70 Using several International Classification of Diseases, Ninth Revision, Clinical Modification codes for marijuana use, a Nationwide Inpatient Sample study found that cannabis use among men and women hospitalized between 2004 and 2011 was associated with a 17% increased relative risk for acute ischemic stroke in a multivariable-adjusted analysis. Concomitant use of tobacco with cannabis increased the risk to 31%.71 Similarly, a separate study using the Nationwide Inpatient Sample but between 2009 and 2010 observed a higher odds of stroke among cannabis users (odds ratio, 1.24 [95% CI, 1.14–1.34]).72 In contrast, investigators using electronic health record data from patients admitted to a single center between 2015 and 2017 found that testing positive for cannabis use was not associated with the risk of ischemic stroke compared with testing negative, even after adjustment for numerous confounders, including age, cigarette smoking, and comorbidities.73 There may be certain populations or scenarios in which cannabis use can be meaningfully linked to stroke. A study of a large longitudinal cohort of Canadian pregnant women that included >1 million participants between 1989 and 2019 with follow-up at 30 years observed that cannabis use disorder was associated with a doubling of risk for hemorrhagic stroke (hazard ratio, 2.08 [95% CI, 1.07–4.05]) but no increased risk for ischemic or other cerebrovascular disease.74 Because of the theoretical vasoactive effect of cannabis, its use has been implicated in some cases of reversible cerebral vasoconstriction syndrome, with 6 of 24 nonidiopathic reversible cerebral vasoconstriction syndrome cases at a Colorado stroke center attributed to marijuana use.75 In addition, an elevated risk of stroke from intracranial arterial stenosis has been described among young cannabis users 18 to 45 years of age wherein vasospasm or reversible cerebral vasoconstriction syndrome may be a potential mechanism. 76 Studies done in experimental models have shown that cannabinoids exert complex effects on cardiac contractility, vascular tone, and atherogenesis. Both vasodilatation and vasoconstriction responses were observed, depending on the experimental model and cannabinoid used. CB1 activation promotes inflammation, upregulates the production of reactive oxygen species, and activates proapoptotic pathways in endothelial cells and cardiomyocytes. In addition, it induces endothelial dysfunction and vascular smooth muscle cell proliferation and migration. These processes have been linked to cardiac dysfunction e182 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 and the development of atherosclerosis.52 This is in contrast to the atheroprotective role associated with CB2. Acute cardiovascular events and stroke also have been reported in patients using synthetic cannabinoids.77 Spice is associated with idiopathic thrombocytopenic purpura, which increases the risk of major hemorrhage.78 In addition, intracranial hemorrhage in Spice users has been linked to the presence of brodifacoum, an adulterant considered a superwarfarin.79 EDUCATION AND FUTURE DIRECTIONS Our understanding of the ramifications of cannabis consumption on brain health is limited but rapidly evolving. Observational studies have produced conflicting results in relation to the effect of marijuana on different outcomes of interest, including hypertension, AF, MI, and cognition. Several methodological factors may explain these apparent contradictions. First, given its historical classification as an illicit drug, the use of marijuana has been underreported for generations. The inclusion of marijuana users in the control group of observational studies that rely on self-reported use could underestimate its effect on brain health. Second, several behaviors such as smoking and alcohol use are associated with marijuana consumption and can influence stroke risk and brain connectivity.80,81 The often missing information on frequency of exposure to these factors limits our ability to determine with accuracy the independent effect of marijuana. Third, the time of exposure, frequency of use, and bioavailability of marijuana, which is affected by the route of administration, diet, and concomitant use of medications that may affect its metabolism, are reported inconsistently.10 Fourth, THC and CBD have different pharmacological effects. Although the use of THC has been associated with detrimental effects, CBD appears to have therapeutic potential in some neurologic disorders.9 The absolute and relative concentrations of these compounds differ according to the strain of cannabis plant and the methodology used to extract the active ingredients.82 Fifth, the gradual increase in the potency of marijuana used recreationally limits the relevance of older studies.5 Sixth, different factors impede the development of long-term placebo-controlled studies, including ethical reasons and the psychotropic effect of THC, which cannot be blinded. Social media may emphasize a beneficial role for marijuana, and the general population may perceive it as a harmless drug. However, the emerging evidence linking marijuana use to cardiovascular events and stroke, as well as the potential and demonstrated drug-to-drug interactions between marijuana and medications commonly used in the general population, calls for caution and highlights the potential importance of active surveillance programs.10,83 In addition, the high density of cannabinoid receptors in areas involved in executive function and memory, the dose-dependent detrimental effect of THC on working and episodic memory, and the role of Table 2. Key Summary Points Section Notes Actions of THC disrupts endocannabinoid signaling pathways and Cannabis affects synaptic plasticity. In the short term, this affects the in Animal strength of interneuronal connections; in the long term, it Models leads to changes in the functioning of neuronal networks. Exposure to THC during adolescence can lead to structural, molecular, and functional alterations of brain circuits, particularly in areas involved in cognition and behavior. Effect of In preclinical models, THC disrupts the normal signaling Prenatal of the endocannabinoid system during development and Exposure to throughout ontogenesis and results in abnormal neurotrans- Cannabinoid mission. Agonist Prenatal THC affects neuroanatomic areas associated with cognition and emotional regulation, including the PFC, limbic system, and ventral tegmentum of the midbrain. Effects of Acute intoxication with marijuana affects memory, behavior, Marijuana Use and impulsivity. on Human The long-term effect of cannabis on cognition may be Cognition domain specific. Neuroimaging studies have shown structural changes in cannabis users; however, the results are inconsistent. Functional changes may be observed in areas of the brain involved in cognition among cannabis users. Early exposure to cannabis may have a negative effect on cognitive function. Effects of Several studies have described an association between Marijuana cannabis use and increased risk of stroke. Use on Data from population survey studies indicate that the pat- Cerebrovastern (heavy vs less) and frequency (>10 d/mo) of cannabiscular Risk and use may increase the risk of stroke. Disease Cigarette smoking is common in cannabis users and may be an important modifier or confounder of the relationship between cannabis use and stroke risk. Given the potential role of cannabis as a vasoactive substance and its potential role in cardiac pathology and atherosclerosis development, cannabis use also may increase stroke risk via reversible cerebral vasoconstriction syndromes or may indirectly increase stroke risk. It is possible that differences among some study findings may be attributable to the years in which population cohorts were studied or recruited because most population cohorts were assembled before 2012. Over the past decade, strains of cannabis have been evolving, resulting in plants with high THC concentrations and some preparations that may have synthetic cannabinoids such as Spice, which may influence the association of cannabis use with stroke. Education The cumulative evidence collected in clinical and preclinical and Future studies suggests that the consumption of marijuana can have Directions a detrimental effect on brain health. The exact ramifications, however, have not been precisely established. Emerging evidence questions the widely accepted belief that marijuana is innocuous and suggests that cannabis, particularly THC, negatively affects brain health through direct and indirect mechanisms. Health care professionals and consumers should receive education on the potential beneficial and harmful effects associated with the use of marijuana, including the increased risk of stroke and cognitive decline. CBD indicates cannabidiol; PFC, prefrontal cortex; and THC, Δ9-tetrahydrocannabinol. cannabinoid-associated biochemical pathways on synaptic plasticity and neuronal development raise concern that long-term exposure to marijuana may affect brain health. There is lack of agreement on whether the effects of Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e183 marijuana resolve completely after months of abstinence. However, the disruption of endocannabinoid signaling pathways during the prenatal and perinatal periods and in adolescence may be detrimental to neurodevelopment. 6,8,9 Key points discussed in this scientific statement are summarized in Table 2. It should be noted that the overarching goal of this scientific statement was to discuss mechanisms by which marijuana use could influence brain health. However, as the field is developing, several important aspects require additional research. As an example, there is limited information comparing the differential effect of recreational, illicit, and medicinal uses of marijuana, as well as the type of cannabis product consumed. Similarly, the modulatory effects of social determinants of health and race and ethnicity on the interaction of brain health and marijuana use are largely unexplored. The latter area of research may be particularly important because communities of color in the United States may be disproportionately affected by natural and synthetic cannabinoids in relation to use and exposure and the legal implications of criminalization of marijuana.84 Public health efforts should be considered to raise awareness about the potential negative effects associated with the use of marijuana in the general population. Possible strategies include the use of standardized concentrations of biologically active components and health warning labels on available formulations. In addition, the use of marijuana should be individualized and closely monitored. Health care professionals and patients should receive unbiased education about the potential consequences of medicinal, recreational, and illicit marijuana use on brain health, particularly when the exposure occurs during vulnerable vital periods. It also may be important for professionals to monitor cognitive performance of Disclosures Writing Group Disclosures marijuana users and to review their medications to identify potential drug-to-drug interactions. Knowledgeable health care professionals will be able to properly educate potential or active marijuana users about its possible adverse effects, empowering them to make an informed decision that is based on unbiased data. ARTICLE INFORMATION The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on July 29, 2021, and the American Heart Association Executive Committee on September 5, 2021. A copy of the document is available at https://professional.heart.org/statements by using either “Search for Guidelines & Statements” or the “Browse by Topic” area. To purchase additional reprints, call 215-356-2721 or email [email protected]. The American Heart Association requests that this document be cited as follows: Testai FD, Gorelick PB, Aparicio HJ, Filbey FM, Gonzalez R, Gottesman RF, Melis M, Piano MR, Rubino T, Song SY; on behalf of the American Heart Association Stroke Brain Health Science Subcommittee of the Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease. Use of marijuana: effect on brain health: a scientific statement from the American Heart Association. Stroke. 2022;53:e176–e187. doi: 10.1161/STR.0000000000000396 The expert peer review of AHA-commissioned documents (eg, scientific statements, clinical practice guidelines, systematic reviews) is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit https://professional.heart.org/statements. Select the “Guidelines & Statements” drop-down menu, then click “Publication Development.” Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at https://www.heart.org/permissions. A link to the “Copyright Permissions Request Form” appears in the second paragraph (https://www.heart.org/en/aboutus/ statements-and-policies/copyright-request-form). Writing group member Employment Research grant Other research support Speakers’ bureau/ honoraria Expert witness Ownership interest Consultant/ advisory board Other Fernando D. Testai University of Illinois at Chicago None None None None None None None Philip B. Gorelick Northwestern University None None None None None None None Hugo J. Aparicio Boston University School of Medicine None None None None None None None Francesca M. Filbey University of Texas at Dallas Center for Brain Health None None None None None None None Raul Gonzalez Florida International University None None None None None None None Rebecca F. Gottesman National Institutes of Health National Institute of Neurological Disorders and Stroke None None None None None None None Miriam Melis University of Cagliari (Italy) NIH None None None None None None Mariann R. Piano Vanderbilt University School of Nursing None None None None None None None Tiziana Rubino University of Insubria (Italy) None None None None None None None Sarah Y. Song Rush University Medical Center None None None None None None None This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity or owns $10000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition. Modest. e184 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 Reviewer Disclosures Other Speakers’ research bureau/ Expert Ownership Consultant/ Reviewer Employment Research grant support honoraria witness interest advisory board Other Mark J. Alberts Hartford HealthCare None None None None None None None Larry A. Allen University of Colorado PCORI†; NIH NHLBI None None None None Novartis; Boston None School of Medicine (K23 HL105896)†; Scientific†; Cytoki- AHA (grant, SFRN)† netics; Amgen George Howard University of Alabama at Birmingham None None None None None None None Farzaneh A. Sorond Northwestern Univer-None None None None None None None sity, Feinberg School of Medicine This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10 000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition. *Modest. †Significant. REFERENCES 1. United Nations Office on Drugs and Crime. World drug report. 2015. Accessed February 10, 2021. https://www.unodc.org/unodc/en/ index.html 2. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry. 2018;5:987–1012. doi: 10.1016/S2215-0366(18)30337-7 3. US Department of Health and Human Services. 2019 NSDUH annual national report. 2020. 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Castaneira G, Rojas K, Galili Y, Field Z, Perez-Perez A, Madruga M, Carlan SJ. Idiopathic thrombocytopenic purpura induced by synthetic cannabinoid. J Addict Med. 2019;13:235–236. doi: 10.1097/ADM. 0000000000000485 79. Kelkar AH, Smith NA, Martial A, Moole H, Tarantino MD, Roberts JC. An outbreak of synthetic cannabinoid–associated coagulopathy in Illinois. N Engl J Med. 2018;379:1216–1223. doi: 10.1056/NEJMoa1807652 80. Hasin DS, Kerridge BT, Saha TD, Huang B, Pickering R, Smith SM, Jung J, Zhang H, Grant BF. Prevalence and correlates of DSM-5 cannabis use disorder, 2012-2013: findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Am J Psychiatry. 2016;173:588–599. doi: 10.1176/appi.ajp.2015.15070907 81. Vergara VM, Weiland BJ, Hutchison KE, Calhoun VD. The impact of combinations of alcohol, nicotine, and cannabis on dynamic brain connectivity. Neuropsychopharmacology. 2018;43:877–890. doi: 10.1038/npp.2017.280 82. Brunt TM, van Genugten M, Höner-Snoeken K, van de Velde MJ, Niesink RJ. Therapeutic satisfaction and subjective effects of different strains of pharmaceutical-grade cannabis. J Clin Psychopharmacol. 2014;34:344– 349. doi: 10.1097/JCP.0000000000000129 83. Kocis PT, Vrana KE. Delta-9-tetrahydrocannabinol and cannabidiol drug- drug interactions. Med Cannabis Cannabinoids. 2020;3:61–73. doi: 10.1159/000507998 84. Wu LT, Zhu H, Swartz MS. Trends in cannabis use disorders among racial/ ethnic population groups in the United States. Drug Alcohol Depend. 2016;165:181–190. doi: 10.1016/j.drugalcdep.2016.06.002 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e187	Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand. What is the clinical consensus on whether THC affects the brain during adolescence? AHA SCIENTIFIC STATEMENT Use of Marijuana: Effect on Brain Health: A Scientific Statement From the American Heart Association The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Fernando D. Testai, MD, PhD, Chair; Philip B. Gorelick, MD, MPH, Vice Chair; Hugo J. Aparicio, MD, MPH; Francesca M. Filbey, PhD; Raul Gonzalez, PhD; Rebecca F. Gottesman, MD, PhD; Miriam Melis, PhD; Mariann R. Piano, RN, PhD; Tiziana Rubino, PhD; Sarah Y. Song, MD; on behalf of the American Heart Association Stroke Brain Health Science Subcommittee of the Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease ABSTRACT: Marijuana is perceived as a harmless drug, and its recreational use has gained popularity among young individuals. The concentration of active ingredients in recreational formulations has gradually increased over time, and high-potency illicit cannabinomimetics have become available. Thus, the consumption of cannabis in the general population is rising. Data from preclinical models demonstrate that cannabinoid receptors are expressed in high density in areas involved in cognition and behavior, particularly during periods of active neurodevelopment and maturation. In addition, growing evidence highlights the role of endogenous cannabinoid pathways in the regulation of neurotransmitter release, synaptic plasticity, and neurodevelopment. In animal models, exogenous cannabinoids disrupt these important processes and lead to cognitive and behavioral abnormalities. These data correlate with the higher risk of cognitive impairment reported in some observational studies done in humans. It is unclear whether the effect of cannabis on cognition reverts after abstinence. However, this evidence, along with the increased risk of stroke reported in marijuana users, raises concerns about its potential long-term effects on cognitive function. This scientific statement reviews the safety of cannabis use from the perspective of brain health, describes mechanistically how cannabis may cause cognitive dysfunction, and advocates for a more informed health care worker and consumer about the potential for cannabis to adversely affect the brain. Key Words: AHA Scientific Statements ◼ brain ◼ cannabis ◼ cognition ◼ marijuana ◼ stroke M M arijuana, or cannabis, was considered an illicit drug for decades. However, in many parts of the world, cannabis has been legalized for medical use or decriminalized for recreational or medicinal applications. This shift in attitude has resulted in a rapid increase in its use. It has been estimated that ≈183 million people in the world used marijuana in 20141 and that 22 million met criteria for cannabis use disorder in 2016.2 In addition, according to the 2002 to 2019 National Survey on Drug Use and Health, the proportion of the US population >12 years of age who used marijuana in the past year increased gradually from 11% in 2002 to 18% in 2019.3 The use of marijuana has gained popularity, particularly among adolescents and young adults, with ≈36% of 12th graders and 43% of college students reporting having used it in the past year.4 In parallel, evidence suggests that the potency of cannabis products in the United States, measured by the concentration of the primary psychoactive constituent of marijuana, Δ9-tetrahydrocannabinol (THC), has gradually increased from ≈4% in 1995 to 15% in 2018.5 Cannabinoid receptors are expressed in high density in areas of the brain involved in executive function and The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. © 2022 American Heart Association, Inc. e176 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 memory such as the hippocampus, amygdala, and prefrontal cortex (PFC), particularly during periods of active brain development.6 Acute intoxication with cannabinoids can impair memory and behavioral inhibition.7 Cannabinoids also regulate anxiety and can produce psychosis- like effects.6 Evidence shows that age at exposure may influence the effect of cannabinoids on cognitive function. For example, the prenatal, perinatal, and adolescent periods may be particularly sensitive to these compounds.8 Data obtained in preclinical models have shown that cannabis and its associated signaling pathways regulate neurotransmission and play an active role in key cerebral processes, including neuroinflammation, neurogenesis, neural migration, synaptic pruning, and white matter development.6,9 Furthermore, experimental data show that cannabinoids can regulate the functioning of different cytochrome-P450 isoforms and uridine 5′-diphospho-glucuronosyltransferases. Thus, there is a potential risk for drug-to-drug interactions with medications commonly used by the elderly such as warfarin, antiarrhythmic agents, sedatives, and anticonvulsants.10 These factors have raised concerns about the potential effect of cannabis on cognitive vitality. The goal of this scientific statement is to critically appraise the safety of cannabis use from the perspective of brain health. CANNABIS AND ENDOCANNABINOIDS Anandamide and 2-arachidonoyl-glycerol are endogenous bioactive lipids that activate 2 G-protein–coupled receptors designated as cannabinoid receptor type 1 (CB1) and 2 (CB2). These lipids, called endocannabinoids, are not stored in vesicles but are synthesized on demand. The system formed by the cannabinoid receptors CB1 and CB2, endogenous ligands, and enzymes involved in their production and degradation is known as the endocannabinoid system (ECS). A detailed description of the composition and regulation of the ECS is beyond the scope of this publication; this topic has been reviewed extensively elsewhere.9,11,12 Phytocannabinoids are exogenous cannabinoids extracted from flowering plants from the cannabis genus, including Cannabis sativa, Cannabis indica, and Cannabis ruderalis. Whether these are species or subspecies is a matter of debate. More than 100 phytocannabinoids have been extracted from these plants, with THC and cannabidiol (CBD) being the most abundant. The relative concentration of THC and CBD in these strains is variable. In general, cannabis cultivars can be classified according to the cannabinoid produced as chemotype I (THC rich), II (THC/CBD balanced), III (CBD rich), IV (cannabigerol rich), or V (cannabinoid free).13 THC is a psychoactive alkaloid that signals through CB1 and CB2 receptors. Cannabinoid receptor type 1 is expressed abundantly in peripheral and central neural cells. In the periphery, CB1 localizes to sympathetic nerve terminals and sensory neurons. In the central nervous system, it is expressed mainly in presynaptic membranes of excitatory and inhibitory neurons, where it regulates the vesicular release of dopamine, GABA, and glutamate. In comparison, CB2 is expressed mainly in immune cells, including microglia.9 CBD is a nonpsychoactive cannabinoid that has antioxidant and anti-inflammatory properties. It is thought that CBD exerts some of the beneficial effects that phytocannabinoids have in Dravet syndrome and Lennox- Gastaut syndrome. Furthermore, studies done in preclinical models suggest that CBD is beneficial in Alzheimer disease, cerebral ischemia, multiple sclerosis, and other neurologic disorders.9,14 The therapeutic potential of CBD is being investigated in different clinical trials. Compared with THC, CBD signals through different pathways but does not activate CB1 and CB2. At low concentration, CBD blocks the orphan G-protein–coupled receptor-55, the equilibrative nucleoside transporter 1, and the transient receptor potential of melastatin type 8 channel. It also activates the serotonin (5-hydroxytryptamine) 1A receptor, the transient receptor potential of ankyrin type 1 channel, and α3 and α1 glycine receptors. At high concentration, CBD activates the nuclear peroxisome proliferator-activated receptor γ and the transient receptor potential of vanilloid types 1 and 2.12,14 Several cannabinoids have received approval in different countries for the treatment of specific medical conditions. In addition, high-potency synthetic cannabimimetics such as Spice are available in the illegal market (Table 1).15–17 NEUROBIOLOGICAL ACTIONS OF CANNABIS IN ANIMAL MODELS Molecular and cellular mechanisms underlying the effects of cannabis on the developing brain are inferred mainly from preclinical studies that permit controlling for social and environmental factors that could influence outcomes of interest. In addition, animal models allow the investigation of a range of human age-related behavioral factors (eg, novelty and sensation seeking, impulsivity, risk-taking behaviors) and key stages of neurodevelopment that are conserved across many mammalian species. However, many individual (eg, species, strain, age) and experimental (eg, design, drug, dose, delivery, regimen) variables, along with objective end points (eg, behavioral paradigm, experimental technique), have contributed to equivocal findings across studies. Nonetheless, experimental animal models of prenatal and adolescent cannabis exposure have proved fundamental in disclosing the underlying neurobiological mechanisms that might explain several clinical neuropsychiatric outcomes outlined here. Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e177 Table 1. Synthetic and Semisynthetic Cannabinoids Cannabinoid type Active ingredient Indication Medical15,16 Cesamet Nabilone (synthetic THC analog) Treatment of refractory cancer chemotherapy– associated nausea and vomiting† Marinol (pill) Dronabinol (synthetic THC) Anorexia with weight loss in patients with AIDS or cancer† Syndros (solution) Dronabinol (synthetic THC) Treatment of refractory cancer chemotherapy– associated nausea and vomiting† Epidiolex Purified CBD Seizures associated with Lennox- Gastaut syndrome and Dravet syndrome in patients >1 y of age Seizures associated with tuberous sclerosis complex in patients >1 y of age* Sativex Nabiximols (extract of THC, CBD, and other minor cannabinoids, terpenoids, and flavonoids) Adjunctive therapy for symptomatic treatment of refractory spasticity in adult patients with multiple sclerosis indication† Adjunctive treatment for symptomatic neuropathy in adult patients with multiple sclerosis indication† Adjunctive treatment for patients with advanced cancer with refractory severe pain indication† Illicit17 K2, Spice, Kronic, Kaos Originally synthesized to study the endocannabinoid system Bind cannabinoid receptors with high affinity and can cause hallucinations, agitation, psychosis, short-term memory loss, seizures, coagulopathy, and myocardial infarction CBD indicates cannabidiol; and THC, Δ9-tetrahydrocannabinol. Approved by the US Food and Drug Administration. †Approved by the Health Products and Food Branch of Health Canada. Animal models have been used to examine the role of the ECS in the modulation of synaptic plasticity, a process that allows the brain to change and adapt to new information.18 The ECS modulates synaptic plasticity by affecting the strength of interneuronal connections and, ultimately, the functioning of neuronal networks. From the mechanistic standpoint, THC activates cannabinoid receptors in the brain, thus interfering with physiological actions of endocannabinoids. Spatial and time resolution of endocannabinoid production is pivotal for correct processing of different brain functions such as higher-order cognition, memory, reward, mood, and stress sensitiv ity.8,19,20 Consequently, THC, activating nonspecifically CB1 receptors in the brain, disrupts the fine-tuning of synaptic activity exerted by endocannabinoids, eventually impairing connectivity of neuronal networks and brain functionality. Although incompletely understood, the way in which THC disrupts memory and learning may be through its differential effect on neurotransmitter release and binding to CB1 receptors.19 For example, THC activates CB1 receptors located on GABAergic interneurons, which represent nearly three-quarters of the brain CB1 receptors, and astrocytes, resulting in the release of hippocampal glutamate. Concomitantly, THC affects the transmission of other neurotransmitters involved in the modulation of memory such as acetylcholine, adenosine, and serotonin.19,20 Furthermore, THC activation of CB1 receptors present on mitochondria leads to decreased cellular respiration and ATP supply.19 ATP is fundamental in maintaining and regulating neurotransmission, and its reduction might contribute to THC- induced cognitive deficits. Repeated exposure to cannabis, especially during the adolescent developmental period, may be especially harmful to brain health and cause structural, molecular, and functional alterations of brain circuits, particularly in the PFC and hippocampus.8,21,22 Long-term THC exposure induces CB1 receptor downregulation and desensitization that appear more intense and widespread after adolescent exposure as opposed to adulthood exposure. 22 Data obtained in experimental models showed that these effects could have implications for neurodevelopmental processes in which the ECS plays a role. Accordingly, long-term THC exposure during adolescence may disrupt dynamic changes occurring in glutamatergic and GABAergic systems, leading to excessive synaptic pruning (ie, loss of synaptic contacts), long-term dysfunction in prefrontal excitatory/inhibitory balance, and desynchronization of PFC neuronal networks, which also dysregulate the mesolimbic dopaminergic pathway (Figure).23 These changes may represent the molecular underpinnings of cognitive deficits and altered emotional reactivity and social behavior observed long after adolescent long-term THC exposure.22 Long-term changes in brain functionality induced by THC exposure during adolescence might also arise from epigenetic modifications with a marked reprogramming of the transcriptome, affecting mainly genes related to synaptic plasticity processes. 8,19 These effects have not been reported after adult THC exposure.19 In addition to the effects on neuron cellular and sub- cellular components, recent evidence suggests that alterations in glial cells have a key role in the actions of THC.24 Long-term THC exposure activates microglia and astrocytes to produce inflammatory cytokines. For example, long-term administration of THC during adolescence increased the microglial expression of the proinflammatory mediators tumor necrosis factor-α, inducible nitric oxide synthase, and cyclooxygenase-2 by 60%, 130%, and 80%, respectively, and reduced the expression of the anti-inflammatory cytokine interleukin-10 by 30% in the PFC. The resulting neuroinflammatory response was associated with memory impairment during adulthood.25 Dose constitutes an additional important variable to consider. Most studies describe detrimental effects of e178 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 Figure. Effect of Δ9-tetrahydrocannabinol (THC) on different neurobiological processes. The effect of THC on the brain constitutes a continuum throughout the lifetime of an individual. However, 2 windows of brain vulnerability have been identified in preclinical models. The colored boxes represent the different processes that have been demonstrated to be affected on exposure to THC during these sensitive developmental periods. PFC indicates prefrontal cortex. THC in models of heavy cannabis use in middle adolescence. However, even lower doses may produce these same effects when administered earlier in adolescence.22 EFFECT OF PRENATAL EXPOSURE TO CANNABINOID AGONISTS A recent study examined associations between prenatal cannabis exposure (PCE) and various indicators of mental and neurocognitive health in a sample of 11489 youth.26 Self-report of maternal cannabis use during pregnancy was associated with various adverse outcomes among youth at 9 to 10 years of age, including poorer performance on tests of neurocognitive functioning and total intracranial volumes, even after controlling for potential confounders. Several reviews describe PCE sequelae in preclinical models.8,24,27–30 Here, we focus on mechanistic insights inferred from animal studies recapitulating the neuropsychiatric features of clinical outcomes.31 The detrimental effect of PCE on cognitive processing and emotional regulation of the progeny has been ascribed to changes in intrinsic and synaptic properties and plasticity of cortical (eg, PFC), limbic (eg, amygdala, hippocampus), and midbrain (eg, ventral tegmentum) regions. Changes in the balance of excitatory and inhibitory input strength, along with alterations in how principal neurons and interneurons receive, integrate, and convey information, have been observed in these neuroanatomic areas (Figure).8,24,27–30 Aberrant glutamatergic function is a common hallmark, as indexed by changes in the expression and function of ionotropic and metabotropic receptors and in dynamic regulation of glutamate levels by glutamate transporters at both synaptic cleft and extrasynaptic spaces. These changes depend largely on the alterations of endocannabinoid signaling pathways caused by exogenous cannabinoids during development and throughout ontogenesis (eg, neural proliferation, survival, directional axonal growth).8,24,27–30 Defects in ECS function also may account for the interneuronopathy observed in many brain regions of PCE offspring, a phenomenon often more prominent in female than in male animals.8,27–29 In the PFC, this persistent inhibitory circuit deficit also is associated with a delayed switch of GABA from its excitatory role early in development to a classic inhibitory function exerted throughout the central nervous system later in life.8,29 This is particularly relevant because the GABA switch represents a critical milestone during neurodevelopment. Any alteration in the normal and predictable temporal sequence of these periods such as delays, stalls, or accelerations imposed by PCE may lead to perturbations of offspring cognitive processing and emotional behavior.8,29 It was observed that marijuana use leads to dysregulation of monoaminergic pathways and stress response systems.8,27–29 PCE hampers the maturation of mono- amines, which also exert trophic actions on target neurons and afferent terminals. This phenomenon may depend on epigenetic modifications and may be implicated in aberrant reward signaling. Furthermore, PCE is associated with an endophenotype in the offspring, which displays protracted dysregulation of stress responsivity that is not explained by glucocorticoid levels. A susceptibility to acute and chronic stress is tied to many psychiatric disorders, ranging from depressed mood and psychosis to substance use disorders and anxiety. A deeper understanding of how PCE interferes with endocannabinoid signaling during neurodevelopment would allow us to explore potential interventions aimed at restoring or reprogramming the hierarchical progression of developmental milestones. EFFECTS OF MARIJUANA USE ON HUMAN COGNITION Acute intoxication from marijuana is associated with impairment of working and episodic memory, behavioral disinhibition, and impulsivity, which can affect performance in real-world activities.6 For example, a meta-analysis from 2016 showed that the odds of being involved in a motor vehicle accident was increased 36% in cannabis users relative to nonusers.32 In addition, a crossover clinical trial published in 2020 investigated the effect of different cannabis products in relation to on-road driving tests. The SD of lateral position, a measure of lane weaving, swerving, and overcorrection, was 20.29 cm at 40 to 100 minutes after inhalation of THC-dominant cannabis and 21.09 cm after inhalation of a mixture of THC and CBD. It is interesting to note that the SD of lateral position after inhalation of CBD-dominant cannabis was similar to that in the placebo group (18.21 cm versus 18.26 cm).33 These observations illustrate the differential short- term effect of THC and CBD on cognition. Evidence also suggests that the short-term effects of cannabinoids are transient and can be influenced by the development of tolerance and the use of other drugs. The long-term effect of cannabis on cognition, however, is less well established. Recent meta-analyses report residual effects of cannabis use on neurocognition, consistent with prior research.34 A meta-analysis by Lovell et al35 in 2020 focused on adult near-daily cannabis use for >2 years and found global neurocognition among users (n=849) to be about one-quarter of an SD worse than that of nonusers (n=764). Four of the 7 domains investigated (decision-making, verbal learning, retention, executive function) showed significant effect sizes ranging from Hedges g=−0.52 to −0.18. A meta- analysis of cannabis users <26 years of age (n=2152) and nonusers (n=6575) also showed a one-quarter of an SD difference in global neurocognitive performance but with more specific domains affected,36 albeit with smaller effect size compared with that found by Lovell et al.35 Both lacked support for worse neurocognition in early adolescence in that neither found that age at onset of cannabis use influenced the association between exposure and cognitive performance. In contrast to these meta-analyses, large longitudinal studies provide stronger causal inferences by examining change over time. In the CARDIA study (Coronary Artery Risk Development in Young Adults), 3385 participants 18 to 30 years of age were followed up longitudinally. Marijuana use was assessed periodically in the 25-year follow-up. In addition, cognitive assessment was completed 25 years after inception. In this study, cumulative years of exposure to marijuana was associated with worse verbal memory (0.13 lower SD in the verbal memory test for each additional 5 years of exposure to marijuana).37 Longitudinal co-twin studies use a research design that additionally controls for shared variance from genetic and environmental factors. Two large longitudinal twin studies (n=3066) with neurocognitive measures collected before (at 9–12 years of age) and after (17–20 years of age) cannabis exposure reported that declines in vocabulary and general knowledge were associated with being a cannabis user but not with amount of cannabis consumed. 38 Twins discordant for cannabis use showed no differences in IQ declines. Thus, differences were likely caused by shared risk factors. Using a similar design, Meier et al39 reported that lower IQ predated cannabis use with no evidence of actual IQ declines among 1989 twins assessed at 5, 12, and 18 years of age. Ross et al40 evaluated other aspects of neurocognition among 856 individual twins and reported only 1 within-family effect of 70 tested. Specifically, frequency of cannabis use at 17 years of age was associated with poorer executive functioning at 23 years of age, but executive functioning problems predating cannabis use could not be ruled out. Magnetic resonance imaging (MRI) techniques demonstrate differential associations of cannabis use with brain structure and function. In terms of brain structure, alterations related to cannabis use have been mixed. In a longitudinal study including 1598 MRIs done in adolescents at baseline and the 5-year follow-up, a dose- dependent association was observed between cannabis use and PFC thinning.41 On the other hand, although a meta-analysis found that regular cannabis consumption was associated with smaller hippocampal (standardized mean difference, 0.14 [95% CI, 0.02–0.27]), medial orbitofrontal cortex (standardized mean difference, 0.30 [95% CI, 0.15–0.45]), and lateral orbitofrontal cortex (standardized mean difference, 0.19 [95% CI, 0.07–0.32]) volumes relative to nonuse, brain volumes were not associated with cannabis use duration and dosage. 42 Other large studies have reported null effects. In 2 e180 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 large twin samples from the United States (n=474) and Australia (n=622), cannabis use was unrelated to volumes of the thalamus, caudate nucleus, putamen, pallidum, hippocampus, amygdala, and nucleus accumbens.43 A multisite study of cortical surface measures (n=262) reported no difference in cortical thickness, surface area, and gyrification index in cannabis users versus nonusers, in cannabis dependence versus nondependence versus nonusers, and in early adolescent versus late adolescent onset of cannabis use versus nonuse.44 Thus, brain structural abnormalities related to cannabis use are inconsistent. Functional MRI studies report more robust effects, particularly after prolonged cannabis use. A meta-analysis of task-based functional MRI studies in current adult and adolescent users found abnormalities in activation in both age groups. Relative to nonusing control subjects, adult cannabis users had greater brain activation in the superior (seed-based d mapping [SDM-Z], 1.561; P<0.002) and posterior (SDM-Z, 1.479; P<0.003) transverse temporal and inferior frontal gyri (SDM-Z, 1.568; P<0.002) and less activation in the striatum (SDM-Z, −1.843; P<0.001), insula (SDM-Z, −1.637; P<0.001), and middle frontal gyrus across different tasks. Adolescent cannabis users also had greater activation in the inferior parietal gyrus (SDM-Z, 1.06; P<0.001) and putamen (SDM-Z, 1.008; P<0.001) compared with nonusers across various tasks, suggesting compensatory neuroadaptive mechanisms.45 These functional abnormalities persist despite cessation of cannabis use and beyond the period when THC metabolites are detectable. A meta-analysis of the same adolescent studies found that >25-day abstinent adolescent cannabis users exhibited greater activation in the right inferior frontal gyrus in addition to other areas relevant for executive functioning and self-regulatory mechanisms.46 Several recent studies examined cannabis effects in populations with premorbid clinical risk factors and those using medical marijuana. A meta-analysis focused only on cannabis users with psychosis <25 years of age (n=529) and nonusing control subjects with psychosis (n=901). In this study, there were significant differences in 3 of 11 domains assessed (premorbid IQ, Hedges g=0.40 [standardized effect size]; current IQ, Hedges g=−0.17; working memory, Hedges g=−0.76).47 Among a sample of 215 adult patients with chronic pain provided daily herbal cannabis containing 12.5% THC for 1 year, no significant neurocognitive differences were found compared with 216 control subjects.48 This is in line with a study of patients with multiple sclerosis in response to oral dronabinol that found no significant differences in MRI-derived measures, including annual percentage of brain volume change and occurrence of new lesions, after 12 months of use.49 These clinical trials suggest no significant adverse effect of THC on neurocognitive symptoms in specific clinical populations. EFFECTS OF MARIJUANA USE ON CEREBROVASCULAR RISK AND DISEASE Cerebrovascular Risk Factors Similar to the literature linking marijuana use with cardiovascular outcomes,10 evidence that marijuana consumption increases the prevalence of specific cerebrovascular risk factors and disease is limited by a preponderance of observational studies, cross-sectional studies, case reports, and case series prone to potential publication and other biases. Postulated adverse effects of marijuana use may include sympathetic nervous system activation, blood pressure changes, platelet activation, and electrophysiological effects.50–52 Concomitant tobacco smoking and other substance use and abuse possibly contribute to these effects, which may be short term and have been studied mostly in low-risk populations such as younger adults. These factors may explain why many longitudinal studies linking marijuana use and cardiovascular or metabolic risk factors have been negative after multivariable adjustment for unhealthy behaviors such as diet and tobacco smoking.53–55 Hypertension, in particular, is an important risk factor for ischemic stroke, hemorrhagic stroke, and subarachnoid hemorrhage. With marijuana use, the most common acute reaction in humans is a decrease in blood pressure resulting from cannabinoid effects on the vasculature and autonomic nervous system.52 Despite this physiological reaction, limited studies using the National Health and Nutrition Examination Survey showed a modest association of recent cannabis use with higher systolic blood pressure and higher prevalence of hypertension among current users 30 to 59 years of age.56 Heavy users, defined as use of marijuana or hashish in >20 of the past 30 days, had higher odds of abnormal blood pressure compared with never-users. Although this difference remained statistically significant after adjustment for age, sex, race, ethnicity, body mass index, education, and survey year, it was no longer statistically significant after additional adjustment for current tobacco and binge alcohol use (adjusted odds ratio, 1.47 [95% CI, 0.99–2.16]).57 The relationship between marijuana use and elevated blood pressure, especially among heavy users, may drive longer-term associations with cerebrovascular outcomes, although this mechanism remains to be studied. Prior cardiovascular disease such as myocardial infarction (MI) or atrial fibrillation (AF) is also an important risk factor for stroke.58 Case reports of MI after marijuana use are mainly among young adults who lack vascular risk factors, with onset of MI shortly after use.59 Risk of MI was elevated 4.8-fold within an hour after smoking marijuana compared with periods of nonuse. This association demonstrates the potential role of marijuana as an acute trigger for cardiovascular disease.60 Over 25 years of follow-up, among 5113 adult participants in Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e181 the Coronary Artery Risk Development in Young Adults study, cumulative or recent marijuana use was not associated with coronary heart disease, stroke, or cardiovascular disease mortality.61 This finding contrasts with a population-based, multi-institutional database study that observed an increased risk of 3-year cumulative incidence of MI among marijuana users compared with control subjects (1.37% vs 0.54%; relative risk, 2.54 [95% CI, 2.45–2.61]).62 Similarly, marijuana use appears to be a trigger for AF. Data from the Nationwide Inpatient Sample show that the percentage of individuals with cannabis use disorder discharged in the postlegalization period (2010–2014) with the diagnosis of arrhythmia increased 31%.63 However, in a study of patients hospitalized for heart failure, marijuana users had a reduced odds of AF compared with nonusers (adjusted odds ratio, 0.87 [95% CI, 0.77–0.98]).50 Simultaneous use of cocaine, stimulants, and other drugs may be responsible for observations of AF among marijuana users, although this remains to be fully studied outside of observational and cross-sectional reports. Risk of Stroke and Transient Ischemic Attack Several case reports and case series mostly in young individuals suggest a relationship between recent and heavy cannabis use and risk of stroke.64–66 In contrast, and as reviewed below, findings among case-control studies,67 population-based studies,68 and studies conducted using outpatient69,70 or inpatient71,72 national databases or hospital electronic health records73 have been equivocal, depending on the study design, covariates considered in the analysis, and source of the population being studied. Inconsistent associations also can be attributable to the presence of comparison groups and whether adjustment of other important risk factors was considered, along with attention to potential confounding by other risk factor and lifestyle features between cannabis users and nonusers. In 1 case-control study using cannabis urine screens to identify cannabis users, the authors found an association between cannabis use and the risk of ischemic stroke and transient ischemic attack, but the association was not significant when tobacco use was included as a covariate (adjusted odds ratio, 1.59 [95% CI, 0.71– 3.70]) among subjects 18 to 55 years of age with and without stroke.67 Similarly, after adjustment for cigarette smoking and alcohol use, another study found no association between cannabis use in young adulthood and the occurrence of fatal and nonfatal stroke later in life among Swedish men in up to 38 years of follow-up.68 Data from studies that have examined more specifically the dose or amount of cannabis consumed within a designated time frame suggest that regular cannabis use may increase the risk of stroke. Using data from population-based surveys, investigators have reported that when no cannabis use was compared with heavy cannabis use in the past year, cannabis use was associated with an increased risk for the occurrence of nonfatal stroke and transient ischemic attack.70 Similarly, another study found that recent (within the past 30 days) and frequent (>10 d/mo) cannabis use was associated with increased risk for the occurrence of stroke compared with nonuse, whereas less frequent cannabis use (≤10 d/mo or less than weekly in the past year) was not associated with increased risk.69,70 Using several International Classification of Diseases, Ninth Revision, Clinical Modification codes for marijuana use, a Nationwide Inpatient Sample study found that cannabis use among men and women hospitalized between 2004 and 2011 was associated with a 17% increased relative risk for acute ischemic stroke in a multivariable-adjusted analysis. Concomitant use of tobacco with cannabis increased the risk to 31%.71 Similarly, a separate study using the Nationwide Inpatient Sample but between 2009 and 2010 observed a higher odds of stroke among cannabis users (odds ratio, 1.24 [95% CI, 1.14–1.34]).72 In contrast, investigators using electronic health record data from patients admitted to a single center between 2015 and 2017 found that testing positive for cannabis use was not associated with the risk of ischemic stroke compared with testing negative, even after adjustment for numerous confounders, including age, cigarette smoking, and comorbidities.73 There may be certain populations or scenarios in which cannabis use can be meaningfully linked to stroke. A study of a large longitudinal cohort of Canadian pregnant women that included >1 million participants between 1989 and 2019 with follow-up at 30 years observed that cannabis use disorder was associated with a doubling of risk for hemorrhagic stroke (hazard ratio, 2.08 [95% CI, 1.07–4.05]) but no increased risk for ischemic or other cerebrovascular disease.74 Because of the theoretical vasoactive effect of cannabis, its use has been implicated in some cases of reversible cerebral vasoconstriction syndrome, with 6 of 24 nonidiopathic reversible cerebral vasoconstriction syndrome cases at a Colorado stroke center attributed to marijuana use.75 In addition, an elevated risk of stroke from intracranial arterial stenosis has been described among young cannabis users 18 to 45 years of age wherein vasospasm or reversible cerebral vasoconstriction syndrome may be a potential mechanism. 76 Studies done in experimental models have shown that cannabinoids exert complex effects on cardiac contractility, vascular tone, and atherogenesis. Both vasodilatation and vasoconstriction responses were observed, depending on the experimental model and cannabinoid used. CB1 activation promotes inflammation, upregulates the production of reactive oxygen species, and activates proapoptotic pathways in endothelial cells and cardiomyocytes. In addition, it induces endothelial dysfunction and vascular smooth muscle cell proliferation and migration. These processes have been linked to cardiac dysfunction e182 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 and the development of atherosclerosis.52 This is in contrast to the atheroprotective role associated with CB2. Acute cardiovascular events and stroke also have been reported in patients using synthetic cannabinoids.77 Spice is associated with idiopathic thrombocytopenic purpura, which increases the risk of major hemorrhage.78 In addition, intracranial hemorrhage in Spice users has been linked to the presence of brodifacoum, an adulterant considered a superwarfarin.79 EDUCATION AND FUTURE DIRECTIONS Our understanding of the ramifications of cannabis consumption on brain health is limited but rapidly evolving. Observational studies have produced conflicting results in relation to the effect of marijuana on different outcomes of interest, including hypertension, AF, MI, and cognition. Several methodological factors may explain these apparent contradictions. First, given its historical classification as an illicit drug, the use of marijuana has been underreported for generations. The inclusion of marijuana users in the control group of observational studies that rely on self-reported use could underestimate its effect on brain health. Second, several behaviors such as smoking and alcohol use are associated with marijuana consumption and can influence stroke risk and brain connectivity.80,81 The often missing information on frequency of exposure to these factors limits our ability to determine with accuracy the independent effect of marijuana. Third, the time of exposure, frequency of use, and bioavailability of marijuana, which is affected by the route of administration, diet, and concomitant use of medications that may affect its metabolism, are reported inconsistently.10 Fourth, THC and CBD have different pharmacological effects. Although the use of THC has been associated with detrimental effects, CBD appears to have therapeutic potential in some neurologic disorders.9 The absolute and relative concentrations of these compounds differ according to the strain of cannabis plant and the methodology used to extract the active ingredients.82 Fifth, the gradual increase in the potency of marijuana used recreationally limits the relevance of older studies.5 Sixth, different factors impede the development of long-term placebo-controlled studies, including ethical reasons and the psychotropic effect of THC, which cannot be blinded. Social media may emphasize a beneficial role for marijuana, and the general population may perceive it as a harmless drug. However, the emerging evidence linking marijuana use to cardiovascular events and stroke, as well as the potential and demonstrated drug-to-drug interactions between marijuana and medications commonly used in the general population, calls for caution and highlights the potential importance of active surveillance programs.10,83 In addition, the high density of cannabinoid receptors in areas involved in executive function and memory, the dose-dependent detrimental effect of THC on working and episodic memory, and the role of Table 2. Key Summary Points Section Notes Actions of THC disrupts endocannabinoid signaling pathways and Cannabis affects synaptic plasticity. In the short term, this affects the in Animal strength of interneuronal connections; in the long term, it Models leads to changes in the functioning of neuronal networks. Exposure to THC during adolescence can lead to structural, molecular, and functional alterations of brain circuits, particularly in areas involved in cognition and behavior. Effect of In preclinical models, THC disrupts the normal signaling Prenatal of the endocannabinoid system during development and Exposure to throughout ontogenesis and results in abnormal neurotrans- Cannabinoid mission. Agonist Prenatal THC affects neuroanatomic areas associated with cognition and emotional regulation, including the PFC, limbic system, and ventral tegmentum of the midbrain. Effects of Acute intoxication with marijuana affects memory, behavior, Marijuana Use and impulsivity. on Human The long-term effect of cannabis on cognition may be Cognition domain specific. Neuroimaging studies have shown structural changes in cannabis users; however, the results are inconsistent. Functional changes may be observed in areas of the brain involved in cognition among cannabis users. Early exposure to cannabis may have a negative effect on cognitive function. Effects of Several studies have described an association between Marijuana cannabis use and increased risk of stroke. Use on Data from population survey studies indicate that the pat- Cerebrovastern (heavy vs less) and frequency (>10 d/mo) of cannabiscular Risk and use may increase the risk of stroke. Disease Cigarette smoking is common in cannabis users and may be an important modifier or confounder of the relationship between cannabis use and stroke risk. Given the potential role of cannabis as a vasoactive substance and its potential role in cardiac pathology and atherosclerosis development, cannabis use also may increase stroke risk via reversible cerebral vasoconstriction syndromes or may indirectly increase stroke risk. It is possible that differences among some study findings may be attributable to the years in which population cohorts were studied or recruited because most population cohorts were assembled before 2012. Over the past decade, strains of cannabis have been evolving, resulting in plants with high THC concentrations and some preparations that may have synthetic cannabinoids such as Spice, which may influence the association of cannabis use with stroke. Education The cumulative evidence collected in clinical and preclinical and Future studies suggests that the consumption of marijuana can have Directions a detrimental effect on brain health. The exact ramifications, however, have not been precisely established. Emerging evidence questions the widely accepted belief that marijuana is innocuous and suggests that cannabis, particularly THC, negatively affects brain health through direct and indirect mechanisms. Health care professionals and consumers should receive education on the potential beneficial and harmful effects associated with the use of marijuana, including the increased risk of stroke and cognitive decline. CBD indicates cannabidiol; PFC, prefrontal cortex; and THC, Δ9-tetrahydrocannabinol. cannabinoid-associated biochemical pathways on synaptic plasticity and neuronal development raise concern that long-term exposure to marijuana may affect brain health. There is lack of agreement on whether the effects of Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e183 marijuana resolve completely after months of abstinence. However, the disruption of endocannabinoid signaling pathways during the prenatal and perinatal periods and in adolescence may be detrimental to neurodevelopment. 6,8,9 Key points discussed in this scientific statement are summarized in Table 2. It should be noted that the overarching goal of this scientific statement was to discuss mechanisms by which marijuana use could influence brain health. However, as the field is developing, several important aspects require additional research. As an example, there is limited information comparing the differential effect of recreational, illicit, and medicinal uses of marijuana, as well as the type of cannabis product consumed. Similarly, the modulatory effects of social determinants of health and race and ethnicity on the interaction of brain health and marijuana use are largely unexplored. The latter area of research may be particularly important because communities of color in the United States may be disproportionately affected by natural and synthetic cannabinoids in relation to use and exposure and the legal implications of criminalization of marijuana.84 Public health efforts should be considered to raise awareness about the potential negative effects associated with the use of marijuana in the general population. Possible strategies include the use of standardized concentrations of biologically active components and health warning labels on available formulations. In addition, the use of marijuana should be individualized and closely monitored. Health care professionals and patients should receive unbiased education about the potential consequences of medicinal, recreational, and illicit marijuana use on brain health, particularly when the exposure occurs during vulnerable vital periods. It also may be important for professionals to monitor cognitive performance of Disclosures Writing Group Disclosures marijuana users and to review their medications to identify potential drug-to-drug interactions. Knowledgeable health care professionals will be able to properly educate potential or active marijuana users about its possible adverse effects, empowering them to make an informed decision that is based on unbiased data. ARTICLE INFORMATION The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on July 29, 2021, and the American Heart Association Executive Committee on September 5, 2021. A copy of the document is available at https://professional.heart.org/statements by using either “Search for Guidelines & Statements” or the “Browse by Topic” area. To purchase additional reprints, call 215-356-2721 or email [email protected]. The American Heart Association requests that this document be cited as follows: Testai FD, Gorelick PB, Aparicio HJ, Filbey FM, Gonzalez R, Gottesman RF, Melis M, Piano MR, Rubino T, Song SY; on behalf of the American Heart Association Stroke Brain Health Science Subcommittee of the Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease. Use of marijuana: effect on brain health: a scientific statement from the American Heart Association. Stroke. 2022;53:e176–e187. doi: 10.1161/STR.0000000000000396 The expert peer review of AHA-commissioned documents (eg, scientific statements, clinical practice guidelines, systematic reviews) is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit https://professional.heart.org/statements. Select the “Guidelines & Statements” drop-down menu, then click “Publication Development.” Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at https://www.heart.org/permissions. A link to the “Copyright Permissions Request Form” appears in the second paragraph (https://www.heart.org/en/aboutus/ statements-and-policies/copyright-request-form). Writing group member Employment Research grant Other research support Speakers’ bureau/ honoraria Expert witness Ownership interest Consultant/ advisory board Other Fernando D. Testai University of Illinois at Chicago None None None None None None None Philip B. Gorelick Northwestern University None None None None None None None Hugo J. Aparicio Boston University School of Medicine None None None None None None None Francesca M. Filbey University of Texas at Dallas Center for Brain Health None None None None None None None Raul Gonzalez Florida International University None None None None None None None Rebecca F. Gottesman National Institutes of Health National Institute of Neurological Disorders and Stroke None None None None None None None Miriam Melis University of Cagliari (Italy) NIH None None None None None None Mariann R. Piano Vanderbilt University School of Nursing None None None None None None None Tiziana Rubino University of Insubria (Italy) None None None None None None None Sarah Y. Song Rush University Medical Center None None None None None None None This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity or owns $10000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition. Modest. e184 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 Reviewer Disclosures Other Speakers’ research bureau/ Expert Ownership Consultant/ Reviewer Employment Research grant support honoraria witness interest advisory board Other Mark J. Alberts Hartford HealthCare None None None None None None None Larry A. Allen University of Colorado PCORI†; NIH NHLBI None None None None Novartis; Boston None School of Medicine (K23 HL105896)†; Scientific†; Cytoki- AHA (grant, SFRN)† netics; Amgen George Howard University of Alabama at Birmingham None None None None None None None Farzaneh A. Sorond Northwestern Univer-None None None None None None None sity, Feinberg School of Medicine This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10 000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition. *Modest. †Significant. REFERENCES 1. United Nations Office on Drugs and Crime. World drug report. 2015. Accessed February 10, 2021. https://www.unodc.org/unodc/en/ index.html 2. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry. 2018;5:987–1012. doi: 10.1016/S2215-0366(18)30337-7 3. US Department of Health and Human Services. 2019 NSDUH annual national report. 2020. 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EVIDENCE: AHA SCIENTIFIC STATEMENT Use of Marijuana: Effect on Brain Health: A Scientific Statement From the American Heart Association The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Fernando D. Testai, MD, PhD, Chair; Philip B. Gorelick, MD, MPH, Vice Chair; Hugo J. Aparicio, MD, MPH; Francesca M. Filbey, PhD; Raul Gonzalez, PhD; Rebecca F. Gottesman, MD, PhD; Miriam Melis, PhD; Mariann R. Piano, RN, PhD; Tiziana Rubino, PhD; Sarah Y. Song, MD; on behalf of the American Heart Association Stroke Brain Health Science Subcommittee of the Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease ABSTRACT: Marijuana is perceived as a harmless drug, and its recreational use has gained popularity among young individuals. The concentration of active ingredients in recreational formulations has gradually increased over time, and high-potency illicit cannabinomimetics have become available. Thus, the consumption of cannabis in the general population is rising. Data from preclinical models demonstrate that cannabinoid receptors are expressed in high density in areas involved in cognition and behavior, particularly during periods of active neurodevelopment and maturation. In addition, growing evidence highlights the role of endogenous cannabinoid pathways in the regulation of neurotransmitter release, synaptic plasticity, and neurodevelopment. In animal models, exogenous cannabinoids disrupt these important processes and lead to cognitive and behavioral abnormalities. These data correlate with the higher risk of cognitive impairment reported in some observational studies done in humans. It is unclear whether the effect of cannabis on cognition reverts after abstinence. However, this evidence, along with the increased risk of stroke reported in marijuana users, raises concerns about its potential long-term effects on cognitive function. This scientific statement reviews the safety of cannabis use from the perspective of brain health, describes mechanistically how cannabis may cause cognitive dysfunction, and advocates for a more informed health care worker and consumer about the potential for cannabis to adversely affect the brain. Key Words: AHA Scientific Statements ◼ brain ◼ cannabis ◼ cognition ◼ marijuana ◼ stroke M M arijuana, or cannabis, was considered an illicit drug for decades. However, in many parts of the world, cannabis has been legalized for medical use or decriminalized for recreational or medicinal applications. This shift in attitude has resulted in a rapid increase in its use. It has been estimated that ≈183 million people in the world used marijuana in 20141 and that 22 million met criteria for cannabis use disorder in 2016.2 In addition, according to the 2002 to 2019 National Survey on Drug Use and Health, the proportion of the US population >12 years of age who used marijuana in the past year increased gradually from 11% in 2002 to 18% in 2019.3 The use of marijuana has gained popularity, particularly among adolescents and young adults, with ≈36% of 12th graders and 43% of college students reporting having used it in the past year.4 In parallel, evidence suggests that the potency of cannabis products in the United States, measured by the concentration of the primary psychoactive constituent of marijuana, Δ9-tetrahydrocannabinol (THC), has gradually increased from ≈4% in 1995 to 15% in 2018.5 Cannabinoid receptors are expressed in high density in areas of the brain involved in executive function and The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. © 2022 American Heart Association, Inc. e176 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 memory such as the hippocampus, amygdala, and prefrontal cortex (PFC), particularly during periods of active brain development.6 Acute intoxication with cannabinoids can impair memory and behavioral inhibition.7 Cannabinoids also regulate anxiety and can produce psychosis- like effects.6 Evidence shows that age at exposure may influence the effect of cannabinoids on cognitive function. For example, the prenatal, perinatal, and adolescent periods may be particularly sensitive to these compounds.8 Data obtained in preclinical models have shown that cannabis and its associated signaling pathways regulate neurotransmission and play an active role in key cerebral processes, including neuroinflammation, neurogenesis, neural migration, synaptic pruning, and white matter development.6,9 Furthermore, experimental data show that cannabinoids can regulate the functioning of different cytochrome-P450 isoforms and uridine 5′-diphospho-glucuronosyltransferases. Thus, there is a potential risk for drug-to-drug interactions with medications commonly used by the elderly such as warfarin, antiarrhythmic agents, sedatives, and anticonvulsants.10 These factors have raised concerns about the potential effect of cannabis on cognitive vitality. The goal of this scientific statement is to critically appraise the safety of cannabis use from the perspective of brain health. CANNABIS AND ENDOCANNABINOIDS Anandamide and 2-arachidonoyl-glycerol are endogenous bioactive lipids that activate 2 G-protein–coupled receptors designated as cannabinoid receptor type 1 (CB1) and 2 (CB2). These lipids, called endocannabinoids, are not stored in vesicles but are synthesized on demand. The system formed by the cannabinoid receptors CB1 and CB2, endogenous ligands, and enzymes involved in their production and degradation is known as the endocannabinoid system (ECS). A detailed description of the composition and regulation of the ECS is beyond the scope of this publication; this topic has been reviewed extensively elsewhere.9,11,12 Phytocannabinoids are exogenous cannabinoids extracted from flowering plants from the cannabis genus, including Cannabis sativa, Cannabis indica, and Cannabis ruderalis. Whether these are species or subspecies is a matter of debate. More than 100 phytocannabinoids have been extracted from these plants, with THC and cannabidiol (CBD) being the most abundant. The relative concentration of THC and CBD in these strains is variable. In general, cannabis cultivars can be classified according to the cannabinoid produced as chemotype I (THC rich), II (THC/CBD balanced), III (CBD rich), IV (cannabigerol rich), or V (cannabinoid free).13 THC is a psychoactive alkaloid that signals through CB1 and CB2 receptors. Cannabinoid receptor type 1 is expressed abundantly in peripheral and central neural cells. In the periphery, CB1 localizes to sympathetic nerve terminals and sensory neurons. In the central nervous system, it is expressed mainly in presynaptic membranes of excitatory and inhibitory neurons, where it regulates the vesicular release of dopamine, GABA, and glutamate. In comparison, CB2 is expressed mainly in immune cells, including microglia.9 CBD is a nonpsychoactive cannabinoid that has antioxidant and anti-inflammatory properties. It is thought that CBD exerts some of the beneficial effects that phytocannabinoids have in Dravet syndrome and Lennox- Gastaut syndrome. Furthermore, studies done in preclinical models suggest that CBD is beneficial in Alzheimer disease, cerebral ischemia, multiple sclerosis, and other neurologic disorders.9,14 The therapeutic potential of CBD is being investigated in different clinical trials. Compared with THC, CBD signals through different pathways but does not activate CB1 and CB2. At low concentration, CBD blocks the orphan G-protein–coupled receptor-55, the equilibrative nucleoside transporter 1, and the transient receptor potential of melastatin type 8 channel. It also activates the serotonin (5-hydroxytryptamine) 1A receptor, the transient receptor potential of ankyrin type 1 channel, and α3 and α1 glycine receptors. At high concentration, CBD activates the nuclear peroxisome proliferator-activated receptor γ and the transient receptor potential of vanilloid types 1 and 2.12,14 Several cannabinoids have received approval in different countries for the treatment of specific medical conditions. In addition, high-potency synthetic cannabimimetics such as Spice are available in the illegal market (Table 1).15–17 NEUROBIOLOGICAL ACTIONS OF CANNABIS IN ANIMAL MODELS Molecular and cellular mechanisms underlying the effects of cannabis on the developing brain are inferred mainly from preclinical studies that permit controlling for social and environmental factors that could influence outcomes of interest. In addition, animal models allow the investigation of a range of human age-related behavioral factors (eg, novelty and sensation seeking, impulsivity, risk-taking behaviors) and key stages of neurodevelopment that are conserved across many mammalian species. However, many individual (eg, species, strain, age) and experimental (eg, design, drug, dose, delivery, regimen) variables, along with objective end points (eg, behavioral paradigm, experimental technique), have contributed to equivocal findings across studies. Nonetheless, experimental animal models of prenatal and adolescent cannabis exposure have proved fundamental in disclosing the underlying neurobiological mechanisms that might explain several clinical neuropsychiatric outcomes outlined here. Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e177 Table 1. Synthetic and Semisynthetic Cannabinoids Cannabinoid type Active ingredient Indication Medical15,16 Cesamet Nabilone (synthetic THC analog) Treatment of refractory cancer chemotherapy– associated nausea and vomiting† Marinol (pill) Dronabinol (synthetic THC) Anorexia with weight loss in patients with AIDS or cancer† Syndros (solution) Dronabinol (synthetic THC) Treatment of refractory cancer chemotherapy– associated nausea and vomiting† Epidiolex Purified CBD Seizures associated with Lennox- Gastaut syndrome and Dravet syndrome in patients >1 y of age Seizures associated with tuberous sclerosis complex in patients >1 y of age* Sativex Nabiximols (extract of THC, CBD, and other minor cannabinoids, terpenoids, and flavonoids) Adjunctive therapy for symptomatic treatment of refractory spasticity in adult patients with multiple sclerosis indication† Adjunctive treatment for symptomatic neuropathy in adult patients with multiple sclerosis indication† Adjunctive treatment for patients with advanced cancer with refractory severe pain indication† Illicit17 K2, Spice, Kronic, Kaos Originally synthesized to study the endocannabinoid system Bind cannabinoid receptors with high affinity and can cause hallucinations, agitation, psychosis, short-term memory loss, seizures, coagulopathy, and myocardial infarction CBD indicates cannabidiol; and THC, Δ9-tetrahydrocannabinol. Approved by the US Food and Drug Administration. †Approved by the Health Products and Food Branch of Health Canada. Animal models have been used to examine the role of the ECS in the modulation of synaptic plasticity, a process that allows the brain to change and adapt to new information.18 The ECS modulates synaptic plasticity by affecting the strength of interneuronal connections and, ultimately, the functioning of neuronal networks. From the mechanistic standpoint, THC activates cannabinoid receptors in the brain, thus interfering with physiological actions of endocannabinoids. Spatial and time resolution of endocannabinoid production is pivotal for correct processing of different brain functions such as higher-order cognition, memory, reward, mood, and stress sensitiv ity.8,19,20 Consequently, THC, activating nonspecifically CB1 receptors in the brain, disrupts the fine-tuning of synaptic activity exerted by endocannabinoids, eventually impairing connectivity of neuronal networks and brain functionality. Although incompletely understood, the way in which THC disrupts memory and learning may be through its differential effect on neurotransmitter release and binding to CB1 receptors.19 For example, THC activates CB1 receptors located on GABAergic interneurons, which represent nearly three-quarters of the brain CB1 receptors, and astrocytes, resulting in the release of hippocampal glutamate. Concomitantly, THC affects the transmission of other neurotransmitters involved in the modulation of memory such as acetylcholine, adenosine, and serotonin.19,20 Furthermore, THC activation of CB1 receptors present on mitochondria leads to decreased cellular respiration and ATP supply.19 ATP is fundamental in maintaining and regulating neurotransmission, and its reduction might contribute to THC- induced cognitive deficits. Repeated exposure to cannabis, especially during the adolescent developmental period, may be especially harmful to brain health and cause structural, molecular, and functional alterations of brain circuits, particularly in the PFC and hippocampus.8,21,22 Long-term THC exposure induces CB1 receptor downregulation and desensitization that appear more intense and widespread after adolescent exposure as opposed to adulthood exposure. 22 Data obtained in experimental models showed that these effects could have implications for neurodevelopmental processes in which the ECS plays a role. Accordingly, long-term THC exposure during adolescence may disrupt dynamic changes occurring in glutamatergic and GABAergic systems, leading to excessive synaptic pruning (ie, loss of synaptic contacts), long-term dysfunction in prefrontal excitatory/inhibitory balance, and desynchronization of PFC neuronal networks, which also dysregulate the mesolimbic dopaminergic pathway (Figure).23 These changes may represent the molecular underpinnings of cognitive deficits and altered emotional reactivity and social behavior observed long after adolescent long-term THC exposure.22 Long-term changes in brain functionality induced by THC exposure during adolescence might also arise from epigenetic modifications with a marked reprogramming of the transcriptome, affecting mainly genes related to synaptic plasticity processes. 8,19 These effects have not been reported after adult THC exposure.19 In addition to the effects on neuron cellular and sub- cellular components, recent evidence suggests that alterations in glial cells have a key role in the actions of THC.24 Long-term THC exposure activates microglia and astrocytes to produce inflammatory cytokines. For example, long-term administration of THC during adolescence increased the microglial expression of the proinflammatory mediators tumor necrosis factor-α, inducible nitric oxide synthase, and cyclooxygenase-2 by 60%, 130%, and 80%, respectively, and reduced the expression of the anti-inflammatory cytokine interleukin-10 by 30% in the PFC. The resulting neuroinflammatory response was associated with memory impairment during adulthood.25 Dose constitutes an additional important variable to consider. Most studies describe detrimental effects of e178 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 Figure. Effect of Δ9-tetrahydrocannabinol (THC) on different neurobiological processes. The effect of THC on the brain constitutes a continuum throughout the lifetime of an individual. However, 2 windows of brain vulnerability have been identified in preclinical models. The colored boxes represent the different processes that have been demonstrated to be affected on exposure to THC during these sensitive developmental periods. PFC indicates prefrontal cortex. THC in models of heavy cannabis use in middle adolescence. However, even lower doses may produce these same effects when administered earlier in adolescence.22 EFFECT OF PRENATAL EXPOSURE TO CANNABINOID AGONISTS A recent study examined associations between prenatal cannabis exposure (PCE) and various indicators of mental and neurocognitive health in a sample of 11489 youth.26 Self-report of maternal cannabis use during pregnancy was associated with various adverse outcomes among youth at 9 to 10 years of age, including poorer performance on tests of neurocognitive functioning and total intracranial volumes, even after controlling for potential confounders. Several reviews describe PCE sequelae in preclinical models.8,24,27–30 Here, we focus on mechanistic insights inferred from animal studies recapitulating the neuropsychiatric features of clinical outcomes.31 The detrimental effect of PCE on cognitive processing and emotional regulation of the progeny has been ascribed to changes in intrinsic and synaptic properties and plasticity of cortical (eg, PFC), limbic (eg, amygdala, hippocampus), and midbrain (eg, ventral tegmentum) regions. Changes in the balance of excitatory and inhibitory input strength, along with alterations in how principal neurons and interneurons receive, integrate, and convey information, have been observed in these neuroanatomic areas (Figure).8,24,27–30 Aberrant glutamatergic function is a common hallmark, as indexed by changes in the expression and function of ionotropic and metabotropic receptors and in dynamic regulation of glutamate levels by glutamate transporters at both synaptic cleft and extrasynaptic spaces. These changes depend largely on the alterations of endocannabinoid signaling pathways caused by exogenous cannabinoids during development and throughout ontogenesis (eg, neural proliferation, survival, directional axonal growth).8,24,27–30 Defects in ECS function also may account for the interneuronopathy observed in many brain regions of PCE offspring, a phenomenon often more prominent in female than in male animals.8,27–29 In the PFC, this persistent inhibitory circuit deficit also is associated with a delayed switch of GABA from its excitatory role early in development to a classic inhibitory function exerted throughout the central nervous system later in life.8,29 This is particularly relevant because the GABA switch represents a critical milestone during neurodevelopment. Any alteration in the normal and predictable temporal sequence of these periods such as delays, stalls, or accelerations imposed by PCE may lead to perturbations of offspring cognitive processing and emotional behavior.8,29 It was observed that marijuana use leads to dysregulation of monoaminergic pathways and stress response systems.8,27–29 PCE hampers the maturation of mono- amines, which also exert trophic actions on target neurons and afferent terminals. This phenomenon may depend on epigenetic modifications and may be implicated in aberrant reward signaling. Furthermore, PCE is associated with an endophenotype in the offspring, which displays protracted dysregulation of stress responsivity that is not explained by glucocorticoid levels. A susceptibility to acute and chronic stress is tied to many psychiatric disorders, ranging from depressed mood and psychosis to substance use disorders and anxiety. A deeper understanding of how PCE interferes with endocannabinoid signaling during neurodevelopment would allow us to explore potential interventions aimed at restoring or reprogramming the hierarchical progression of developmental milestones. EFFECTS OF MARIJUANA USE ON HUMAN COGNITION Acute intoxication from marijuana is associated with impairment of working and episodic memory, behavioral disinhibition, and impulsivity, which can affect performance in real-world activities.6 For example, a meta-analysis from 2016 showed that the odds of being involved in a motor vehicle accident was increased 36% in cannabis users relative to nonusers.32 In addition, a crossover clinical trial published in 2020 investigated the effect of different cannabis products in relation to on-road driving tests. The SD of lateral position, a measure of lane weaving, swerving, and overcorrection, was 20.29 cm at 40 to 100 minutes after inhalation of THC-dominant cannabis and 21.09 cm after inhalation of a mixture of THC and CBD. It is interesting to note that the SD of lateral position after inhalation of CBD-dominant cannabis was similar to that in the placebo group (18.21 cm versus 18.26 cm).33 These observations illustrate the differential short- term effect of THC and CBD on cognition. Evidence also suggests that the short-term effects of cannabinoids are transient and can be influenced by the development of tolerance and the use of other drugs. The long-term effect of cannabis on cognition, however, is less well established. Recent meta-analyses report residual effects of cannabis use on neurocognition, consistent with prior research.34 A meta-analysis by Lovell et al35 in 2020 focused on adult near-daily cannabis use for >2 years and found global neurocognition among users (n=849) to be about one-quarter of an SD worse than that of nonusers (n=764). Four of the 7 domains investigated (decision-making, verbal learning, retention, executive function) showed significant effect sizes ranging from Hedges g=−0.52 to −0.18. A meta- analysis of cannabis users <26 years of age (n=2152) and nonusers (n=6575) also showed a one-quarter of an SD difference in global neurocognitive performance but with more specific domains affected,36 albeit with smaller effect size compared with that found by Lovell et al.35 Both lacked support for worse neurocognition in early adolescence in that neither found that age at onset of cannabis use influenced the association between exposure and cognitive performance. In contrast to these meta-analyses, large longitudinal studies provide stronger causal inferences by examining change over time. In the CARDIA study (Coronary Artery Risk Development in Young Adults), 3385 participants 18 to 30 years of age were followed up longitudinally. Marijuana use was assessed periodically in the 25-year follow-up. In addition, cognitive assessment was completed 25 years after inception. In this study, cumulative years of exposure to marijuana was associated with worse verbal memory (0.13 lower SD in the verbal memory test for each additional 5 years of exposure to marijuana).37 Longitudinal co-twin studies use a research design that additionally controls for shared variance from genetic and environmental factors. Two large longitudinal twin studies (n=3066) with neurocognitive measures collected before (at 9–12 years of age) and after (17–20 years of age) cannabis exposure reported that declines in vocabulary and general knowledge were associated with being a cannabis user but not with amount of cannabis consumed. 38 Twins discordant for cannabis use showed no differences in IQ declines. Thus, differences were likely caused by shared risk factors. Using a similar design, Meier et al39 reported that lower IQ predated cannabis use with no evidence of actual IQ declines among 1989 twins assessed at 5, 12, and 18 years of age. Ross et al40 evaluated other aspects of neurocognition among 856 individual twins and reported only 1 within-family effect of 70 tested. Specifically, frequency of cannabis use at 17 years of age was associated with poorer executive functioning at 23 years of age, but executive functioning problems predating cannabis use could not be ruled out. Magnetic resonance imaging (MRI) techniques demonstrate differential associations of cannabis use with brain structure and function. In terms of brain structure, alterations related to cannabis use have been mixed. In a longitudinal study including 1598 MRIs done in adolescents at baseline and the 5-year follow-up, a dose- dependent association was observed between cannabis use and PFC thinning.41 On the other hand, although a meta-analysis found that regular cannabis consumption was associated with smaller hippocampal (standardized mean difference, 0.14 [95% CI, 0.02–0.27]), medial orbitofrontal cortex (standardized mean difference, 0.30 [95% CI, 0.15–0.45]), and lateral orbitofrontal cortex (standardized mean difference, 0.19 [95% CI, 0.07–0.32]) volumes relative to nonuse, brain volumes were not associated with cannabis use duration and dosage. 42 Other large studies have reported null effects. In 2 e180 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 large twin samples from the United States (n=474) and Australia (n=622), cannabis use was unrelated to volumes of the thalamus, caudate nucleus, putamen, pallidum, hippocampus, amygdala, and nucleus accumbens.43 A multisite study of cortical surface measures (n=262) reported no difference in cortical thickness, surface area, and gyrification index in cannabis users versus nonusers, in cannabis dependence versus nondependence versus nonusers, and in early adolescent versus late adolescent onset of cannabis use versus nonuse.44 Thus, brain structural abnormalities related to cannabis use are inconsistent. Functional MRI studies report more robust effects, particularly after prolonged cannabis use. A meta-analysis of task-based functional MRI studies in current adult and adolescent users found abnormalities in activation in both age groups. Relative to nonusing control subjects, adult cannabis users had greater brain activation in the superior (seed-based d mapping [SDM-Z], 1.561; P<0.002) and posterior (SDM-Z, 1.479; P<0.003) transverse temporal and inferior frontal gyri (SDM-Z, 1.568; P<0.002) and less activation in the striatum (SDM-Z, −1.843; P<0.001), insula (SDM-Z, −1.637; P<0.001), and middle frontal gyrus across different tasks. Adolescent cannabis users also had greater activation in the inferior parietal gyrus (SDM-Z, 1.06; P<0.001) and putamen (SDM-Z, 1.008; P<0.001) compared with nonusers across various tasks, suggesting compensatory neuroadaptive mechanisms.45 These functional abnormalities persist despite cessation of cannabis use and beyond the period when THC metabolites are detectable. A meta-analysis of the same adolescent studies found that >25-day abstinent adolescent cannabis users exhibited greater activation in the right inferior frontal gyrus in addition to other areas relevant for executive functioning and self-regulatory mechanisms.46 Several recent studies examined cannabis effects in populations with premorbid clinical risk factors and those using medical marijuana. A meta-analysis focused only on cannabis users with psychosis <25 years of age (n=529) and nonusing control subjects with psychosis (n=901). In this study, there were significant differences in 3 of 11 domains assessed (premorbid IQ, Hedges g=0.40 [standardized effect size]; current IQ, Hedges g=−0.17; working memory, Hedges g=−0.76).47 Among a sample of 215 adult patients with chronic pain provided daily herbal cannabis containing 12.5% THC for 1 year, no significant neurocognitive differences were found compared with 216 control subjects.48 This is in line with a study of patients with multiple sclerosis in response to oral dronabinol that found no significant differences in MRI-derived measures, including annual percentage of brain volume change and occurrence of new lesions, after 12 months of use.49 These clinical trials suggest no significant adverse effect of THC on neurocognitive symptoms in specific clinical populations. EFFECTS OF MARIJUANA USE ON CEREBROVASCULAR RISK AND DISEASE Cerebrovascular Risk Factors Similar to the literature linking marijuana use with cardiovascular outcomes,10 evidence that marijuana consumption increases the prevalence of specific cerebrovascular risk factors and disease is limited by a preponderance of observational studies, cross-sectional studies, case reports, and case series prone to potential publication and other biases. Postulated adverse effects of marijuana use may include sympathetic nervous system activation, blood pressure changes, platelet activation, and electrophysiological effects.50–52 Concomitant tobacco smoking and other substance use and abuse possibly contribute to these effects, which may be short term and have been studied mostly in low-risk populations such as younger adults. These factors may explain why many longitudinal studies linking marijuana use and cardiovascular or metabolic risk factors have been negative after multivariable adjustment for unhealthy behaviors such as diet and tobacco smoking.53–55 Hypertension, in particular, is an important risk factor for ischemic stroke, hemorrhagic stroke, and subarachnoid hemorrhage. With marijuana use, the most common acute reaction in humans is a decrease in blood pressure resulting from cannabinoid effects on the vasculature and autonomic nervous system.52 Despite this physiological reaction, limited studies using the National Health and Nutrition Examination Survey showed a modest association of recent cannabis use with higher systolic blood pressure and higher prevalence of hypertension among current users 30 to 59 years of age.56 Heavy users, defined as use of marijuana or hashish in >20 of the past 30 days, had higher odds of abnormal blood pressure compared with never-users. Although this difference remained statistically significant after adjustment for age, sex, race, ethnicity, body mass index, education, and survey year, it was no longer statistically significant after additional adjustment for current tobacco and binge alcohol use (adjusted odds ratio, 1.47 [95% CI, 0.99–2.16]).57 The relationship between marijuana use and elevated blood pressure, especially among heavy users, may drive longer-term associations with cerebrovascular outcomes, although this mechanism remains to be studied. Prior cardiovascular disease such as myocardial infarction (MI) or atrial fibrillation (AF) is also an important risk factor for stroke.58 Case reports of MI after marijuana use are mainly among young adults who lack vascular risk factors, with onset of MI shortly after use.59 Risk of MI was elevated 4.8-fold within an hour after smoking marijuana compared with periods of nonuse. This association demonstrates the potential role of marijuana as an acute trigger for cardiovascular disease.60 Over 25 years of follow-up, among 5113 adult participants in Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e181 the Coronary Artery Risk Development in Young Adults study, cumulative or recent marijuana use was not associated with coronary heart disease, stroke, or cardiovascular disease mortality.61 This finding contrasts with a population-based, multi-institutional database study that observed an increased risk of 3-year cumulative incidence of MI among marijuana users compared with control subjects (1.37% vs 0.54%; relative risk, 2.54 [95% CI, 2.45–2.61]).62 Similarly, marijuana use appears to be a trigger for AF. Data from the Nationwide Inpatient Sample show that the percentage of individuals with cannabis use disorder discharged in the postlegalization period (2010–2014) with the diagnosis of arrhythmia increased 31%.63 However, in a study of patients hospitalized for heart failure, marijuana users had a reduced odds of AF compared with nonusers (adjusted odds ratio, 0.87 [95% CI, 0.77–0.98]).50 Simultaneous use of cocaine, stimulants, and other drugs may be responsible for observations of AF among marijuana users, although this remains to be fully studied outside of observational and cross-sectional reports. Risk of Stroke and Transient Ischemic Attack Several case reports and case series mostly in young individuals suggest a relationship between recent and heavy cannabis use and risk of stroke.64–66 In contrast, and as reviewed below, findings among case-control studies,67 population-based studies,68 and studies conducted using outpatient69,70 or inpatient71,72 national databases or hospital electronic health records73 have been equivocal, depending on the study design, covariates considered in the analysis, and source of the population being studied. Inconsistent associations also can be attributable to the presence of comparison groups and whether adjustment of other important risk factors was considered, along with attention to potential confounding by other risk factor and lifestyle features between cannabis users and nonusers. In 1 case-control study using cannabis urine screens to identify cannabis users, the authors found an association between cannabis use and the risk of ischemic stroke and transient ischemic attack, but the association was not significant when tobacco use was included as a covariate (adjusted odds ratio, 1.59 [95% CI, 0.71– 3.70]) among subjects 18 to 55 years of age with and without stroke.67 Similarly, after adjustment for cigarette smoking and alcohol use, another study found no association between cannabis use in young adulthood and the occurrence of fatal and nonfatal stroke later in life among Swedish men in up to 38 years of follow-up.68 Data from studies that have examined more specifically the dose or amount of cannabis consumed within a designated time frame suggest that regular cannabis use may increase the risk of stroke. Using data from population-based surveys, investigators have reported that when no cannabis use was compared with heavy cannabis use in the past year, cannabis use was associated with an increased risk for the occurrence of nonfatal stroke and transient ischemic attack.70 Similarly, another study found that recent (within the past 30 days) and frequent (>10 d/mo) cannabis use was associated with increased risk for the occurrence of stroke compared with nonuse, whereas less frequent cannabis use (≤10 d/mo or less than weekly in the past year) was not associated with increased risk.69,70 Using several International Classification of Diseases, Ninth Revision, Clinical Modification codes for marijuana use, a Nationwide Inpatient Sample study found that cannabis use among men and women hospitalized between 2004 and 2011 was associated with a 17% increased relative risk for acute ischemic stroke in a multivariable-adjusted analysis. Concomitant use of tobacco with cannabis increased the risk to 31%.71 Similarly, a separate study using the Nationwide Inpatient Sample but between 2009 and 2010 observed a higher odds of stroke among cannabis users (odds ratio, 1.24 [95% CI, 1.14–1.34]).72 In contrast, investigators using electronic health record data from patients admitted to a single center between 2015 and 2017 found that testing positive for cannabis use was not associated with the risk of ischemic stroke compared with testing negative, even after adjustment for numerous confounders, including age, cigarette smoking, and comorbidities.73 There may be certain populations or scenarios in which cannabis use can be meaningfully linked to stroke. A study of a large longitudinal cohort of Canadian pregnant women that included >1 million participants between 1989 and 2019 with follow-up at 30 years observed that cannabis use disorder was associated with a doubling of risk for hemorrhagic stroke (hazard ratio, 2.08 [95% CI, 1.07–4.05]) but no increased risk for ischemic or other cerebrovascular disease.74 Because of the theoretical vasoactive effect of cannabis, its use has been implicated in some cases of reversible cerebral vasoconstriction syndrome, with 6 of 24 nonidiopathic reversible cerebral vasoconstriction syndrome cases at a Colorado stroke center attributed to marijuana use.75 In addition, an elevated risk of stroke from intracranial arterial stenosis has been described among young cannabis users 18 to 45 years of age wherein vasospasm or reversible cerebral vasoconstriction syndrome may be a potential mechanism. 76 Studies done in experimental models have shown that cannabinoids exert complex effects on cardiac contractility, vascular tone, and atherogenesis. Both vasodilatation and vasoconstriction responses were observed, depending on the experimental model and cannabinoid used. CB1 activation promotes inflammation, upregulates the production of reactive oxygen species, and activates proapoptotic pathways in endothelial cells and cardiomyocytes. In addition, it induces endothelial dysfunction and vascular smooth muscle cell proliferation and migration. These processes have been linked to cardiac dysfunction e182 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 and the development of atherosclerosis.52 This is in contrast to the atheroprotective role associated with CB2. Acute cardiovascular events and stroke also have been reported in patients using synthetic cannabinoids.77 Spice is associated with idiopathic thrombocytopenic purpura, which increases the risk of major hemorrhage.78 In addition, intracranial hemorrhage in Spice users has been linked to the presence of brodifacoum, an adulterant considered a superwarfarin.79 EDUCATION AND FUTURE DIRECTIONS Our understanding of the ramifications of cannabis consumption on brain health is limited but rapidly evolving. Observational studies have produced conflicting results in relation to the effect of marijuana on different outcomes of interest, including hypertension, AF, MI, and cognition. Several methodological factors may explain these apparent contradictions. First, given its historical classification as an illicit drug, the use of marijuana has been underreported for generations. The inclusion of marijuana users in the control group of observational studies that rely on self-reported use could underestimate its effect on brain health. Second, several behaviors such as smoking and alcohol use are associated with marijuana consumption and can influence stroke risk and brain connectivity.80,81 The often missing information on frequency of exposure to these factors limits our ability to determine with accuracy the independent effect of marijuana. Third, the time of exposure, frequency of use, and bioavailability of marijuana, which is affected by the route of administration, diet, and concomitant use of medications that may affect its metabolism, are reported inconsistently.10 Fourth, THC and CBD have different pharmacological effects. Although the use of THC has been associated with detrimental effects, CBD appears to have therapeutic potential in some neurologic disorders.9 The absolute and relative concentrations of these compounds differ according to the strain of cannabis plant and the methodology used to extract the active ingredients.82 Fifth, the gradual increase in the potency of marijuana used recreationally limits the relevance of older studies.5 Sixth, different factors impede the development of long-term placebo-controlled studies, including ethical reasons and the psychotropic effect of THC, which cannot be blinded. Social media may emphasize a beneficial role for marijuana, and the general population may perceive it as a harmless drug. However, the emerging evidence linking marijuana use to cardiovascular events and stroke, as well as the potential and demonstrated drug-to-drug interactions between marijuana and medications commonly used in the general population, calls for caution and highlights the potential importance of active surveillance programs.10,83 In addition, the high density of cannabinoid receptors in areas involved in executive function and memory, the dose-dependent detrimental effect of THC on working and episodic memory, and the role of Table 2. Key Summary Points Section Notes Actions of THC disrupts endocannabinoid signaling pathways and Cannabis affects synaptic plasticity. In the short term, this affects the in Animal strength of interneuronal connections; in the long term, it Models leads to changes in the functioning of neuronal networks. Exposure to THC during adolescence can lead to structural, molecular, and functional alterations of brain circuits, particularly in areas involved in cognition and behavior. Effect of In preclinical models, THC disrupts the normal signaling Prenatal of the endocannabinoid system during development and Exposure to throughout ontogenesis and results in abnormal neurotrans- Cannabinoid mission. Agonist Prenatal THC affects neuroanatomic areas associated with cognition and emotional regulation, including the PFC, limbic system, and ventral tegmentum of the midbrain. Effects of Acute intoxication with marijuana affects memory, behavior, Marijuana Use and impulsivity. on Human The long-term effect of cannabis on cognition may be Cognition domain specific. Neuroimaging studies have shown structural changes in cannabis users; however, the results are inconsistent. Functional changes may be observed in areas of the brain involved in cognition among cannabis users. Early exposure to cannabis may have a negative effect on cognitive function. Effects of Several studies have described an association between Marijuana cannabis use and increased risk of stroke. Use on Data from population survey studies indicate that the pat- Cerebrovastern (heavy vs less) and frequency (>10 d/mo) of cannabiscular Risk and use may increase the risk of stroke. Disease Cigarette smoking is common in cannabis users and may be an important modifier or confounder of the relationship between cannabis use and stroke risk. Given the potential role of cannabis as a vasoactive substance and its potential role in cardiac pathology and atherosclerosis development, cannabis use also may increase stroke risk via reversible cerebral vasoconstriction syndromes or may indirectly increase stroke risk. It is possible that differences among some study findings may be attributable to the years in which population cohorts were studied or recruited because most population cohorts were assembled before 2012. Over the past decade, strains of cannabis have been evolving, resulting in plants with high THC concentrations and some preparations that may have synthetic cannabinoids such as Spice, which may influence the association of cannabis use with stroke. Education The cumulative evidence collected in clinical and preclinical and Future studies suggests that the consumption of marijuana can have Directions a detrimental effect on brain health. The exact ramifications, however, have not been precisely established. Emerging evidence questions the widely accepted belief that marijuana is innocuous and suggests that cannabis, particularly THC, negatively affects brain health through direct and indirect mechanisms. Health care professionals and consumers should receive education on the potential beneficial and harmful effects associated with the use of marijuana, including the increased risk of stroke and cognitive decline. CBD indicates cannabidiol; PFC, prefrontal cortex; and THC, Δ9-tetrahydrocannabinol. cannabinoid-associated biochemical pathways on synaptic plasticity and neuronal development raise concern that long-term exposure to marijuana may affect brain health. There is lack of agreement on whether the effects of Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e183 marijuana resolve completely after months of abstinence. However, the disruption of endocannabinoid signaling pathways during the prenatal and perinatal periods and in adolescence may be detrimental to neurodevelopment. 6,8,9 Key points discussed in this scientific statement are summarized in Table 2. It should be noted that the overarching goal of this scientific statement was to discuss mechanisms by which marijuana use could influence brain health. However, as the field is developing, several important aspects require additional research. As an example, there is limited information comparing the differential effect of recreational, illicit, and medicinal uses of marijuana, as well as the type of cannabis product consumed. Similarly, the modulatory effects of social determinants of health and race and ethnicity on the interaction of brain health and marijuana use are largely unexplored. The latter area of research may be particularly important because communities of color in the United States may be disproportionately affected by natural and synthetic cannabinoids in relation to use and exposure and the legal implications of criminalization of marijuana.84 Public health efforts should be considered to raise awareness about the potential negative effects associated with the use of marijuana in the general population. Possible strategies include the use of standardized concentrations of biologically active components and health warning labels on available formulations. In addition, the use of marijuana should be individualized and closely monitored. Health care professionals and patients should receive unbiased education about the potential consequences of medicinal, recreational, and illicit marijuana use on brain health, particularly when the exposure occurs during vulnerable vital periods. It also may be important for professionals to monitor cognitive performance of Disclosures Writing Group Disclosures marijuana users and to review their medications to identify potential drug-to-drug interactions. Knowledgeable health care professionals will be able to properly educate potential or active marijuana users about its possible adverse effects, empowering them to make an informed decision that is based on unbiased data. ARTICLE INFORMATION The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on July 29, 2021, and the American Heart Association Executive Committee on September 5, 2021. A copy of the document is available at https://professional.heart.org/statements by using either “Search for Guidelines & Statements” or the “Browse by Topic” area. To purchase additional reprints, call 215-356-2721 or email [email protected]. The American Heart Association requests that this document be cited as follows: Testai FD, Gorelick PB, Aparicio HJ, Filbey FM, Gonzalez R, Gottesman RF, Melis M, Piano MR, Rubino T, Song SY; on behalf of the American Heart Association Stroke Brain Health Science Subcommittee of the Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease. Use of marijuana: effect on brain health: a scientific statement from the American Heart Association. Stroke. 2022;53:e176–e187. doi: 10.1161/STR.0000000000000396 The expert peer review of AHA-commissioned documents (eg, scientific statements, clinical practice guidelines, systematic reviews) is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit https://professional.heart.org/statements. Select the “Guidelines & Statements” drop-down menu, then click “Publication Development.” Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at https://www.heart.org/permissions. A link to the “Copyright Permissions Request Form” appears in the second paragraph (https://www.heart.org/en/aboutus/ statements-and-policies/copyright-request-form). Writing group member Employment Research grant Other research support Speakers’ bureau/ honoraria Expert witness Ownership interest Consultant/ advisory board Other Fernando D. Testai University of Illinois at Chicago None None None None None None None Philip B. Gorelick Northwestern University None None None None None None None Hugo J. Aparicio Boston University School of Medicine None None None None None None None Francesca M. Filbey University of Texas at Dallas Center for Brain Health None None None None None None None Raul Gonzalez Florida International University None None None None None None None Rebecca F. Gottesman National Institutes of Health National Institute of Neurological Disorders and Stroke None None None None None None None Miriam Melis University of Cagliari (Italy) NIH None None None None None None Mariann R. Piano Vanderbilt University School of Nursing None None None None None None None Tiziana Rubino University of Insubria (Italy) None None None None None None None Sarah Y. Song Rush University Medical Center None None None None None None None This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity or owns $10000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition. Modest. e184 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 Reviewer Disclosures Other Speakers’ research bureau/ Expert Ownership Consultant/ Reviewer Employment Research grant support honoraria witness interest advisory board Other Mark J. Alberts Hartford HealthCare None None None None None None None Larry A. Allen University of Colorado PCORI†; NIH NHLBI None None None None Novartis; Boston None School of Medicine (K23 HL105896)†; Scientific†; Cytoki- AHA (grant, SFRN)† netics; Amgen George Howard University of Alabama at Birmingham None None None None None None None Farzaneh A. Sorond Northwestern Univer-None None None None None None None sity, Feinberg School of Medicine This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10 000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition. Modest. †Significant. REFERENCES 1. United Nations Office on Drugs and Crime. World drug report. 2015. Accessed February 10, 2021. https://www.unodc.org/unodc/en/ index.html 2. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry. 2018;5:987–1012. doi: 10.1016/S2215-0366(18)30337-7 3. US Department of Health and Human Services. 2019 NSDUH annual national report. 2020. 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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.	Discuss how Sensory Processing Sensitivity is currently measured and what some of the impacts that Sensory Processing Sensitivity would have on someone's everyday life or activities.	Sensory Processing Sensitivity (SPS) is considered a temperament or personality trait. It refers to a person's sensitivity to subtle environmental stimuli, the depth and intensity with which these stimuli are processed, and the impact this has in terms of emotional and physiological reactivity (e.g., the extent to which a person is easily disturbed by crowds and chaotic situations and the consequent need to withdraw and unwind). A highly sensitive person is characterised by a (greatly) increased degree of SPS. Since the existing limited scientific research suggested that there is a link between high SPS and the development of mental and physical symptoms (such as fatigue), we conducted a number of studies on how the concept is measured, and what the possible link is with (other) personality traits and some clinical outcomes. In a first study, the psychometric properties of the Dutch version of the Highly Sensitive Person Scale (HSPS) developed by Aron and Aron (1997) were explored in a general population sample (N=998), a sample of patients suffering from (chronic) fatigue complaints (N=340), and a sample of chronic pain patients (N=337). Results demonstrated that the scale was a valid and reliable measure of the ‘Sensory Processing Sensitivity’ construct. A bi-factor model, consisting of a general sensitivity factor and three separate factors, provided the best fit to the data in each sample. The three separate factors, capturing different dimensions of sensory processing sensitivity, were labelled ‘Ease of Excitation’, ‘Sensory and Aesthetic Sensitivity’, and ‘Low Sensory Threshold’. Distinct patterns of associations were found between these factors and the Big Five personality traits (De Gucht et al., 2023). During the validation process of the HSPS it became apparent that this scale offers a restricted perspective on the Sensory Processing Sensitivity concept. Based on the current literature, several different dimensions can be distinguished within this concept, namely (1) (heightened) sensitivity to (subtle) sensory stimuli, including neutral perceptual sensitivity to both internal and external stimuli, affective sensitivity, and associative sensitivity, (2) sensory discomfort, and (3) emotional or physiological reactivity. The fact that these dimensions are not adequately covered by the HSPS developed by Aron & Aron (1997) was the starting point for study 2, focusing on the development of a more comprehensive scale, the Sensory Processing Sensitivity Questionnaire (SPSQ). The item pool generated for the development of the SPSQ consisted of 60 items. After exploratory factor analysis, 43 items remained, divided into six specific factors: (1) Sensory Sensitivity to Subtle Internal and External Stimuli, (2) Emotional and Physiological Reactivity, (3) Sensory Discomfort, (4) Sensory Comfort, (5) Social-Affective Sensitivity, and (6) Aesthetic Sensitivity. Confirmatory factor analysis indicated that a higher-order bi-factor model consisting of two higher-order factors (a positive and negative dimension), a general sensitivity factor and six specific factors had the best fit. Strong positive associations were found between Emotional and Physiological Reactivity, the negative higher-order dimension, and Neuroticism; the same holds for the association between Aesthetic Sensitivity, the positive higher-order dimension, and Openness. Emotional and Physiological Reactivity and the negative higher-order dimension showed clear associations with clinical outcomes (i.e., anxiety, depression, somatic complaints, and fatigue) (De Gucht et al., 2022). With 43 items, the SPSQ is an extensive questionnaire. Incorporating such a questionnaire in research including multiple variables may lead to surveys becoming quite long. One of the problems with long surveys is that they often result in lower response rates, which can have an impact on the generalizability of the findings due to non-response bias. For this reason, we decided to develop a short form (study 3), similar in content and structure to the original scale, and possessing strong psychometric qualities. Such an abbreviated version of the SPSQ has the advantage of measuring many both positive and negative characteristics of SPS and doing so using a limited number of items. The Short Form (SPSQ-SF) was developed using a split-sample validation design. Within a large selection sample, items were retained based on impact on internal consistency reliability, fit to the hierarchical structure of the original SPSQ, and information curves based on a Graded Response Model. In the replication sample, the dimensionality and fit to the latent structure of the SPSQ were evaluated. The results of our study indicate a good fit of the SPSQ-SF. It is strongly correlated to the original SPSQ. Convergent, discriminant and concurrent validity was established in relation to other instruments measuring aspects of SPS, Big Five personality traits and clinical outcomes, respectively (De Gucht & Woestenburg, manuscript submitted for publication).	[question] Discuss how Sensory Processing Sensitivity is currently measured and what some of the impacts that Sensory Processing Sensitivity would have on someone's everyday life or activities. ===================== [text] Sensory Processing Sensitivity (SPS) is considered a temperament or personality trait. It refers to a person's sensitivity to subtle environmental stimuli, the depth and intensity with which these stimuli are processed, and the impact this has in terms of emotional and physiological reactivity (e.g., the extent to which a person is easily disturbed by crowds and chaotic situations and the consequent need to withdraw and unwind). A highly sensitive person is characterised by a (greatly) increased degree of SPS. Since the existing limited scientific research suggested that there is a link between high SPS and the development of mental and physical symptoms (such as fatigue), we conducted a number of studies on how the concept is measured, and what the possible link is with (other) personality traits and some clinical outcomes. In a first study, the psychometric properties of the Dutch version of the Highly Sensitive Person Scale (HSPS) developed by Aron and Aron (1997) were explored in a general population sample (N=998), a sample of patients suffering from (chronic) fatigue complaints (N=340), and a sample of chronic pain patients (N=337). Results demonstrated that the scale was a valid and reliable measure of the ‘Sensory Processing Sensitivity’ construct. A bi-factor model, consisting of a general sensitivity factor and three separate factors, provided the best fit to the data in each sample. The three separate factors, capturing different dimensions of sensory processing sensitivity, were labelled ‘Ease of Excitation’, ‘Sensory and Aesthetic Sensitivity’, and ‘Low Sensory Threshold’. Distinct patterns of associations were found between these factors and the Big Five personality traits (De Gucht et al., 2023). During the validation process of the HSPS it became apparent that this scale offers a restricted perspective on the Sensory Processing Sensitivity concept. Based on the current literature, several different dimensions can be distinguished within this concept, namely (1) (heightened) sensitivity to (subtle) sensory stimuli, including neutral perceptual sensitivity to both internal and external stimuli, affective sensitivity, and associative sensitivity, (2) sensory discomfort, and (3) emotional or physiological reactivity. The fact that these dimensions are not adequately covered by the HSPS developed by Aron & Aron (1997) was the starting point for study 2, focusing on the development of a more comprehensive scale, the Sensory Processing Sensitivity Questionnaire (SPSQ). The item pool generated for the development of the SPSQ consisted of 60 items. After exploratory factor analysis, 43 items remained, divided into six specific factors: (1) Sensory Sensitivity to Subtle Internal and External Stimuli, (2) Emotional and Physiological Reactivity, (3) Sensory Discomfort, (4) Sensory Comfort, (5) Social-Affective Sensitivity, and (6) Aesthetic Sensitivity. Confirmatory factor analysis indicated that a higher-order bi-factor model consisting of two higher-order factors (a positive and negative dimension), a general sensitivity factor and six specific factors had the best fit. Strong positive associations were found between Emotional and Physiological Reactivity, the negative higher-order dimension, and Neuroticism; the same holds for the association between Aesthetic Sensitivity, the positive higher-order dimension, and Openness. Emotional and Physiological Reactivity and the negative higher-order dimension showed clear associations with clinical outcomes (i.e., anxiety, depression, somatic complaints, and fatigue) (De Gucht et al., 2022). With 43 items, the SPSQ is an extensive questionnaire. Incorporating such a questionnaire in research including multiple variables may lead to surveys becoming quite long. One of the problems with long surveys is that they often result in lower response rates, which can have an impact on the generalizability of the findings due to non-response bias. For this reason, we decided to develop a short form (study 3), similar in content and structure to the original scale, and possessing strong psychometric qualities. Such an abbreviated version of the SPSQ has the advantage of measuring many both positive and negative characteristics of SPS and doing so using a limited number of items. The Short Form (SPSQ-SF) was developed using a split-sample validation design. Within a large selection sample, items were retained based on impact on internal consistency reliability, fit to the hierarchical structure of the original SPSQ, and information curves based on a Graded Response Model. In the replication sample, the dimensionality and fit to the latent structure of the SPSQ were evaluated. The results of our study indicate a good fit of the SPSQ-SF. It is strongly correlated to the original SPSQ. Convergent, discriminant and concurrent validity was established in relation to other instruments measuring aspects of SPS, Big Five personality traits and clinical outcomes, respectively (De Gucht & Woestenburg, manuscript submitted for publication). https://www.universiteitleiden.nl/en/research/research-projects/social-and-behavioural-sciences/hypersensitivity-stimulus-perception-information-processing-and-reporting-of-emotional-and-somatic-symptoms ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.	[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: Sensory Processing Sensitivity (SPS) is considered a temperament or personality trait. It refers to a person's sensitivity to subtle environmental stimuli, the depth and intensity with which these stimuli are processed, and the impact this has in terms of emotional and physiological reactivity (e.g., the extent to which a person is easily disturbed by crowds and chaotic situations and the consequent need to withdraw and unwind). A highly sensitive person is characterised by a (greatly) increased degree of SPS. Since the existing limited scientific research suggested that there is a link between high SPS and the development of mental and physical symptoms (such as fatigue), we conducted a number of studies on how the concept is measured, and what the possible link is with (other) personality traits and some clinical outcomes. In a first study, the psychometric properties of the Dutch version of the Highly Sensitive Person Scale (HSPS) developed by Aron and Aron (1997) were explored in a general population sample (N=998), a sample of patients suffering from (chronic) fatigue complaints (N=340), and a sample of chronic pain patients (N=337). Results demonstrated that the scale was a valid and reliable measure of the ‘Sensory Processing Sensitivity’ construct. A bi-factor model, consisting of a general sensitivity factor and three separate factors, provided the best fit to the data in each sample. The three separate factors, capturing different dimensions of sensory processing sensitivity, were labelled ‘Ease of Excitation’, ‘Sensory and Aesthetic Sensitivity’, and ‘Low Sensory Threshold’. Distinct patterns of associations were found between these factors and the Big Five personality traits (De Gucht et al., 2023). During the validation process of the HSPS it became apparent that this scale offers a restricted perspective on the Sensory Processing Sensitivity concept. Based on the current literature, several different dimensions can be distinguished within this concept, namely (1) (heightened) sensitivity to (subtle) sensory stimuli, including neutral perceptual sensitivity to both internal and external stimuli, affective sensitivity, and associative sensitivity, (2) sensory discomfort, and (3) emotional or physiological reactivity. The fact that these dimensions are not adequately covered by the HSPS developed by Aron & Aron (1997) was the starting point for study 2, focusing on the development of a more comprehensive scale, the Sensory Processing Sensitivity Questionnaire (SPSQ). The item pool generated for the development of the SPSQ consisted of 60 items. After exploratory factor analysis, 43 items remained, divided into six specific factors: (1) Sensory Sensitivity to Subtle Internal and External Stimuli, (2) Emotional and Physiological Reactivity, (3) Sensory Discomfort, (4) Sensory Comfort, (5) Social-Affective Sensitivity, and (6) Aesthetic Sensitivity. Confirmatory factor analysis indicated that a higher-order bi-factor model consisting of two higher-order factors (a positive and negative dimension), a general sensitivity factor and six specific factors had the best fit. Strong positive associations were found between Emotional and Physiological Reactivity, the negative higher-order dimension, and Neuroticism; the same holds for the association between Aesthetic Sensitivity, the positive higher-order dimension, and Openness. Emotional and Physiological Reactivity and the negative higher-order dimension showed clear associations with clinical outcomes (i.e., anxiety, depression, somatic complaints, and fatigue) (De Gucht et al., 2022). With 43 items, the SPSQ is an extensive questionnaire. Incorporating such a questionnaire in research including multiple variables may lead to surveys becoming quite long. One of the problems with long surveys is that they often result in lower response rates, which can have an impact on the generalizability of the findings due to non-response bias. For this reason, we decided to develop a short form (study 3), similar in content and structure to the original scale, and possessing strong psychometric qualities. Such an abbreviated version of the SPSQ has the advantage of measuring many both positive and negative characteristics of SPS and doing so using a limited number of items. The Short Form (SPSQ-SF) was developed using a split-sample validation design. Within a large selection sample, items were retained based on impact on internal consistency reliability, fit to the hierarchical structure of the original SPSQ, and information curves based on a Graded Response Model. In the replication sample, the dimensionality and fit to the latent structure of the SPSQ were evaluated. The results of our study indicate a good fit of the SPSQ-SF. It is strongly correlated to the original SPSQ. Convergent, discriminant and concurrent validity was established in relation to other instruments measuring aspects of SPS, Big Five personality traits and clinical outcomes, respectively (De Gucht & Woestenburg, manuscript submitted for publication). USER: Discuss how Sensory Processing Sensitivity is currently measured and what some of the impacts that Sensory Processing Sensitivity would have on someone's everyday life or activities. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	28	26	740	null	799
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]	I found this alarming article about microplastics making their way into the human body. Using this article as a reference, please explain what the red flags are for humans in regards to microplastics. Use at least 400 words.	When Jaime Ross, PhD, a neuroscientist and assistant professor at the University of Rhode Island College of Pharmacy, decided to study how contaminating the drinking water of mice with tiny fragments of plastic might affect their cognitive function, she didn’t expect the experiment to yield much. But in just three weeks, Ross and her team found microplastics had made their way into the mice’s brains, passing the robust defenses of the blood-brain barrier. The researchers performed a variety of tests and found that the microplastic-exposed mice started exhibiting signs of cognitive decline similar to dementia. “I didn’t really think we were going to see anything,” Ross says. But when they examined the mice’s tissues, they were shocked. “Every one we looked at we found the microplastics. It was surprising, especially finding them in the brain. Things are not supposed to go there!” The research findings from Ross’ team, published in August 2023, add to a slew of recent studies pointing to an alarming trend: microplastics are everywhere. Minuscule plastic particles that come from degraded plastic products are found throughout the environment. Scientists estimate there are 8-10 million metric tons of plastics in the oceans, and some of that is consumed by fish and other wildlife. Microplastics have been detected in fruits and vegetables, plastic water bottles, the air, cosmetics, and household dust. Now, researchers are finding them in almost every part of the human body, including in breast milk, the placenta, testicles, hearts, livers, and kidneys. Despite these findings, experts say that little is known and understood about what impact these microplastics have on human health. A few studies have drawn associations between microplastics and poor health outcomes, including cardiovascular disease and low male fertility. And chemicals often found in plastics are known to cause a variety of health problems, including cancers, metabolic disorders, attention deficit/hyperactivity disorder, and fertility issues. But most of the studies raising alarm have been in labs or in animal models that don’t give a complete picture of the effect on humans, says Mary Margaret Johnson, MD, PhD, a principal research scientist of environmental health at Harvard T.H. Chan School of Public Health in Boston. “I do think there needs to be more funding devoted to researching how it really is impacting our organs and disease itself,” she says. What are microplastics? Though plastics have become ubiquitous in modern life, they weren’t invented until the mid-1800s and weren’t produced on a large scale until the 1950s. Over the past century, technology to create a huge variety of malleable polymers (chains of large, repeating molecules) has evolved into the umbrella term plastics, which are often derived from petroleum and other fossil fuels, according to the Science History Institute in Philadelphia. Plastics are used in most containers and packaging materials; in most of the fabrics that make clothing, bedding, carpeting, and towels; in the construction of buildings and motor vehicles; and in many of the materials used in health care settings to prevent the spread of infection, among many other uses. The production of plastics worldwide has doubled in the last two decades, according to Our World in Data. Plastic’s versatility, durability, and low weight-to-strength ratio have made it an efficient material for many of life’s modern conveniences. However, by their nature, plastics can break down and degrade into smaller pieces. At the same time, scientists have found that plastic materials can exist for decades, if not longer, without completely disintegrating. Scientists have studied the impact of plastic on the ecological environment for decades and have raised concerns about the health effects of some chemicals used in plastics. But it’s only within the last several years that researchers have discovered the extent to which microplastics (which range from 1 nanometer, 1/80,000 the width of a strand of hair, to 5 millimeters, the size of a pencil-top eraser) and nanoplastics (which are even smaller and invisible) have become embedded in the environment and in human bodies, explains Tracey Woodruff, PhD, MPH, a professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences and director of the Program on Reproductive Health and the Environment at the University of California San Francisco (UCSF) School of Medicine. Woodruff, who has studied the effect of some chemicals found in plastics on human health, reproduction, and development for two decades, first started looking into microplastics in 2021. She and a group of scientists from across the University of California system reviewed hundreds of existing studies on microplastics and health and compiled a report for state lawmakers to consider during policymaking. Though mostly based on animal studies, Woodruff and her colleagues concluded that there was evidence that microplastics could harm fertility and increase cancer risk in humans. “Governments have not really fully figured out what they’re going to do about this,” Woodruff says. There have been some efforts to ban the use of plastic microbeads in cosmetics, but not much beyond that, she adds. Red flags for human health While there haven’t yet been any definitive studies showing that microplastics cause health problems in humans, researchers have identified several red flags that call for further investigation. In Ross’ research in mice, for example, the scientists used plastic particles that were “clean,” meaning that they did not have any of the known toxic chemicals found in many plastics and they were also free of bacteria and viruses that microplastics can pick up from environmental exposure. And yet, with the mere presence of the microplastics, the mice began to experience negative effects. This could be because the immune system recognizes the presence of a foreign invader and triggers inflammation, which can have a negative effect on a range of organs. “We just wanted to see the effect of plastic itself, but that’s not what is really in the environment,” Ross says. “Plastics in the environment are not this way; they’re not pristine.” Ross’ work has raised even more questions about microplastics in the body. “We’re trying to understand: How are they getting into the brain? What do they do? Where do they go? Do they get out?” she says. Sheela Sathyanarayana, MD, MPH, a professor in the University of Washington Department of Pediatrics and the Department of Environmental and Occupational Health Sciences, worries that the harm from microplastics in the body could be compounded by what are known as endocrine disrupting chemicals that are found in many plastics. Bisphenol A (BPA), phthalates, and per- and polyfluoroalkyl substances (PFAS) are just a few of the chemicals known to imitate hormones and disrupt the body’s natural endocrine system, which is responsible for making the hormones that govern processes such as growth and development, metabolism, appetite, mood, and certain aspects of reproduction. Sathyanarayana has focused her research on studying the impact of exposure to endocrine disrupting chemicals on reproduction and has found that they can have a profound impact, especially during fetal development. “That’s when organ development is happening; that’s when programming for later life happens,” Sathyanarayana says. “Whatever happens during pregnancy will affect your later life and health for the whole continuum.” She gave the example of research that found some women who experience famine while pregnant later have babies who experience obesity, likely because of the effect their mothers’ starvation has on the development of the babies’ metabolism. Fetal exposure to endocrine disrupting chemicals has been associated with abnormal development of reproductive organs in male babies, with increased risk of metabolic disorders in childhood, and may be associated with the child developing attention deficit hyperactivity disorder (ADHD). Some of these chemicals have also been linked to lower sperm quality in men.	<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> I found this alarming article about microplastics making their way into the human body. Using this article as a reference, please explain what the red flags are for humans in regards to microplastics. Use at least 400 words. <TEXT> When Jaime Ross, PhD, a neuroscientist and assistant professor at the University of Rhode Island College of Pharmacy, decided to study how contaminating the drinking water of mice with tiny fragments of plastic might affect their cognitive function, she didn’t expect the experiment to yield much. But in just three weeks, Ross and her team found microplastics had made their way into the mice’s brains, passing the robust defenses of the blood-brain barrier. The researchers performed a variety of tests and found that the microplastic-exposed mice started exhibiting signs of cognitive decline similar to dementia. “I didn’t really think we were going to see anything,” Ross says. But when they examined the mice’s tissues, they were shocked. “Every one we looked at we found the microplastics. It was surprising, especially finding them in the brain. Things are not supposed to go there!” The research findings from Ross’ team, published in August 2023, add to a slew of recent studies pointing to an alarming trend: microplastics are everywhere. Minuscule plastic particles that come from degraded plastic products are found throughout the environment. Scientists estimate there are 8-10 million metric tons of plastics in the oceans, and some of that is consumed by fish and other wildlife. Microplastics have been detected in fruits and vegetables, plastic water bottles, the air, cosmetics, and household dust. Now, researchers are finding them in almost every part of the human body, including in breast milk, the placenta, testicles, hearts, livers, and kidneys. Despite these findings, experts say that little is known and understood about what impact these microplastics have on human health. A few studies have drawn associations between microplastics and poor health outcomes, including cardiovascular disease and low male fertility. And chemicals often found in plastics are known to cause a variety of health problems, including cancers, metabolic disorders, attention deficit/hyperactivity disorder, and fertility issues. But most of the studies raising alarm have been in labs or in animal models that don’t give a complete picture of the effect on humans, says Mary Margaret Johnson, MD, PhD, a principal research scientist of environmental health at Harvard T.H. Chan School of Public Health in Boston. “I do think there needs to be more funding devoted to researching how it really is impacting our organs and disease itself,” she says. What are microplastics? Though plastics have become ubiquitous in modern life, they weren’t invented until the mid-1800s and weren’t produced on a large scale until the 1950s. Over the past century, technology to create a huge variety of malleable polymers (chains of large, repeating molecules) has evolved into the umbrella term plastics, which are often derived from petroleum and other fossil fuels, according to the Science History Institute in Philadelphia. Plastics are used in most containers and packaging materials; in most of the fabrics that make clothing, bedding, carpeting, and towels; in the construction of buildings and motor vehicles; and in many of the materials used in health care settings to prevent the spread of infection, among many other uses. The production of plastics worldwide has doubled in the last two decades, according to Our World in Data. Plastic’s versatility, durability, and low weight-to-strength ratio have made it an efficient material for many of life’s modern conveniences. However, by their nature, plastics can break down and degrade into smaller pieces. At the same time, scientists have found that plastic materials can exist for decades, if not longer, without completely disintegrating. Scientists have studied the impact of plastic on the ecological environment for decades and have raised concerns about the health effects of some chemicals used in plastics. But it’s only within the last several years that researchers have discovered the extent to which microplastics (which range from 1 nanometer, 1/80,000 the width of a strand of hair, to 5 millimeters, the size of a pencil-top eraser) and nanoplastics (which are even smaller and invisible) have become embedded in the environment and in human bodies, explains Tracey Woodruff, PhD, MPH, a professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences and director of the Program on Reproductive Health and the Environment at the University of California San Francisco (UCSF) School of Medicine. Woodruff, who has studied the effect of some chemicals found in plastics on human health, reproduction, and development for two decades, first started looking into microplastics in 2021. She and a group of scientists from across the University of California system reviewed hundreds of existing studies on microplastics and health and compiled a report for state lawmakers to consider during policymaking. Though mostly based on animal studies, Woodruff and her colleagues concluded that there was evidence that microplastics could harm fertility and increase cancer risk in humans. “Governments have not really fully figured out what they’re going to do about this,” Woodruff says. There have been some efforts to ban the use of plastic microbeads in cosmetics, but not much beyond that, she adds. Red flags for human health While there haven’t yet been any definitive studies showing that microplastics cause health problems in humans, researchers have identified several red flags that call for further investigation. In Ross’ research in mice, for example, the scientists used plastic particles that were “clean,” meaning that they did not have any of the known toxic chemicals found in many plastics and they were also free of bacteria and viruses that microplastics can pick up from environmental exposure. And yet, with the mere presence of the microplastics, the mice began to experience negative effects. This could be because the immune system recognizes the presence of a foreign invader and triggers inflammation, which can have a negative effect on a range of organs. “We just wanted to see the effect of plastic itself, but that’s not what is really in the environment,” Ross says. “Plastics in the environment are not this way; they’re not pristine.” Ross’ work has raised even more questions about microplastics in the body. “We’re trying to understand: How are they getting into the brain? What do they do? Where do they go? Do they get out?” she says. Sheela Sathyanarayana, MD, MPH, a professor in the University of Washington Department of Pediatrics and the Department of Environmental and Occupational Health Sciences, worries that the harm from microplastics in the body could be compounded by what are known as endocrine disrupting chemicals that are found in many plastics. Bisphenol A (BPA), phthalates, and per- and polyfluoroalkyl substances (PFAS) are just a few of the chemicals known to imitate hormones and disrupt the body’s natural endocrine system, which is responsible for making the hormones that govern processes such as growth and development, metabolism, appetite, mood, and certain aspects of reproduction. Sathyanarayana has focused her research on studying the impact of exposure to endocrine disrupting chemicals on reproduction and has found that they can have a profound impact, especially during fetal development. “That’s when organ development is happening; that’s when programming for later life happens,” Sathyanarayana says. “Whatever happens during pregnancy will affect your later life and health for the whole continuum.” She gave the example of research that found some women who experience famine while pregnant later have babies who experience obesity, likely because of the effect their mothers’ starvation has on the development of the babies’ metabolism. Fetal exposure to endocrine disrupting chemicals has been associated with abnormal development of reproductive organs in male babies, with increased risk of metabolic disorders in childhood, and may be associated with the child developing attention deficit hyperactivity disorder (ADHD). Some of these chemicals have also been linked to lower sperm quality in men. https://www.aamc.org/news/microplastics-are-inside-us-all-what-does-mean-our-health	<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document] EVIDENCE: When Jaime Ross, PhD, a neuroscientist and assistant professor at the University of Rhode Island College of Pharmacy, decided to study how contaminating the drinking water of mice with tiny fragments of plastic might affect their cognitive function, she didn’t expect the experiment to yield much. But in just three weeks, Ross and her team found microplastics had made their way into the mice’s brains, passing the robust defenses of the blood-brain barrier. The researchers performed a variety of tests and found that the microplastic-exposed mice started exhibiting signs of cognitive decline similar to dementia. “I didn’t really think we were going to see anything,” Ross says. But when they examined the mice’s tissues, they were shocked. “Every one we looked at we found the microplastics. It was surprising, especially finding them in the brain. Things are not supposed to go there!” The research findings from Ross’ team, published in August 2023, add to a slew of recent studies pointing to an alarming trend: microplastics are everywhere. Minuscule plastic particles that come from degraded plastic products are found throughout the environment. Scientists estimate there are 8-10 million metric tons of plastics in the oceans, and some of that is consumed by fish and other wildlife. Microplastics have been detected in fruits and vegetables, plastic water bottles, the air, cosmetics, and household dust. Now, researchers are finding them in almost every part of the human body, including in breast milk, the placenta, testicles, hearts, livers, and kidneys. Despite these findings, experts say that little is known and understood about what impact these microplastics have on human health. A few studies have drawn associations between microplastics and poor health outcomes, including cardiovascular disease and low male fertility. And chemicals often found in plastics are known to cause a variety of health problems, including cancers, metabolic disorders, attention deficit/hyperactivity disorder, and fertility issues. But most of the studies raising alarm have been in labs or in animal models that don’t give a complete picture of the effect on humans, says Mary Margaret Johnson, MD, PhD, a principal research scientist of environmental health at Harvard T.H. Chan School of Public Health in Boston. “I do think there needs to be more funding devoted to researching how it really is impacting our organs and disease itself,” she says. What are microplastics? Though plastics have become ubiquitous in modern life, they weren’t invented until the mid-1800s and weren’t produced on a large scale until the 1950s. Over the past century, technology to create a huge variety of malleable polymers (chains of large, repeating molecules) has evolved into the umbrella term plastics, which are often derived from petroleum and other fossil fuels, according to the Science History Institute in Philadelphia. Plastics are used in most containers and packaging materials; in most of the fabrics that make clothing, bedding, carpeting, and towels; in the construction of buildings and motor vehicles; and in many of the materials used in health care settings to prevent the spread of infection, among many other uses. The production of plastics worldwide has doubled in the last two decades, according to Our World in Data. Plastic’s versatility, durability, and low weight-to-strength ratio have made it an efficient material for many of life’s modern conveniences. However, by their nature, plastics can break down and degrade into smaller pieces. At the same time, scientists have found that plastic materials can exist for decades, if not longer, without completely disintegrating. Scientists have studied the impact of plastic on the ecological environment for decades and have raised concerns about the health effects of some chemicals used in plastics. But it’s only within the last several years that researchers have discovered the extent to which microplastics (which range from 1 nanometer, 1/80,000 the width of a strand of hair, to 5 millimeters, the size of a pencil-top eraser) and nanoplastics (which are even smaller and invisible) have become embedded in the environment and in human bodies, explains Tracey Woodruff, PhD, MPH, a professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences and director of the Program on Reproductive Health and the Environment at the University of California San Francisco (UCSF) School of Medicine. Woodruff, who has studied the effect of some chemicals found in plastics on human health, reproduction, and development for two decades, first started looking into microplastics in 2021. She and a group of scientists from across the University of California system reviewed hundreds of existing studies on microplastics and health and compiled a report for state lawmakers to consider during policymaking. Though mostly based on animal studies, Woodruff and her colleagues concluded that there was evidence that microplastics could harm fertility and increase cancer risk in humans. “Governments have not really fully figured out what they’re going to do about this,” Woodruff says. There have been some efforts to ban the use of plastic microbeads in cosmetics, but not much beyond that, she adds. Red flags for human health While there haven’t yet been any definitive studies showing that microplastics cause health problems in humans, researchers have identified several red flags that call for further investigation. In Ross’ research in mice, for example, the scientists used plastic particles that were “clean,” meaning that they did not have any of the known toxic chemicals found in many plastics and they were also free of bacteria and viruses that microplastics can pick up from environmental exposure. And yet, with the mere presence of the microplastics, the mice began to experience negative effects. This could be because the immune system recognizes the presence of a foreign invader and triggers inflammation, which can have a negative effect on a range of organs. “We just wanted to see the effect of plastic itself, but that’s not what is really in the environment,” Ross says. “Plastics in the environment are not this way; they’re not pristine.” Ross’ work has raised even more questions about microplastics in the body. “We’re trying to understand: How are they getting into the brain? What do they do? Where do they go? Do they get out?” she says. Sheela Sathyanarayana, MD, MPH, a professor in the University of Washington Department of Pediatrics and the Department of Environmental and Occupational Health Sciences, worries that the harm from microplastics in the body could be compounded by what are known as endocrine disrupting chemicals that are found in many plastics. Bisphenol A (BPA), phthalates, and per- and polyfluoroalkyl substances (PFAS) are just a few of the chemicals known to imitate hormones and disrupt the body’s natural endocrine system, which is responsible for making the hormones that govern processes such as growth and development, metabolism, appetite, mood, and certain aspects of reproduction. Sathyanarayana has focused her research on studying the impact of exposure to endocrine disrupting chemicals on reproduction and has found that they can have a profound impact, especially during fetal development. “That’s when organ development is happening; that’s when programming for later life happens,” Sathyanarayana says. “Whatever happens during pregnancy will affect your later life and health for the whole continuum.” She gave the example of research that found some women who experience famine while pregnant later have babies who experience obesity, likely because of the effect their mothers’ starvation has on the development of the babies’ metabolism. Fetal exposure to endocrine disrupting chemicals has been associated with abnormal development of reproductive organs in male babies, with increased risk of metabolic disorders in childhood, and may be associated with the child developing attention deficit hyperactivity disorder (ADHD). Some of these chemicals have also been linked to lower sperm quality in men. USER: I found this alarming article about microplastics making their way into the human body. Using this article as a reference, please explain what the red flags are for humans in regards to microplastics. Use at least 400 words. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	20	38	1,263	null	412
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]	I am a researcher and want to write a review on the impact of human pathogens on health. I am now focusing on group A streptococcus and have no idea what type of diseases this pathogen can cause. Are you able to give me information so that I can write on the topic?	Streptococcus pyogenes, also known as group A Streptococcus (GAS), is a bacterium commonly present in the throat and on the skin (1, 2). This pathogen is notorious for causing strep throat and impetigo, accounting for approximately 700 million non-invasive infections each year (3–5). However, GAS can also lead to serious invasive diseases, including necrotizing fasciitis and streptococcal toxic shock syndrome, resulting in over 150,000 deaths annually (4). Additionally, GAS is the immunological trigger for acute rheumatic fever and rheumatic heart disease, causing substantial death and disability in many developing countries. Despite rising GAS resistance to certain antibiotic classes, the pathogen has fortunately remained susceptible to penicillin and other β-lactam agents (6). There is presently no commercially available vaccine to protect against GAS infection (7). GAS presents a challenge for vaccine antigen selection due to the variability in the abundant surface-exposed M protein with over 230 emm types circulating globally (8). The most common emm type, M1, is a major contributor to GAS global epidemiology and is particularly prominent in severe, invasive infections (9). The search for new GAS antibiotic targets and vaccine candidates is hindered by a knowledge gap in fundamental GAS biology, partly because M1-type GAS strains are exceptionally challenging to manipulate genetically (10, 11). In this study, we present a toolbox for GAS genetic engineering, utilizing the hard-to-transform and clinically relevant M1T1-type strain 5448 (NV1) as a model (1, 12). We selected strain 5448 since it is commonly used, and we reckoned that if our approaches work in this strain, they are highly likely to also work in generally easier-to-work-with GAS strains. This toolbox should be generally applicable to GAS and related bacteria, encompassing protocols for recombineering using GoldenGate-assembled linear DNA, oligo-based single guide RNA (sgRNA) cloning, a titratable doxycycline-inducible promoter, and CRISPR interference (CRISPRi) effective both in vitro and in vivo in a murine GAS infection model. Overall, this work overcomes significant technical challenges of working with GAS, facilitating genetic engineering and targeted gene knockdowns to advance our insights into the physiology and cell biology of this preeminent human bacterial pathogen. GAS5448, a widely used strain in fundamental research, serves as a clinical representative of the globally distributed M1T1 serotype associated with severe invasive infections. While 5448 has been effectively employed in murine models of GAS infection (16, 17), its genetic manipulation poses challenges, with even the construction of transposon mutant libraries proving highly difficult (10, 11, 18). To enhance GAS 5448 transformation efficiencies while retaining full virulence, we targeted one of the major barriers to transformation—the HsdR restriction subunit of the conserved three-component Type I restriction-modification (RM) system, HsdRSM. Hsd, denoting host specificity of DNA, signifies how these Type I RM systems cleave intracellular (foreign) DNA with improper methylation patterns. Mutations in this system improve transformation efficiency in other GAS strains (19–22), but with potential pleiotropic consequences. For example, while the deletion of the entire hsdRSM system in serotype M28 GAS strain MEW123 boosted transformation efficiency, it concurrently reduced virulence in a murine model of infection (20). A spectinomycin marker-replacement mutant eliminating just the restriction subunit hsdR also increased transformation efficiency but led to partially methylated genomic DNA likely due to polar effects (20).	{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I am a researcher and want to write a review on the impact of human pathogens on health. I am now focusing on group A streptococcus and have no idea what type of diseases this pathogen can cause. Are you able to give me information so that I can write on the topic? {passage 0} ========== Streptococcus pyogenes, also known as group A Streptococcus (GAS), is a bacterium commonly present in the throat and on the skin (1, 2). This pathogen is notorious for causing strep throat and impetigo, accounting for approximately 700 million non-invasive infections each year (3–5). However, GAS can also lead to serious invasive diseases, including necrotizing fasciitis and streptococcal toxic shock syndrome, resulting in over 150,000 deaths annually (4). Additionally, GAS is the immunological trigger for acute rheumatic fever and rheumatic heart disease, causing substantial death and disability in many developing countries. Despite rising GAS resistance to certain antibiotic classes, the pathogen has fortunately remained susceptible to penicillin and other β-lactam agents (6). There is presently no commercially available vaccine to protect against GAS infection (7). GAS presents a challenge for vaccine antigen selection due to the variability in the abundant surface-exposed M protein with over 230 emm types circulating globally (8). The most common emm type, M1, is a major contributor to GAS global epidemiology and is particularly prominent in severe, invasive infections (9). The search for new GAS antibiotic targets and vaccine candidates is hindered by a knowledge gap in fundamental GAS biology, partly because M1-type GAS strains are exceptionally challenging to manipulate genetically (10, 11). In this study, we present a toolbox for GAS genetic engineering, utilizing the hard-to-transform and clinically relevant M1T1-type strain 5448 (NV1) as a model (1, 12). We selected strain 5448 since it is commonly used, and we reckoned that if our approaches work in this strain, they are highly likely to also work in generally easier-to-work-with GAS strains. This toolbox should be generally applicable to GAS and related bacteria, encompassing protocols for recombineering using GoldenGate-assembled linear DNA, oligo-based single guide RNA (sgRNA) cloning, a titratable doxycycline-inducible promoter, and CRISPR interference (CRISPRi) effective both in vitro and in vivo in a murine GAS infection model. Overall, this work overcomes significant technical challenges of working with GAS, facilitating genetic engineering and targeted gene knockdowns to advance our insights into the physiology and cell biology of this preeminent human bacterial pathogen. GAS5448, a widely used strain in fundamental research, serves as a clinical representative of the globally distributed M1T1 serotype associated with severe invasive infections. While 5448 has been effectively employed in murine models of GAS infection (16, 17), its genetic manipulation poses challenges, with even the construction of transposon mutant libraries proving highly difficult (10, 11, 18). To enhance GAS 5448 transformation efficiencies while retaining full virulence, we targeted one of the major barriers to transformation—the HsdR restriction subunit of the conserved three-component Type I restriction-modification (RM) system, HsdRSM. Hsd, denoting host specificity of DNA, signifies how these Type I RM systems cleave intracellular (foreign) DNA with improper methylation patterns. Mutations in this system improve transformation efficiency in other GAS strains (19–22), but with potential pleiotropic consequences. For example, while the deletion of the entire hsdRSM system in serotype M28 GAS strain MEW123 boosted transformation efficiency, it concurrently reduced virulence in a murine model of infection (20). A spectinomycin marker-replacement mutant eliminating just the restriction subunit hsdR also increased transformation efficiency but led to partially methylated genomic DNA likely due to polar effects (20). https://journals.asm.org/doi/full/10.1128/mbio.00840-24?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org	{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document] EVIDENCE: Streptococcus pyogenes, also known as group A Streptococcus (GAS), is a bacterium commonly present in the throat and on the skin (1, 2). This pathogen is notorious for causing strep throat and impetigo, accounting for approximately 700 million non-invasive infections each year (3–5). However, GAS can also lead to serious invasive diseases, including necrotizing fasciitis and streptococcal toxic shock syndrome, resulting in over 150,000 deaths annually (4). Additionally, GAS is the immunological trigger for acute rheumatic fever and rheumatic heart disease, causing substantial death and disability in many developing countries. Despite rising GAS resistance to certain antibiotic classes, the pathogen has fortunately remained susceptible to penicillin and other β-lactam agents (6). There is presently no commercially available vaccine to protect against GAS infection (7). GAS presents a challenge for vaccine antigen selection due to the variability in the abundant surface-exposed M protein with over 230 emm types circulating globally (8). The most common emm type, M1, is a major contributor to GAS global epidemiology and is particularly prominent in severe, invasive infections (9). The search for new GAS antibiotic targets and vaccine candidates is hindered by a knowledge gap in fundamental GAS biology, partly because M1-type GAS strains are exceptionally challenging to manipulate genetically (10, 11). In this study, we present a toolbox for GAS genetic engineering, utilizing the hard-to-transform and clinically relevant M1T1-type strain 5448 (NV1) as a model (1, 12). We selected strain 5448 since it is commonly used, and we reckoned that if our approaches work in this strain, they are highly likely to also work in generally easier-to-work-with GAS strains. This toolbox should be generally applicable to GAS and related bacteria, encompassing protocols for recombineering using GoldenGate-assembled linear DNA, oligo-based single guide RNA (sgRNA) cloning, a titratable doxycycline-inducible promoter, and CRISPR interference (CRISPRi) effective both in vitro and in vivo in a murine GAS infection model. Overall, this work overcomes significant technical challenges of working with GAS, facilitating genetic engineering and targeted gene knockdowns to advance our insights into the physiology and cell biology of this preeminent human bacterial pathogen. GAS5448, a widely used strain in fundamental research, serves as a clinical representative of the globally distributed M1T1 serotype associated with severe invasive infections. While 5448 has been effectively employed in murine models of GAS infection (16, 17), its genetic manipulation poses challenges, with even the construction of transposon mutant libraries proving highly difficult (10, 11, 18). To enhance GAS 5448 transformation efficiencies while retaining full virulence, we targeted one of the major barriers to transformation—the HsdR restriction subunit of the conserved three-component Type I restriction-modification (RM) system, HsdRSM. Hsd, denoting host specificity of DNA, signifies how these Type I RM systems cleave intracellular (foreign) DNA with improper methylation patterns. Mutations in this system improve transformation efficiency in other GAS strains (19–22), but with potential pleiotropic consequences. For example, while the deletion of the entire hsdRSM system in serotype M28 GAS strain MEW123 boosted transformation efficiency, it concurrently reduced virulence in a murine model of infection (20). A spectinomycin marker-replacement mutant eliminating just the restriction subunit hsdR also increased transformation efficiency but led to partially methylated genomic DNA likely due to polar effects (20). USER: I am a researcher and want to write a review on the impact of human pathogens on health. I am now focusing on group A streptococcus and have no idea what type of diseases this pathogen can cause. Are you able to give me information so that I can write on the topic? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	26	53	528	null	291
Draw your answer from the above text only. Write in complete sentences and limit your answer to 150 words and 2 paragraphs. Do not use bullet points or bolding.	Detail the strategies the government is employing to encourage compliance in the tax system.	1.10 Increasing the effectiveness of the Office of Tax Simplification (OTS) – The government is publishing its first five-year review of the OTS, launched in March 2021, to examine the effectiveness of the OTS. It makes eight recommendations. 1.11 Response to Office of Tax Simplification Review of Capital Gains Tax (CGT) – The government is publishing its response to the OTS’s two-part review of CGT. The government has carefully considered the OTS’s recommendations and will keep the CGT system under review to ensure it is simple and efficient. The government has accepted five of the technical recommendations in the OTS’s second report and will work towards their implementation. 1.12 Response to Office of Tax Simplification Review of Inheritance Tax (IHT) – The government is publishing its response to the OTS’s review of the design of IHT. It has decided not to proceed with any changes at this point in time. The government responded to the OTS’s review of the administration of IHT in March 2021. 6 Chapter 2 Tackling non-compliance 2.1 Since 2010 the government has introduced over 150 new measures and invested over £2 billion in HMRC to tackle non-compliance in the tax system – this has secured and protected over £250 billion which would otherwise have gone unpaid. Significant reforms include: the introduction of the General Anti-Abuse Rule; Accelerated Payments; the implementation of the OECD Base Erosion and Profit Shifting Action Plan; and a range of measures to clamp down on promoters of tax avoidance. The measures announced in this document build on that strong base and further the government’s aim for everyone to pay the tax that is legally due, no matter who they are. 2.2 Modernising tax debt collection for non-paying businesses – The government is publishing a call for evidence on how HMRC can modernise its collection of tax debts to reflect the changing nature of the economy, where an increased use of e-commerce has given rise to new business practices – including the conduct of business in the UK without having a presence or physical assets here. The call for evidence also seeks views on HMRC’s approach to the small minority of business taxpayers who do not engage with HMRC and hold off paying their tax for as long as they can, forcing HMRC to resort to costly and time-consuming enforcement action. The proposals will not affect taxpayers who are in temporary financial difficulty and need support from HMRC to get back onto a sustainable financial footing – including those affected by the Covid-19 pandemic. 2.3 OECD’s Model Mandatory Disclosure Rules to tackle non-compliance – At Spring Budget 2021, the government announced that it would implement the OECD’s Model Mandatory Disclosure Rules. The government is now issuing a technical consultation and draft regulations. Mandatory Disclosure Rules require advisers (and sometimes taxpayers) to report information to the tax authorities on certain prescribed arrangements and structures, including those that could circumvent existing tax transparency reporting rules known as the Common Reporting Standard. This information will be exchanged with relevant tax authorities to help deter non-compliance, assist in identifying and challenging evasion, and support the development of tax policy. 2.4 Improving Transfer Pricing Documentation – The government is publishing a summary of responses to the consultation that closed in June 2021. It will legislate in 2022 to require businesses that are in scope of country-by-country reporting to maintain a master file and local file in line with OECD Base Erosion and Profit Shifting Action 13, and a supporting 7 summary audit trail. These changes will take effect from April 2023. The government will continue to review the case for companies to submit an International Dealings Schedule. 2.5 Extending tax conditionality to licences in Scotland and Northern Ireland – The government is publishing a summary of responses to the consultation on extending tax conditionality to certain licences in Scotland and Northern Ireland from April 2023. This makes the renewal of certain licences conditional on applicants completing checks that confirm they are appropriately registered for tax. The policy will be developed through continued engagement with the Devolved Administrations and is consistent with reforms which come into force in England and Wales in April 2022. Licensing bodies will have to obtain confirmation that an applicant has completed the check before deciding on their renewal application, making it more difficult for traders to operate in the hidden economy. The government remains committed to exploring further the wider application of tax conditionality. 2.6 Strengthening and modernising Individual Savings Accounts (ISA) compliance and penalties – In December 2020, the Economic Secretary to the Treasury announced that: “The Treasury is urgently looking at the sufficiency of checks on IF [Innovative Finance] ISA managers and the penalties regime.” Following that announcement, the government is now publishing a call for evidence on proposals to enhance ISA compliance, which will help determine how the current approach can be strengthened and modernised to encourage ISA managers and investors to get things right first time. The proposals apply to all types of ISA – Cash, Stocks and Shares, Junior, Lifetime and Innovative Finance. 2.7 Consulting on making Stamp Duty Land Tax (SDLT) reliefs fairer – The government is publishing a consultation on the SDLT reliefs for purchases of mixed property and multiple dwellings. These reliefs are being exploited by some purchasers to unfairly reduce their tax liability. This consultation sets out potential changes to make the system fairer and reduce the scope for misuse and incorrect claims. 2.8 New stakeholder forum on tackling offshore tax non-compliance – The government has established an HMRC stakeholder forum with representative bodies and agents to explore ideas to tackle offshore tax non-compliance. This follows from the publication of two discussion documents in spring 2021, as part of implementing HMRC’s ‘No Safe Havens’ strategy. The documents sought views on how to help taxpayers reduce offshore noncompliance in relation to non-UK income, gains and assets, and how to reduce and prevent international tax debt. 2.9 Exploring the potential of VAT split payment – The government is committed to exploring further VAT split payment, an alternative method of VAT collection where the tax element of a digital payment could be remitted directly to HMRC. While the work is at an exploratory stage, the government will continue to assess the potential of split payment both for tackling overseas VAT non-compliance and wider tax modernisation. The government 8 is grateful for the ongoing input of stakeholders in the payments industry and will continue to take this work forward collaboratively, including through the Industry Working Group established in 2018. 2.10 Use of marketed tax avoidance schemes in the UK – HMRC is publishing its annual report on the use of marketed tax avoidance schemes in the UK. It sets out the numbers and characteristics of taxpayers using avoidance schemes in the tax year 2019-2020. The report includes data on occupations, locations, ages and the average declared incomes of those involved in avoidance. 9 Chapter 3 Further tax policy announcements 3.1 It is important that the tax system continues to be fit for the modern world, and that government continues to take action to level the playing field and increase transparency. The policies set out in this section open new consultations on promising areas for potential reform and set out next steps on reform work already underway. Taxes fit for the modern world 3.2 Ensuring Landfill Tax continues to support environmental objectives – In spring 2021, the government announced it would review aspects of Landfill Tax in England and Northern Ireland. It is now launching a call for evidence, focused on how Landfill Tax can continue to support the government's ambitious environmental objectives, including achieving zero avoidable waste by 2050.	Detail the strategies the government is employing to encourage compliance in the tax system. 1.10 Increasing the effectiveness of the Office of Tax Simplification (OTS) – The government is publishing its first five-year review of the OTS, launched in March 2021, to examine the effectiveness of the OTS. It makes eight recommendations. 1.11 Response to Office of Tax Simplification Review of Capital Gains Tax (CGT) – The government is publishing its response to the OTS’s two-part review of CGT. The government has carefully considered the OTS’s recommendations and will keep the CGT system under review to ensure it is simple and efficient. The government has accepted five of the technical recommendations in the OTS’s second report and will work towards their implementation. 1.12 Response to Office of Tax Simplification Review of Inheritance Tax (IHT) – The government is publishing its response to the OTS’s review of the design of IHT. It has decided not to proceed with any changes at this point in time. The government responded to the OTS’s review of the administration of IHT in March 2021. 6 Chapter 2 Tackling non-compliance 2.1 Since 2010 the government has introduced over 150 new measures and invested over £2 billion in HMRC to tackle non-compliance in the tax system – this has secured and protected over £250 billion which would otherwise have gone unpaid. Significant reforms include: the introduction of the General Anti-Abuse Rule; Accelerated Payments; the implementation of the OECD Base Erosion and Profit Shifting Action Plan; and a range of measures to clamp down on promoters of tax avoidance. The measures announced in this document build on that strong base and further the government’s aim for everyone to pay the tax that is legally due, no matter who they are. 2.2 Modernising tax debt collection for non-paying businesses – The government is publishing a call for evidence on how HMRC can modernise its collection of tax debts to reflect the changing nature of the economy, where an increased use of e-commerce has given rise to new business practices – including the conduct of business in the UK without having a presence or physical assets here. The call for evidence also seeks views on HMRC’s approach to the small minority of business taxpayers who do not engage with HMRC and hold off paying their tax for as long as they can, forcing HMRC to resort to costly and time-consuming enforcement action. The proposals will not affect taxpayers who are in temporary financial difficulty and need support from HMRC to get back onto a sustainable financial footing – including those affected by the Covid-19 pandemic. 2.3 OECD’s Model Mandatory Disclosure Rules to tackle non-compliance – At Spring Budget 2021, the government announced that it would implement the OECD’s Model Mandatory Disclosure Rules. The government is now issuing a technical consultation and draft regulations. Mandatory Disclosure Rules require advisers (and sometimes taxpayers) to report information to the tax authorities on certain prescribed arrangements and structures, including those that could circumvent existing tax transparency reporting rules known as the Common Reporting Standard. This information will be exchanged with relevant tax authorities to help deter non-compliance, assist in identifying and challenging evasion, and support the development of tax policy. 2.4 Improving Transfer Pricing Documentation – The government is publishing a summary of responses to the consultation that closed in June 2021. It will legislate in 2022 to require businesses that are in scope of country-by-country reporting to maintain a master file and local file in line with OECD Base Erosion and Profit Shifting Action 13, and a supporting 7 summary audit trail. These changes will take effect from April 2023. The government will continue to review the case for companies to submit an International Dealings Schedule. 2.5 Extending tax conditionality to licences in Scotland and Northern Ireland – The government is publishing a summary of responses to the consultation on extending tax conditionality to certain licences in Scotland and Northern Ireland from April 2023. This makes the renewal of certain licences conditional on applicants completing checks that confirm they are appropriately registered for tax. The policy will be developed through continued engagement with the Devolved Administrations and is consistent with reforms which come into force in England and Wales in April 2022. Licensing bodies will have to obtain confirmation that an applicant has completed the check before deciding on their renewal application, making it more difficult for traders to operate in the hidden economy. The government remains committed to exploring further the wider application of tax conditionality. 2.6 Strengthening and modernising Individual Savings Accounts (ISA) compliance and penalties – In December 2020, the Economic Secretary to the Treasury announced that: “The Treasury is urgently looking at the sufficiency of checks on IF [Innovative Finance] ISA managers and the penalties regime.” Following that announcement, the government is now publishing a call for evidence on proposals to enhance ISA compliance, which will help determine how the current approach can be strengthened and modernised to encourage ISA managers and investors to get things right first time. The proposals apply to all types of ISA – Cash, Stocks and Shares, Junior, Lifetime and Innovative Finance. 2.7 Consulting on making Stamp Duty Land Tax (SDLT) reliefs fairer – The government is publishing a consultation on the SDLT reliefs for purchases of mixed property and multiple dwellings. These reliefs are being exploited by some purchasers to unfairly reduce their tax liability. This consultation sets out potential changes to make the system fairer and reduce the scope for misuse and incorrect claims. 2.8 New stakeholder forum on tackling offshore tax non-compliance – The government has established an HMRC stakeholder forum with representative bodies and agents to explore ideas to tackle offshore tax non-compliance. This follows from the publication of two discussion documents in spring 2021, as part of implementing HMRC’s ‘No Safe Havens’ strategy. The documents sought views on how to help taxpayers reduce offshore noncompliance in relation to non-UK income, gains and assets, and how to reduce and prevent international tax debt. 2.9 Exploring the potential of VAT split payment – The government is committed to exploring further VAT split payment, an alternative method of VAT collection where the tax element of a digital payment could be remitted directly to HMRC. While the work is at an exploratory stage, the government will continue to assess the potential of split payment both for tackling overseas VAT non-compliance and wider tax modernisation. The government 8 is grateful for the ongoing input of stakeholders in the payments industry and will continue to take this work forward collaboratively, including through the Industry Working Group established in 2018. 2.10 Use of marketed tax avoidance schemes in the UK – HMRC is publishing its annual report on the use of marketed tax avoidance schemes in the UK. It sets out the numbers and characteristics of taxpayers using avoidance schemes in the tax year 2019-2020. The report includes data on occupations, locations, ages and the average declared incomes of those involved in avoidance. 9 Chapter 3 Further tax policy announcements 3.1 It is important that the tax system continues to be fit for the modern world, and that government continues to take action to level the playing field and increase transparency. The policies set out in this section open new consultations on promising areas for potential reform and set out next steps on reform work already underway. Taxes fit for the modern world 3.2 Ensuring Landfill Tax continues to support environmental objectives – In spring 2021, the government announced it would review aspects of Landfill Tax in England and Northern Ireland. It is now launching a call for evidence, focused on how Landfill Tax can continue to support the government's ambitious environmental objectives, including achieving zero avoidable waste by 2050. Draw your answer from the above text only. Write in complete sentences and limit your answer to 150 words and 2 paragraphs. Do not use bullet points or bolding.	Draw your answer from the above text only. Write in complete sentences and limit your answer to 150 words and 2 paragraphs. Do not use bullet points or bolding. EVIDENCE: 1.10 Increasing the effectiveness of the Office of Tax Simplification (OTS) – The government is publishing its first five-year review of the OTS, launched in March 2021, to examine the effectiveness of the OTS. It makes eight recommendations. 1.11 Response to Office of Tax Simplification Review of Capital Gains Tax (CGT) – The government is publishing its response to the OTS’s two-part review of CGT. The government has carefully considered the OTS’s recommendations and will keep the CGT system under review to ensure it is simple and efficient. The government has accepted five of the technical recommendations in the OTS’s second report and will work towards their implementation. 1.12 Response to Office of Tax Simplification Review of Inheritance Tax (IHT) – The government is publishing its response to the OTS’s review of the design of IHT. It has decided not to proceed with any changes at this point in time. The government responded to the OTS’s review of the administration of IHT in March 2021. 6 Chapter 2 Tackling non-compliance 2.1 Since 2010 the government has introduced over 150 new measures and invested over £2 billion in HMRC to tackle non-compliance in the tax system – this has secured and protected over £250 billion which would otherwise have gone unpaid. Significant reforms include: the introduction of the General Anti-Abuse Rule; Accelerated Payments; the implementation of the OECD Base Erosion and Profit Shifting Action Plan; and a range of measures to clamp down on promoters of tax avoidance. The measures announced in this document build on that strong base and further the government’s aim for everyone to pay the tax that is legally due, no matter who they are. 2.2 Modernising tax debt collection for non-paying businesses – The government is publishing a call for evidence on how HMRC can modernise its collection of tax debts to reflect the changing nature of the economy, where an increased use of e-commerce has given rise to new business practices – including the conduct of business in the UK without having a presence or physical assets here. The call for evidence also seeks views on HMRC’s approach to the small minority of business taxpayers who do not engage with HMRC and hold off paying their tax for as long as they can, forcing HMRC to resort to costly and time-consuming enforcement action. The proposals will not affect taxpayers who are in temporary financial difficulty and need support from HMRC to get back onto a sustainable financial footing – including those affected by the Covid-19 pandemic. 2.3 OECD’s Model Mandatory Disclosure Rules to tackle non-compliance – At Spring Budget 2021, the government announced that it would implement the OECD’s Model Mandatory Disclosure Rules. The government is now issuing a technical consultation and draft regulations. Mandatory Disclosure Rules require advisers (and sometimes taxpayers) to report information to the tax authorities on certain prescribed arrangements and structures, including those that could circumvent existing tax transparency reporting rules known as the Common Reporting Standard. This information will be exchanged with relevant tax authorities to help deter non-compliance, assist in identifying and challenging evasion, and support the development of tax policy. 2.4 Improving Transfer Pricing Documentation – The government is publishing a summary of responses to the consultation that closed in June 2021. It will legislate in 2022 to require businesses that are in scope of country-by-country reporting to maintain a master file and local file in line with OECD Base Erosion and Profit Shifting Action 13, and a supporting 7 summary audit trail. These changes will take effect from April 2023. The government will continue to review the case for companies to submit an International Dealings Schedule. 2.5 Extending tax conditionality to licences in Scotland and Northern Ireland – The government is publishing a summary of responses to the consultation on extending tax conditionality to certain licences in Scotland and Northern Ireland from April 2023. This makes the renewal of certain licences conditional on applicants completing checks that confirm they are appropriately registered for tax. The policy will be developed through continued engagement with the Devolved Administrations and is consistent with reforms which come into force in England and Wales in April 2022. Licensing bodies will have to obtain confirmation that an applicant has completed the check before deciding on their renewal application, making it more difficult for traders to operate in the hidden economy. The government remains committed to exploring further the wider application of tax conditionality. 2.6 Strengthening and modernising Individual Savings Accounts (ISA) compliance and penalties – In December 2020, the Economic Secretary to the Treasury announced that: “The Treasury is urgently looking at the sufficiency of checks on IF [Innovative Finance] ISA managers and the penalties regime.” Following that announcement, the government is now publishing a call for evidence on proposals to enhance ISA compliance, which will help determine how the current approach can be strengthened and modernised to encourage ISA managers and investors to get things right first time. The proposals apply to all types of ISA – Cash, Stocks and Shares, Junior, Lifetime and Innovative Finance. 2.7 Consulting on making Stamp Duty Land Tax (SDLT) reliefs fairer – The government is publishing a consultation on the SDLT reliefs for purchases of mixed property and multiple dwellings. These reliefs are being exploited by some purchasers to unfairly reduce their tax liability. This consultation sets out potential changes to make the system fairer and reduce the scope for misuse and incorrect claims. 2.8 New stakeholder forum on tackling offshore tax non-compliance – The government has established an HMRC stakeholder forum with representative bodies and agents to explore ideas to tackle offshore tax non-compliance. This follows from the publication of two discussion documents in spring 2021, as part of implementing HMRC’s ‘No Safe Havens’ strategy. The documents sought views on how to help taxpayers reduce offshore noncompliance in relation to non-UK income, gains and assets, and how to reduce and prevent international tax debt. 2.9 Exploring the potential of VAT split payment – The government is committed to exploring further VAT split payment, an alternative method of VAT collection where the tax element of a digital payment could be remitted directly to HMRC. While the work is at an exploratory stage, the government will continue to assess the potential of split payment both for tackling overseas VAT non-compliance and wider tax modernisation. The government 8 is grateful for the ongoing input of stakeholders in the payments industry and will continue to take this work forward collaboratively, including through the Industry Working Group established in 2018. 2.10 Use of marketed tax avoidance schemes in the UK – HMRC is publishing its annual report on the use of marketed tax avoidance schemes in the UK. It sets out the numbers and characteristics of taxpayers using avoidance schemes in the tax year 2019-2020. The report includes data on occupations, locations, ages and the average declared incomes of those involved in avoidance. 9 Chapter 3 Further tax policy announcements 3.1 It is important that the tax system continues to be fit for the modern world, and that government continues to take action to level the playing field and increase transparency. The policies set out in this section open new consultations on promising areas for potential reform and set out next steps on reform work already underway. Taxes fit for the modern world 3.2 Ensuring Landfill Tax continues to support environmental objectives – In spring 2021, the government announced it would review aspects of Landfill Tax in England and Northern Ireland. It is now launching a call for evidence, focused on how Landfill Tax can continue to support the government's ambitious environmental objectives, including achieving zero avoidable waste by 2050. USER: Detail the strategies the government is employing to encourage compliance in the tax system. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	29	14	1,280	null	181
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]	Analyze the development of gene therapies for Metachromatic Leukodystrophy (MLD) and Severe Combined Immunodeficiency (SCID), focusing on the role of lentiviral vectors in their success. Discuss the mechanisms by which Libmeldy and OTL-101 function. Evaluate the long-term clinical efficacy of these therapies, particularly in terms of enzyme activity levels in patients, and the associated impact on survival rates.	Revolutionary gene therapy technique, developed with support from MRC, has led to life-saving treatment for rare genetic childhood disease. Metachromatic leukodystrophy (MLD) is a rare genetic disease that effects children and causes severe damage to the nervous system and organs, resulting in a life expectancy of between just five and eight years. In February 2023, it was announced by the NHS that a 19-month-old baby had become the first child in the UK to receive a life-saving gene therapy treatment for MLD. Previously, it was not possible to stop the disease and treatment was aimed at relieving symptoms using a variety of drugs to ease muscle spasms, treat infections and control seizures. Metachromatic leukodystrophy MLD is caused by an abnormal build-up of substances called sulphatides in the nerve cells, particularly in the white matter of the brain. The build-up takes the place of myelin, the insulating material which is essential for normal transmission of messages between nerves. Normally this build-up is broken down and removed from the body by an enzyme called arylsulphatase A. But in MLD the gene responsible for producing the enzyme is faulty so the normal process cannot occur. Curing the disease requires adding in a good version of the gene for the enzyme by a one-time therapy called ‘Libmeldy’. The therapy works by removing the patient’s stems cells and using lentiviral vectors, a type of virus-based delivery system, to introduce the correct gene, and then injecting the treated cells back into the patient. Gene therapy using lentiviral vectors The development of gene therapy for inherited childhood diseases such as MLD has required long term research funding investment. The Medical Research Council (MRC) has been a major funder of UK gene therapy research for more than 20 years. This includes Professor Gaspar’s studies of rare inherited childhood diseases and lentiviral vectors that have formed the basis of this MLD breakthrough. ‘Bubble boy disease’ Young patient stood with doctor, both are smiling Professor Bobby Gaspar and Teigan, who received treatment for severe combined immunodeficiency. Credit: Great Ormond Street Hospital One of Professor Gaspar’s early successes was the development of a treatment of the rare immune disorder ‘bubble boy disease’. ‘Bubble boy disease’ is so called because affected children have severe combined immunodeficiency (SCID) and are extremely vulnerable to infectious diseases, some of them had become famous for living in a sterile environment. In the most severe forms, children with SCID are unable to fight off even very mild infections and, without treatment, will usually die within the first year of life. Several years of research was done by Bobby Gaspar at Great Ormond Street Hospital and the UCL Institute of Child Health. This focused on developing a gene therapy treatment for a type of SCID known as adenosine deaminase deficiency (ADA), characterised by the lack of an enzyme called adenosine deaminase. Support from MRC’s Developmental Pathway Funding Scheme took this therapy, now called OTL-101, into the clinic and supported the establishment of Orchard Therapeutics. Orchard Therapeutics In 2017, both US and UK drug regulatory authorities granted OTL-101 designations reserved for treatments addressing high unmet need. These developments showed the commercial potential of Professor Gaspar’s work and highlight gene therapy’s ability to improve human health. In April 2018, GlaxoSmithKline signed a strategic agreement to transfer its rare disease gene therapy portfolio to Orchard Therapeutics, strengthening Orchard’s position as a global leader in gene therapy for rare diseases. In May 2021 the researchers followed up 50 patients treated for ADA-SCID with OTL-101, and the results showed 100% survival. Over 95% of the patients had sustained expression of the ADA enzyme showing that the gene therapy was successful, after two to three years following the treatment.	<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> Analyze the development of gene therapies for Metachromatic Leukodystrophy (MLD) and Severe Combined Immunodeficiency (SCID), focusing on the role of lentiviral vectors in their success. Discuss the mechanisms by which Libmeldy and OTL-101 function. Evaluate the long-term clinical efficacy of these therapies, particularly in terms of enzyme activity levels in patients, and the associated impact on survival rates. <TEXT> Revolutionary gene therapy technique, developed with support from MRC, has led to life-saving treatment for rare genetic childhood disease. Metachromatic leukodystrophy (MLD) is a rare genetic disease that effects children and causes severe damage to the nervous system and organs, resulting in a life expectancy of between just five and eight years. In February 2023, it was announced by the NHS that a 19-month-old baby had become the first child in the UK to receive a life-saving gene therapy treatment for MLD. Previously, it was not possible to stop the disease and treatment was aimed at relieving symptoms using a variety of drugs to ease muscle spasms, treat infections and control seizures. Metachromatic leukodystrophy MLD is caused by an abnormal build-up of substances called sulphatides in the nerve cells, particularly in the white matter of the brain. The build-up takes the place of myelin, the insulating material which is essential for normal transmission of messages between nerves. Normally this build-up is broken down and removed from the body by an enzyme called arylsulphatase A. But in MLD the gene responsible for producing the enzyme is faulty so the normal process cannot occur. Curing the disease requires adding in a good version of the gene for the enzyme by a one-time therapy called ‘Libmeldy’. The therapy works by removing the patient’s stems cells and using lentiviral vectors, a type of virus-based delivery system, to introduce the correct gene, and then injecting the treated cells back into the patient. Gene therapy using lentiviral vectors The development of gene therapy for inherited childhood diseases such as MLD has required long term research funding investment. The Medical Research Council (MRC) has been a major funder of UK gene therapy research for more than 20 years. This includes Professor Gaspar’s studies of rare inherited childhood diseases and lentiviral vectors that have formed the basis of this MLD breakthrough. ‘Bubble boy disease’ Young patient stood with doctor, both are smiling Professor Bobby Gaspar and Teigan, who received treatment for severe combined immunodeficiency. Credit: Great Ormond Street Hospital One of Professor Gaspar’s early successes was the development of a treatment of the rare immune disorder ‘bubble boy disease’. ‘Bubble boy disease’ is so called because affected children have severe combined immunodeficiency (SCID) and are extremely vulnerable to infectious diseases, some of them had become famous for living in a sterile environment. In the most severe forms, children with SCID are unable to fight off even very mild infections and, without treatment, will usually die within the first year of life. Several years of research was done by Bobby Gaspar at Great Ormond Street Hospital and the UCL Institute of Child Health. This focused on developing a gene therapy treatment for a type of SCID known as adenosine deaminase deficiency (ADA), characterised by the lack of an enzyme called adenosine deaminase. Support from MRC’s Developmental Pathway Funding Scheme took this therapy, now called OTL-101, into the clinic and supported the establishment of Orchard Therapeutics. Orchard Therapeutics In 2017, both US and UK drug regulatory authorities granted OTL-101 designations reserved for treatments addressing high unmet need. These developments showed the commercial potential of Professor Gaspar’s work and highlight gene therapy’s ability to improve human health. In April 2018, GlaxoSmithKline signed a strategic agreement to transfer its rare disease gene therapy portfolio to Orchard Therapeutics, strengthening Orchard’s position as a global leader in gene therapy for rare diseases. In May 2021 the researchers followed up 50 patients treated for ADA-SCID with OTL-101, and the results showed 100% survival. Over 95% of the patients had sustained expression of the ADA enzyme showing that the gene therapy was successful, after two to three years following the treatment. https://www.ukri.org/who-we-are/how-we-are-doing/research-outcomes-and-impact/mrc/mrc-funded-discovery-science-underpins-gene-therapy-cures/	<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document] EVIDENCE: Revolutionary gene therapy technique, developed with support from MRC, has led to life-saving treatment for rare genetic childhood disease. Metachromatic leukodystrophy (MLD) is a rare genetic disease that effects children and causes severe damage to the nervous system and organs, resulting in a life expectancy of between just five and eight years. In February 2023, it was announced by the NHS that a 19-month-old baby had become the first child in the UK to receive a life-saving gene therapy treatment for MLD. Previously, it was not possible to stop the disease and treatment was aimed at relieving symptoms using a variety of drugs to ease muscle spasms, treat infections and control seizures. Metachromatic leukodystrophy MLD is caused by an abnormal build-up of substances called sulphatides in the nerve cells, particularly in the white matter of the brain. The build-up takes the place of myelin, the insulating material which is essential for normal transmission of messages between nerves. Normally this build-up is broken down and removed from the body by an enzyme called arylsulphatase A. But in MLD the gene responsible for producing the enzyme is faulty so the normal process cannot occur. Curing the disease requires adding in a good version of the gene for the enzyme by a one-time therapy called ‘Libmeldy’. The therapy works by removing the patient’s stems cells and using lentiviral vectors, a type of virus-based delivery system, to introduce the correct gene, and then injecting the treated cells back into the patient. Gene therapy using lentiviral vectors The development of gene therapy for inherited childhood diseases such as MLD has required long term research funding investment. The Medical Research Council (MRC) has been a major funder of UK gene therapy research for more than 20 years. This includes Professor Gaspar’s studies of rare inherited childhood diseases and lentiviral vectors that have formed the basis of this MLD breakthrough. ‘Bubble boy disease’ Young patient stood with doctor, both are smiling Professor Bobby Gaspar and Teigan, who received treatment for severe combined immunodeficiency. Credit: Great Ormond Street Hospital One of Professor Gaspar’s early successes was the development of a treatment of the rare immune disorder ‘bubble boy disease’. ‘Bubble boy disease’ is so called because affected children have severe combined immunodeficiency (SCID) and are extremely vulnerable to infectious diseases, some of them had become famous for living in a sterile environment. In the most severe forms, children with SCID are unable to fight off even very mild infections and, without treatment, will usually die within the first year of life. Several years of research was done by Bobby Gaspar at Great Ormond Street Hospital and the UCL Institute of Child Health. This focused on developing a gene therapy treatment for a type of SCID known as adenosine deaminase deficiency (ADA), characterised by the lack of an enzyme called adenosine deaminase. Support from MRC’s Developmental Pathway Funding Scheme took this therapy, now called OTL-101, into the clinic and supported the establishment of Orchard Therapeutics. Orchard Therapeutics In 2017, both US and UK drug regulatory authorities granted OTL-101 designations reserved for treatments addressing high unmet need. These developments showed the commercial potential of Professor Gaspar’s work and highlight gene therapy’s ability to improve human health. In April 2018, GlaxoSmithKline signed a strategic agreement to transfer its rare disease gene therapy portfolio to Orchard Therapeutics, strengthening Orchard’s position as a global leader in gene therapy for rare diseases. In May 2021 the researchers followed up 50 patients treated for ADA-SCID with OTL-101, and the results showed 100% survival. Over 95% of the patients had sustained expression of the ADA enzyme showing that the gene therapy was successful, after two to three years following the treatment. USER: Analyze the development of gene therapies for Metachromatic Leukodystrophy (MLD) and Severe Combined Immunodeficiency (SCID), focusing on the role of lentiviral vectors in their success. Discuss the mechanisms by which Libmeldy and OTL-101 function. Evaluate the long-term clinical efficacy of these therapies, particularly in terms of enzyme activity levels in patients, and the associated impact on survival rates. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	20	58	615	null	587
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. Answer in twenty words or less, do not use bullet points or lists in your answer.	What legal basis is being used to analyze the merger between Microsoft and Activision Blizzard?	On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23 Microsoft and Activision Blizzard in the Video Game Industry Microsoft distributes video games using Microsoft Store, its subscription service Game Pass,24 and its cloud gaming service Xbox Cloud Gaming (Beta);25 publishes games, including the franchises Halo and Minecraft; 26 and owns 23 gaming studios.27 In 2021, Microsoft had the second-highest share in the U.S. market for game consoles at 34.8%, according to a report from MarketLine, an industry research firm; estimates for Sony and Nintendo were 40.7% and 24.5%, respectively.28 In January 2022, Microsoft stated that it had more than 25 million Game Pass subscribers.29 In April 2022, Microsoft reported that more than 10 million people have streamed games over Xbox Cloud Gaming,30 although it is unclear how long or how many times users accessed the service. Estimates from Ampere Analysis reportedly indicate that Game Pass makes up about 60% of the video game subscription market.31 Among video game publishers in the United States, Microsoft had the highest market share at 23.9%, according to IBISWorld.32 Activision Blizzard is a video game publisher and developer primarily known for its franchise games, which include World of Warcraft, Call of Duty, Diablo, and Candy Crush. 33 The company can be separated into three segments—Activision, Blizzard, and King—that each contain their own gaming studios. Among video game publishers in the United States, Activision Blizzard had the second highest market share at 10%, according to IBISWorld.34 Activision also distributes video games for PCs through its digital store—Battle.net.35	What legal basis is being used to analyze the merger between Microsoft and Activision Blizzard? 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. Answer in twenty words or less, do not use bullet points or lists in your answer. On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23 Microsoft and Activision Blizzard in the Video Game Industry Microsoft distributes video games using Microsoft Store, its subscription service Game Pass,24 and its cloud gaming service Xbox Cloud Gaming (Beta);25 publishes games, including the franchises Halo and Minecraft; 26 and owns 23 gaming studios.27 In 2021, Microsoft had the second-highest share in the U.S. market for game consoles at 34.8%, according to a report from MarketLine, an industry research firm; estimates for Sony and Nintendo were 40.7% and 24.5%, respectively.28 In January 2022, Microsoft stated that it had more than 25 million Game Pass subscribers.29 In April 2022, Microsoft reported that more than 10 million people have streamed games over Xbox Cloud Gaming,30 although it is unclear how long or how many times users accessed the service. Estimates from Ampere Analysis reportedly indicate that Game Pass makes up about 60% of the video game subscription market.31 Among video game publishers in the United States, Microsoft had the highest market share at 23.9%, according to IBISWorld.32 Activision Blizzard is a video game publisher and developer primarily known for its franchise games, which include World of Warcraft, Call of Duty, Diablo, and Candy Crush. 33 The company can be separated into three segments—Activision, Blizzard, and King—that each contain their own gaming studios. Among video game publishers in the United States, Activision Blizzard had the second highest market share at 10%, according to IBISWorld.34 Activision also distributes video games for PCs through its digital store—Battle.net.35	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. Answer in twenty words or less, do not use bullet points or lists in your answer. EVIDENCE: On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23 Microsoft and Activision Blizzard in the Video Game Industry Microsoft distributes video games using Microsoft Store, its subscription service Game Pass,24 and its cloud gaming service Xbox Cloud Gaming (Beta);25 publishes games, including the franchises Halo and Minecraft; 26 and owns 23 gaming studios.27 In 2021, Microsoft had the second-highest share in the U.S. market for game consoles at 34.8%, according to a report from MarketLine, an industry research firm; estimates for Sony and Nintendo were 40.7% and 24.5%, respectively.28 In January 2022, Microsoft stated that it had more than 25 million Game Pass subscribers.29 In April 2022, Microsoft reported that more than 10 million people have streamed games over Xbox Cloud Gaming,30 although it is unclear how long or how many times users accessed the service. Estimates from Ampere Analysis reportedly indicate that Game Pass makes up about 60% of the video game subscription market.31 Among video game publishers in the United States, Microsoft had the highest market share at 23.9%, according to IBISWorld.32 Activision Blizzard is a video game publisher and developer primarily known for its franchise games, which include World of Warcraft, Call of Duty, Diablo, and Candy Crush. 33 The company can be separated into three segments—Activision, Blizzard, and King—that each contain their own gaming studios. Among video game publishers in the United States, Activision Blizzard had the second highest market share at 10%, according to IBISWorld.34 Activision also distributes video games for PCs through its digital store—Battle.net.35 USER: What legal basis is being used to analyze the merger between Microsoft and Activision Blizzard? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	44	15	900	null	717
Please respond using only information provided in the context block. If the information needed to answer the question is not within the context block, state that you cannot answer.	I am interested in what context one would use the glGenFrameBuffers() function. What does this function do exactly? Please include any extra information to help understand the function.	Up to this point, all of our discussion regarding buffers has focused on the buffers provided by the windowing system, as you requested when you called glutCreateWindow() (and configured by your call to glutInitDisplayMode()). Although you can quite successfully use any technique with just those buffers, quite often various operations require moving data between buffers superfluously. This is where framebuffer objects enter the picture (as part of OpenGL Version 3.0). Using framebuffer objects, you can create our own framebuffers and use their attached renderbuffers to minimize data copies and optimize performance. Framebuffer objects are quite useful for performing off-screen-rendering, updating texture maps, and engaging in buffer ping-ponging (a data-transfer techniques used in GPGPU). The framebuffer that is provided by the windowing system is the only framebuffer that is available to the display system of your graphics server— that is, it is the only one you can see on your screen. It also places restrictions on the use of the buffers that were created when your window opened. By comparison, the framebuffers that your application creates cannot be displayed on your monitor; they support only off-screen rendering. Another difference between window-system-provided framebuffers and framebuffers you create is that those managed by the window system allocate their buffers—color, depth, stencil, and accumulation—when your window is created. When you create an application-managed framebuffer object, you need to create additional renderbuffers that you associate with the framebuffer objects you created. The buffers with the window-systemprovided buffers can never be associated with an application-created framebuffer object, and vice versa. To allocate an application-generated framebuffer object name, you need to call glGenFramebuffers() which will allocate an unused identifier for the framebuffer object. As compared to some other objects within OpenGL (e.g., texture objects and display lists), you always need to use an name returned from glGenFramebuffers(). Allocating a framebuffer object name doesn’t actually create the framebuffer object or allocate any storage for it. Those tasks are handled through a call to glBindFramebuffer(). glBindFramebuffer() operates in a similar manner to many of the other glBind() routines you’ve seen in OpenGL. The first time it is called for a particular framebuffer, it causes void glGenFramebuffers(GLsize n, GLuint ids); Allocate n unused framebuffer object names, and return those names in ids. storage for the object to be allocated and initialized. Any subsequent calls will bind the provided framebuffer object name as the active one. As with all of the other objects you have encountered in OpenGL, you can release an application-allocated framebuffer by calling glDeleteFramebuffers(). That function will mark the framebuffer object’s name as unallocated and release any resources associated with the framebuffer object. For completeness, you can determine whether a particular unsigned integer is an application-allocated framebuffer object by calling glIsFramebuffer():. void glBindFramebuffer(GLenum target, GLuint framebuffer); Specifies either a framebuffer for either reading or writing. When target is GL_DRAW_FRAMEBUFFER, framebuffer specifies the destination framebuffer for rendering. Similarly, when target is set to GL_READ_ FRAMEBUFFER, framebuffer specifies the source of read operations. Passing GL_FRAMEBUFFER for target sets both the read and write framebuffer bindings to framebuffer. framebuffer must either be zero, which binds target to the default; a window-system provided framebuffer; or a framebuffer object generated by a call to glGenFramebuffers(). A GL_INVALID_OPERATION error is generated if framebuffer is neither zero nor a valid framebuffer object previously generated by calling glGenFramebuffers(), but not deleted by calling glDeleteFramebuffers(). void glDeleteFramebuffers(GLsize n, const GLuint ids); Deallocates the n framebuffer objects associated with the names provided in ids. If a framebuffer object is currently bound (i.e., its name was passed to the most recent call to glBindFramebuffer()), and is deleted, the framebuffer target is immediately bound to id zero (the window-system provided framebuffer), and the framebuffer object is released. No errors are generated by glDeleteFramebuffers(). Unused names or zero are simply ignored. GLboolean glIsFramebuffer(GLuint framebuffer); Framebuffer Objects 529 Once a framebuffer object is created, you still can’t do much with it. You need to provide a place for drawing to go and reading to come from; those places are called framebuffer attachments. We’ll discuss those in more detail after we examine renderbuffers, which are one type of buffer you can attach to a framebuffer object. Renderbuffers Renderbuffers are effectively memory managed by OpenGL that contains formatted image data. The data that a renderbuffer holds takes meaning once it is attached to a framebuffer object, assuming that the format of the image buffer matches what OpenGL is expecting to render into (e.g., you can’t render colors into the depth buffer). As with many other buffers in OpenGL, the process of allocating and deleting buffers is similar to what you’ve seen before. To create a new renderbuffer, you would call glGenRenderbuffers(). Likewise, a call to glDeleteRenderbuffers() will release the storage associated with a renderbuffer. Returns GL_TRUE if framebuffer is the name of a framebuffer returned from glGenFramebuffers(). Returns GL_FALSE if framebuffer is zero (the window-system default framebuffer) or a value that’s either unallocated or been deleted by a call to glDeleteFramebuffers(). void glGenRenderbuffers(GLsizei n, GLuint ids); Allocate n unused renderbuffer object names, and return those names in ids. Names are unused until bound with a call to glBindRenderbuffer(). void glDeleteRenderbuffers(GLsizei n, const GLuint ids); Deallocates the n renderbuffer objects associated with the names provided in ids. If one of the renderbuffers is currently bound and passed to glDeleteRenderbuffers(), a binding of zero replaces the binding at the current framebuffer attachment point, in addition to the renderbuffer being released. No errors are generated by glDeleteRenderbuffers(). Unused names or zero are simply ignored. Likewise, you can determine whether a name represents a valid renderbuffer by calling glIsRenderbuffer(). Similar to the process of binding a framebuffer object so that you can modify its state, you call glBindRenderbuffer() to affect a renderbuffer’s creation and to modify the state associated with it, which includes the format of the image data that it contains. Creating Renderbuffer Storage When you first call glBindRenderbuffer() with an unused renderbuffer name, the OpenGL server creates a renderbuffer with all its state information set to the default values. In this configuration, no storage has been allocated to store image data. Before you can attach a renderbuffer to a framebuffer and render into it, you need to allocate storage and specify its image format. This is done by calling either glRenderbufferStorage() or glRenderbufferStorageMultisample(). void glIsRenderbuffer(GLuint renderbuffer); Returns GL_TRUE if renderbuffer is the name of a renderbuffer returned from glGenRenderbuffers(). Returns GL_FALSE if renderbuffer is zero (the window-system default framebuffer) or a value that’s either unallocated or been deleted by a call to glDeleteRenderbuffers(). void glBindRenderbuffer(GLenum target, GLuint renderbuffer); Creates a renderbuffer and associates it with the name renderbuffer. target must be GL_RENDERBUFFER. renderbuffer must either be zero, which removes any renderbuffer binding, or a name that was generated by a call to glGenRenderbuffers(); otherwise, a GL_INVALID_OPERATION error will be generated. void glRenderbufferStorage(GLenum target, GLenum internalformat, GLsizei width, GLsizei height); void glRenderbufferStorageMultisample(GLenum target, GLsizei samples, GLenum internalformat, GLsizei width, GLsizei height); Framebuffer Objects 531 Allocates storage for image data for the bound renderbuffer. target must be GL_RENDERBUFFER. For a color-renderable buffer, internalformat must be one of: GL_RED, GL_R8, GL_R16, GL_RG, GL_RG8, GL_RG16, GL_RGB, GL_R3_G3_B2, GL_RGB4, GL_RGB5, GL_RGB8, GL_RGB10, GL_RGB12, GL_RGB16, GL_RGBA, GL_RGBA2, GL_RGBA4, GL_RGB5_A1, GL_RGBA8, GL_RGB10_A2, GL_RGBA12, GL_RGBA16, GL_SRGB, GL_SRGB8, GL_SRGB_ALPHA, GL_SRGB8_ALPHA8,GL_R16F, GL_R32F, GL_RG16F, GL_RG32F, GL_RGB16F, GL_RGB32F, GL_RGBA16F, GL_RGBA32F, GL_R11F_G11F_B10F, GL_RGB9_E5, GL_R8I, GL_R8UI, GL_R16I, GL_R16UI, GL_R32I, GL_R32UI, GL_RG8I, GL_RG8UI, GL_RG16I, GL_RG16UI, GL_RG32I, GL_RG32UI, GL_RGB8I, GL_RGB8UI, GL_RGB16I, GL_RGB16UI, GL_RGB32I, GL_RGB32UI, GL_RGBA8I, GL_RGBA8UI, GL_RGBA16I, GL_RGBA16UI, GL_RGBA32I. OpenGL version 3.1 adds the additional following formats: GL_R8_SNORM, GL_R16_SNORM, GL_RG8_SNORM, GL_RG16_SNORM, GL_RGB8_ SNORM, GL_RGB16_SNORM, GL_RGBA8_SNORM, GL_RGBA16_SNORM. To use a renderbuffer as a depth buffer, it must be depth-renderable, which is specified by setting internalformat to either GL_DEPTH_COMPONENT, GL_DEPTH_COMPONENT16, GL_DEPTH_COMPONENT32, GL_DEPTH_ COMPONENT32, or GL_DEPTH_COMPONENT32F. For use exclusively as a stencil buffer, internalformat should be specified as either GL_STENCIL_INDEX, GL_STENCIL_INDEX1, GL_STENCIL_ INDEX4, GL_STENCIL_INDEX8, or GL_STENCIL_INDEX16. For packed depth-stencil storage, internalformat must be GL_DEPTH_ STENCIL, which allows the renderbuffer to be attached as the depth buffer, stencil buffer, or at the combined depth-stencil attachment point. width and height specify the size of the renderbuffer in pixels, and samples specifies the number of multisample samples per pixel. Setting samples to zero in a call to glRenderbufferStorageMultisample() is identical to calling glRenderbufferStorage(). A GL_INVALID_VALUE is generated if width or height is greater than the value returned when querying GL_MAX_RENDERBUFFER_SIZE, or if samples is greater than the value returned when querying GL_MAX_ SAMPLES. A GL_INVALID_OPERATION is generated if internalformat is a signed- or unsigned-integer format (e.g., a format containing a “I”, or “UI” in its token), and samples is not zero, and the implementation doesn’t support multisampled integer buffers. Finally, if the renderbuffer size and format combined exceed the available memory able to be allocated, then a GL_OUT_OF_MEMORY error is generated. Example 10-6 Creating an RGBA Color Renderbuffer: fbo.c glGenRenderbuffers( 1, &color ); glBindRenderbuffer( GL_RENDERBUFFER, color ); glRenderbufferStorage( GL_RENDERBUFFER, GL_RGBA, 256, 256 ); Once you have created storage for your renderbuffer, you need to attach it to a framebuffer object before you can render into it. Framebuffer Attachments When you render, you can send the results of that rendering to a number of places: • The color buffer to create an image, or even multiple color buffers if you’re using multiple render targets (see “Special Output Values” in Chapter 15) • The depth buffer to store occlusion information • The stencil buffer for storing per-pixel masks to control rendering Each of those buffers represents a framebuffer attachment, to which you can attach suitable image buffers that you later render into, or read from. Currently, there are two types of rendering surfaces you can associate with one of those attachments: renderbuffers and a level of a texture image. Attachment Name Description GL_COLOR_ATTACHMENTi The ith color buffer. i can range from zero (the default color buffer) to GL_MAX_COLOR_ATTACHMENTS–1 GL_DEPTH_ATTACHMENT The depth buffer GL_STENCIL_ATTACHMENT The stencil buffer GL_DEPTH_STENCIL_ATTACHMENT A special attachment for packed depthstencil buffers (which require the renderbuffer to have been allocated as a GL_DEPTH_STENCIL pixel format) We’ll first discuss attaching a renderbuffer to a framebuffer object, which is done by calling glFramebufferRenderbuffer(). In Example 10-7, we create and attach two renderbuffers: one for color, and the other for depth. We then proceed to render, and finally copy the results back to the window-system-provided framebuffer to display the results. You might use this technique to generate frames for a movie rendering offscreen, where you don’t have to worry about the visible framebuffer being corrupted by overlapping windows or someone resizing the window and interrupting rendering. One important point to remember is that you might need to reset the viewport for each framebuffer before rendering, particularly if the size of your application-defined framebuffers differs from the window-system provided framebuffer. Another very common use for framebuffer objects is to update textures dynamically. You might do this to indicate changes in a surface’s appearance (such as bullet holes in a wall in a game) or to update values in a lookup table if you’re doing GPGPU-like computations. In these cases, you bind a level of a texture map as the framebuffer attachment, as compared to a renderbuffer. After rendering, the texture map can be detached from the framebuffer so that it can be used in subsequent rendering. Note: Nothing prevents you from reading from a texture that is simultaneously bound as a framebuffer attachment for writing. In this scenario, called a framebuffer rendering loop, the results are undefined for both operations. That is, the values returned from sampling the bound texture map, as well as the values written into the texture level while bound, will likely be incorrect. void glFramebufferTexture1D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level); void glFramebufferTexture2D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level); void glFramebufferTexture3D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level, GLint layer); Attaches a level of a texture objects as a rendering attachment to a framebuffer object. target must be either GL_READ_FRAMEBUFFER, GL_DRAW_FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_FRAMEBUFFER). attachment must be one of the framebuffer attachment points: GL_COLOR_ATTACHMENTi, GL_DEPTH_ ATTACHMENT, GL_STENCIL_ATTACHMENT, or GL_DEPTH_STENCIL_ ATTACHMENT (in which case, the internal format of the texture must be GL_DEPTH_STENCIL). For glFramebufferTexture1D(), texturetarget must be GL_TEXTURE_1D, if texture is not zero. For glFramebufferTexture2D(), texturetarget must be GL_TEXTURE_2D, GL_TEXTURE_RECTANGLE, GL_TEXTURE_CUBE_ MAP_POSITIVE_X, GL_TEXTURE_CUBE_MAP_POSITIVE_Y, GL_ TEXTURE_CUBE_MAP_POSITIVE_Z, GL_TEXTURE_CUBE_MAP_ NEGATIVE_X, GL_TEXTURE_CUBE_MAP_NEGATIVE_Y, GL_TEXTURE_ CUBE_MAP_NEGATIVE_Z, and for glFramebufferTexture3D() texturetarget must be GL_TEXTURE_3D. Similar to the previous example, Example 10-8 demonstrates the process of dynamically updating a texture, using the texture after its update is completed, and then rendering with it later. Framebuffer Completeness Given the myriad of combinations between texture and buffer formats, and between framebuffer attachments, various situations can arise that prevent the completion of rendering when you are using applicationdefined framebuffer objects. After modifying the attachments to a framebuffer object, it’s best to check the framebuffer’s status by calling glCheckFramebufferStatus(). The errors representing the various violations of framebuffer configurations are listed in Table 10-7. Of the listed errors, GL_FRAMEBUFFER_UNSUPPORTED is very implementation dependent, and may be the most complicated to debug. void glFramebufferTextureLayer(GLenum target, GLenum attachment, GLuint texture, GLint level, GLint layer); Attaches a layer of a three-dimensional texture, or a one- or twodimensional array texture as a framebuffer attachment, in a similar manner to glFramebufferTexture3D(). target must be one of GL_READ_FRAMEBUFFER, GL_DRAW_ FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_ FRAMEBUFFER). attachment must be one of GL_COLOR_ATTACHMENTi, GL_DEPTH_ATTACHMENT, GL_STENCIL_ATTACHMENT, or GL_DEPTH_ STENCIL_ATTACHMENT. texture must be either zero, indicating that the current binding for the attachment should be released, or a texture object name (as returned from glGenTextures()). level indicates the mipmap level of the texture object, and layer represents which layer of the texture (or array element) should be bound as an attachment. GLenum glCheckFramebufferStatus(GLenum target); Returns one of the framebuffer completeness status enums listed in Table 10-7. target must be one of GL_READ_FRAMEBUFFER, GL_DRAW_ FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_ FRAMEBUFFER). If glCheckFramebufferStatus() generates an error, zero is returned. Framebuffer Objects 539 Copying Pixel Rectangles While glCopyPixels() has been the default routine for replicating blocks of pixels since OpenGL Version 1.0, as OpenGL expanded its rendering facilities, a more substantial pixel-copying routine was required. glBlitFramebuffer(), described below, subsumes the operations of glCopyPixels() and glPixelZoom() in a single, enhanced call. glBlitFramebuffer() allows greater pixel filtering during the copy operation, much in the same manner as texture mapping (in fact, the same filtering operations, GL_NEAREST and GL_LINEAR are used during the copy). Additionally, this routine is aware of multisampled buffers, and supports copying between different framebuffers (as controlled by framebuffer objects). Framebuffer Completeness Status Enum Description GL_FRAMEBUFFER_COMPLETE The framebuffer and its attachments match the rendering or reading state required. GL_FRAMEBUFFER_UNDEFINED The bound framebuffer is specified to be the default framebuffer (i.e., glBindFramebuffer() with zero specified as the framebuffer), and the default framebuffer doesn’t exist. GL_FRAMEBUFFER_ INCOMPLETE_ATTACHMENT A necessary attachment to the bound framebuffer is uninitialized GL_FRAMEBUFFER_ INCOMPLETE_MISSING_ ATTACHMENT There are no images (e.g., texture layers or renderbuffers) attached to the framebuffer. GL_FRAMEBUFFER_ INCOMPLETE_DRAW_BUFFER Every drawing buffer (e.g., GL_DRAW_BUFFERi as specified by glDrawBuffers()) has an attachment. GL_FRAMEBUFFER_ INCOMPLETE_READ_BUFFER An attachment exists for the buffer specified for the buffer specified by glReadBuffer(). GL_FRAMEBUFFER_ UNSUPPORTED The combination of images attached to the framebuffer object is incompatible with the requirements of the OpenGL implementation. GL_FRAMEBUFFER_ INCOMPLETE_MULTISAMPLE The number of samples for all images across the framebuffer’s attachments do not match. void glBlitFramebuffer(GLint srcX0, GLint srcY0, GLint srcX1, GLint srcY1, GLint dstX0, GLint dstY0, GLint dstX1, GLint dstY1, GLbitfield buffers, GLenum filter); Copies a rectangle of pixel values from one region of the read framebuffer to another region of the draw framebuffer, potentially resizing, reversing, converting, and filtering the pixels in the process. srcX0, srcY0, srcX1, srcY1 represent the source region where pixels are sourced from, and written to the rectangular region specified by dstX0, dstY0, dstX1, dstY1. buffers is the bitwise-or of GL_COLOR_BUFFER_BIT, GL_DEPTH_BUFFER_ BIT, and GL_STENCIL_BUFFER_BIT, which represent the buffers in which the copy should occur. Finally, filter specifies the method of interpolation done if the two rectangular regions are different sizes, and must be one of GL_NEAREST or GL_LINEAR; no filtering is applied if the regions are the same size. If there are multiple color draw buffers (See “Rendering to Multiple Output Buffers” on page 729), each buffer receives a copy of the source region. If srcX1 < srcX0, or dstX1 < dstX0, the image is reversed in the horizontal direction. Likewise, if srcY1 < srcY0 or dstY1 < dstY0, the image is reverse in the vertical direction. However, If both the source and destination sizes are negative in the same direction, no reversal is done. If the source and destination buffers are of different formats, conversion of the pixel values is done in most situations. However, if the read color buffer is a floating-point format, and any of the write color buffers are not, or vice verse; and if the read color buffer is a signed (unsigned) integer format and not all of the draw buffers are signed (unsigned) integer values, the call will generate a GL_INVALID_OPERATION, and no pixels will be copied. Multisampled buffers also have an effect on the copying of pixels. If the source buffer is multisampled, and the destination is not, the samples are resolved to a single pixel value for the destination buffer. Conversely, if the source buffer is not multisampled, and the destination is, the source pixel’s data is replicated for each sample. Finally, if both buffers are multisampled and the number of samples for each buffer is the same, the samples are copied without modification. However, if the buffers have a different number of samples, no pixels are copied, and a GL_INVALID_ OPERATION error is generated. A GL_INVALID_VALUE error is generated if buffers has other bits set than those permitted, or if filter is other than GL_LINEAR or GL_NEAREST Chapter Objectives After reading this chapter, you’ll be able to do the following: • Render concave filled polygons by first tessellating them into convex polygons, which can be rendered using standard OpenGL routines • Use the OpenGL Utility Library to create quadrics objects to render and model the surfaces of spheres and cylinders, and to tessellate disks (circles) and partial disks (arcs) Note: In OpenGL Version 3.1, some of the techniques and functions described in this chapter—particularly those relating to quadric objects—were likely affected by deprecation. While many of these features can be found in the GLU library, they rely on OpenGL functions that were removed. The OpenGL Library (GL) is designed for low-level operations, both streamlined and accessible to hardware acceleration. The OpenGL Utility Library (GLU) complements the OpenGL library, supporting higher-level operations. Some of the GLU operations are covered in other chapters. Mipmapping (gluBuildDMipmaps()) and image scaling (gluScaleImage()) are discussed along with other facets of texture mapping in Chapter 9. Several matrix transformation GLU routines (gluOrtho2D(), gluPerspective(), gluLookAt(), gluProject(), gluUnProject(), and gluUnProject4()) are described in Chapter 3. The use of gluPickMatrix() is explained in Chapter 13. The GLU NURBS facilities, which are built atop OpenGL evaluators, are covered in Chapter 12. Only two GLU topics remain: polygon tessellators and quadric surfaces; these topics are discussed in this chapter. To optimize performance, the basic OpenGL renders only convex polygons, but the GLU contains routines for tessellating concave polygons into convex ones, which the basic OpenGL can handle. Where the basic OpenGL operates on simple primitives, such as points, lines, and filled polygons, the GLU can create higher-level objects, such as the surfaces of spheres, cylinders, and cones. This chapter has the following major sections. • “Polygon Tessellation” explains how to tessellate concave polygons into easier-to-render convex polygons. • “Quadrics: Rendering Spheres, Cylinders, and Disks” describes how to generate spheres, cylinders, circles and arcs, including data such as surface normals and texture coordinates. Polygon Tessellation As discussed in “Describing Points, Lines, and Polygons” in Chapter 2, OpenGL can directly display only simple convex polygons. A polygon is simple if the edges intersect only at vertices, there are no duplicate vertices, and exactly two edges meet at any vertex. If your application requires the display of concave polygons, polygons containing holes, or polygons with intersecting edges, these polygons must first be subdivided into simple convex polygons before they can be displayed. Such subdivision is called tessellation, and the GLU provides a collection of routines that perform tessellation. These routines take as input arbitrary contours, which describe hard-to-render polygons, and they return some combination of triangles, triangle meshes, triangle fans, and lines. If you think a polygon may need tessellation, follow these typical steps: 1. Create a new tessellation object with gluNewTess(). 2. Use gluTessCallback() several times to register callback functions to perform operations during the tessellation. The trickiest case for a callback function is when the tessellation algorithm detects an intersection and must call the function registered for the GLU_TESS_ COMBINE callback. 3. Specify tessellation properties by calling gluTessProperty(). The most important property is the winding rule, which determines the regions that should be filled and those that should remain unshaded. 4. Create and render tessellated polygons by specifying the contours of one or more closed polygons. If the data for the object is static, encapsulate the tessellated polygons in a display list. (If you don’t have to recalculate the tessellation repeatedly, using display lists is more efficient.) 5. If you need to tessellate something else, you may reuse your tessellation object. If you are forever finished with your tessellation object, you may delete it with gluDeleteTess(). Note: The tessellator described here was introduced in Version 1.2 of the GLU. If you are using an older version of the GLU, you must use routines described in “Describing GLU Errors” on page 557. To query which version of GLU you have, use gluGetString(GLU_VERSION), which returns a string with your GLU version number. If you don’t seem to have gluGetString() in your GLU, then you have GLU 1.0, which did not yet have the gluGetString() routine. Creating a Tessellation Object As a complex polygon is being described and tessellated, it has associated data, such as the vertices, edges, and callback functions. All this data is tied to a single tessellation object. To perform tessellation, your program first has to create a tessellation object using the routine gluNewTess(). A single tessellation object can be reused for all your tessellations. This object is required only because library routines might need to do their own tessellations, and they should be able to do so without interfering with any tessellation that your program is doing. It might also be useful to have multiple tessellation objects if you want to use different sets of callbacks for different tessellations. A typical program, however, allocates a single tessellation object and uses it for all its tessellations. There’s no real need to free it, because it uses a small amount of memory. On the other hand, it never hurts to be tidy. Tessellation Callback Routines After you create a tessellation object, you must provide a series of callback routines to be called at appropriate times during the tessellation. After specifying the callbacks, you describe the contours of one or more polygons using GLU routines. When the description of the contours is complete, the tessellation facility invokes your callback routines as necessary. Any functions that are omitted are simply not called during the tessellation, and any information they might have returned to your program is lost. All are specified by the single routine gluTessCallback(). GLUtesselator* gluNewTess(void); Creates a new tessellation object and returns a pointer to it. A null pointer is returned if the creation fails. Polygon Tessellation 545 void gluTessCallback(GLUtesselator tessobj, GLenum type, void (fn)()); Associates the callback function fn with the tessellation object tessobj. The type of the callback is determined by the parameter type, which can be GLU_TESS_BEGIN, GLU_TESS_BEGIN_DATA, GLU_TESS_EDGE_FLAG, GLU_TESS_EDGE_FLAG_DATA, GLU_TESS_VERTEX, GLU_TESS_VERTEX_ DATA, GLU_TESS_END, GLU_TESS_END_DATA, GLU_TESS_COMBINE, GLU_TESS_COMBINE_DATA, GLU_TESS_ERROR, or GLU_TESS_ERROR_ DATA. The 12 possible callback functions have the following prototypes: GLU_TESS_BEGIN void begin(GLenum type); GLU_TESS_BEGIN_DATA void begin(GLenum type, void user_data); GLU_TESS_EDGE_FLAG void edgeFlag(GLboolean flag); GLU_TESS_EDGE_FLAG_DATA void edgeFlag(GLboolean flag, void user_data); GLU_TESS_VERTEX void vertex(void vertex_data); GLU_TESS_VERTEX_DATA void vertex(void vertex_data, void user_data); GLU_TESS_END void end(void); GLU_TESS_END_DATA void end(void user_data); GLU_TESS_COMBINE void combine( GLdouble coords[3], voidvertex_data[4], GLfloat weight[4], void outData); GLU_TESS_COMBINE_DATA void combine( GLdouble coords[3], voidvertex_data[4], GLfloat weight[4], void *outData, void user_data); GLU_TESS_ERROR void error(GLenum errno); GLU_TESS_ERROR_DATA void error(GLenum errno, void user_data); To change a callback routine, simply call gluTessCallback() with the new routine. To eliminate a callback routine without replacing it with a new one, pass gluTessCallback() a null pointer for the appropriate function. As tessellation proceeds, the callback routines are called in a manner similar to how you use the OpenGL commands glBegin(), glEdgeFlag(), glVertex(), and glEnd(). (See “Marking Polygon Boundary Edges” in Chapter 2 for more information about glEdgeFlag().) The combine callback is used to create new vertices where edges intersect. The error callback is invoked during the tessellation only if something goes wrong. For every tessellator object created, a GLU_TESS_BEGIN callback is invoked with one of four possible parameters: GL_TRIANGLE_FAN, GL_TRIANGLE_ STRIP, GL_TRIANGLES, or GL_LINE_LOOP. When the tessellator decomposes the polygons, the tessellation algorithm decides which type of triangle primitive is most efficient to use. (If the GLU_TESS_BOUNDARY_ONLY property is enabled, then GL_LINE_LOOP is used for rendering.) Since edge flags make no sense in a triangle fan or triangle strip, if there is a callback associated with GLU_TESS_EDGE_FLAG that enables edge flags, the GLU_TESS_BEGIN callback is called only with GL_TRIANGLES. The GLU_TESS_EDGE_FLAG callback works exactly analogously to the OpenGL glEdgeFlag() call. After the GLU_TESS_BEGIN callback routine is called and before the callback associated with GLU_TESS_END is called, some combination of the GLU_TESS_EDGE_FLAG and GLU_TESS_VERTEX callbacks is invoked (usually by calls to gluTessVertex(), which is described on page 555). The associated edge flags and vertices are interpreted exactly as they are in OpenGL between glBegin() and the matching glEnd(). If something goes wrong, the error callback is passed a GLU error number. A character string describing the error is obtained using the routine gluErrorString(). (See “Describing GLU Errors” on page 557 for more information about this routine.) Example 11-1 shows a portion of tess.c, in which a tessellation object is created and several callbacks are registered. Example 11-1 Registering Tessellation Callbacks: tess.c #ifndef CALLBACK #define CALLBACK #endif Polygon Tessellation 547 / a portion of init() / tobj = gluNewTess(); gluTessCallback(tobj, GLU_TESS_VERTEX, glVertex3dv); gluTessCallback(tobj, GLU_TESS_BEGIN, beginCallback); gluTessCallback(tobj, GLU_TESS_END, endCallback); gluTessCallback(tobj, GLU_TESS_ERROR, errorCallback); / the callback routines registered by gluTessCallback() / void CALLBACK beginCallback(GLenum which) { glBegin(which); } void CALLBACK endCallback(void) { glEnd(); } void CALLBACK errorCallback(GLenum errorCode) { const GLubyte estring; estring = gluErrorString(errorCode); fprintf(stderr, "Tessellation Error: %s\n", estring); exit(0); } Note: Type casting of callback functions is tricky, especially if you wish to make code that runs equally well on Microsoft Windows and UNIX. To run on Microsoft Windows, programs that declare callback functions, such as tess.c, need the symbol CALLBACK in the declarations of functions. The trick of using an empty definition for CALLBACK (as demonstrated below) allows the code to run well on both Microsoft Windows and UNIX: #ifndef CALLBACK #define CALLBACK #endif void CALLBACK callbackFunction(...) { .... } In Example 11-1, the registered GLU_TESS_VERTEX callback is simply glVertex3dv(), and only the coordinates at each vertex are passed along. However, if you want to specify more information at every vertex, such as a color value, a surface normal vector, or a texture coordinate, you’ll have to make a more complex callback routine. Example 11-2 shows the start of another tessellated object, further along in program tess.c. The registered function vertexCallback() expects to receive a parameter that is a pointer to six double-length floating-point values: the x-, y-, and z-coordinates and the red, green, and blue color values for that vertex. Example 11-2 Vertex and Combine Callbacks: tess.c /* a different portion of init() / gluTessCallback(tobj, GLU_TESS_VERTEX, vertexCallback); gluTessCallback(tobj, GLU_TESS_BEGIN, beginCallback); gluTessCallback(tobj, GLU_TESS_END, endCallback); gluTessCallback(tobj, GLU_TESS_ERROR, errorCallback); gluTessCallback(tobj, GLU_TESS_COMBINE, combineCallback); / new callback routines registered by these calls / void CALLBACK vertexCallback(GLvoid vertex) { const GLdouble pointer; pointer = (GLdouble ) vertex; glColor3dv(pointer+3); glVertex3dv(vertex); } void CALLBACK combineCallback(GLdouble coords[3], GLdouble vertex_data[4], GLfloat weight[4], GLdouble dataOut ) { GLdouble vertex; int i; vertex = (GLdouble ) malloc(6 sizeof(GLdouble)); vertex[0] = coords[0]; vertex[1] = coords[1]; vertex[2] = coords[2]; for (i = 3; i < 6; i++) vertex[i] = weight[0] * vertex_data[0][i] + weight[1] * vertex_data[1][i] + weight[2] * vertex_data[2][i] + weight[3] * vertex_data[3][i]; dataOut = vertex; } Polygon Tessellation 549 Example 11-2 also shows the use of the GLU_TESS_COMBINE callback. Whenever the tessellation algorithm examines the input contours, detects an intersection, and decides it must create a new vertex, the GLU_TESS_ COMBINE callback is invoked. The callback is also called when the tessellator decides to merge features of two vertices that are very close to one another. The newly created vertex is a linear combination of up to four existing vertices, referenced by vertex_data[0..3] in Example 11-2. The coefficients of the linear combination are given by weight[0..3]; these weights sum to 1.0. coords gives the location of the new vertex. The registered callback routine must allocate memory for another vertex, perform a weighted interpolation of data using vertex_data and weight, and return the new vertex pointer as dataOut. combineCallback() in Example 11-2 interpolates the RGB color value. The function allocates a six-element array, puts the x-, y-, and z-coordinates in the first three elements, and then puts the weighted average of the RGB color values in the last three elements. User-Specified Data Six kinds of callbacks can be registered. Since there are two versions of each kind of callback, there are 12 callbacks in all. For each kind of callback, there is one with user-specified data and one without. The user-specified data is given by the application to gluTessBeginPolygon() and is then passed, unaltered, to each DATA callback routine. With GLU_TESS_BEGIN_DATA, the user-specified data may be used for “per-polygon” data. If you specify both versions of a particular callback, the callback with user_data is used, and the other is ignored. Therefore, although there are 12 callbacks, you can have a maximum of six callback functions active at any one time. For instance, Example 11-2 uses smooth shading, so vertexCallback() specifies an RGB color for every vertex. If you want to do lighting and smooth shading, the callback would specify a surface normal for every vertex. However, if you want lighting and flat shading, you might specify only one surface normal for every polygon, not for every vertex. In that case, you might choose to use the GLU_TESS_BEGIN_DATA callback and pass the vertex coordinates and surface normal in the user_data pointer. Tessellation Properties Prior to tessellation and rendering, you may use gluTessProperty() to set several properties to affect the tessellation algorithm. The most important and complicated of these properties is the winding rule, which determines what is considered “interior” and “exterior.” Winding Numbers and Winding Rules For a single contour, the winding number of a point is the signed number of revolutions we make around that point while traveling once around the contour (where a counterclockwise revolution is positive and a clockwise revolution is negative). When there are several contours, the individual winding numbers are summed. This procedure associates a signed integer value with each point in the plane. Note that the winding number is the same for all points in a single region. void gluTessProperty(GLUtesselator tessobj, GLenum property, GLdouble value); For the tessellation object tessobj, the current value of property is set to value. property is GLU_TESS_BOUNDARY_ONLY, GLU_TESS_TOLERANCE, or GLU_TESS_WINDING_RULE. If property is GLU_TESS_BOUNDARY_ONLY, value is either GL_TRUE or GL_FALSE. When it is set to GL_TRUE, polygons are no longer tessellated into filled polygons; line loops are drawn to outline the contours that separate the polygon interior and exterior. The default value is GL_FALSE. (See gluTessNormal() to see how to control the winding direction of the contours.) If property is GLU_TESS_TOLERANCE, value is a distance used to calculate whether two vertices are close enough together to be merged by the GLU_TESS_COMBINE callback. The tolerance value is multiplied by the largest coordinate magnitude of an input vertex to determine the maximum distance any feature can move as a result of a single merge operation. Feature merging may not be supported by your implementation, and the tolerance value is only a hint. The default tolerance value is zero. The GLU_TESS_WINDING_RULE property determines which parts of the polygon are on the interior and which are on the exterior and should not be filled. value can be GLU_TESS_WINDING_ODD (the default), GLU_ TESS_WINDING_NONZERO, GLU_TESS_WINDING_POSITIVE, GLU_ TESS_WINDING_NEGATIVE, or GLU_TESS_WINDING_ABS_GEQ_TWO. In the set at the left, all three contours are counterclockwise, so each nested interior region adds 1 to the winding number. In the middle set, the two interior contours are drawn clockwise, so the winding number decreases and actually becomes negative. The winding rule classifies a region as inside if its winding number belongs to the chosen category (odd, nonzero, positive, negative, or “absolute value greater than or equal to 2”). The odd and nonzero rules are common ways to define the interior. The positive, negative, and “absolute value t 2” winding rules have some limited use for polygon CSG (computational solid geometry) operations. The program tesswind.c demonstrates the effects of winding rules. The four sets of contours shown in Figure 11-3 are rendered. The user can then cycle through the different winding rule properties to see their effects. For each winding rule, the dark areas represent interiors. Note the effects of clockwise and counterclockwise winding. CSG Uses for Winding Rules GLU_TESS_WINDING_ODD and GLU_TESS_WINDING_NONZERO are the most commonly used winding rules. They work for the most typical cases of shading. The winding rules are also designed for CSG operations, making it easy to find the union, difference, or intersection (Boolean operations) of several contours. 1 2 3 1 0 -1 1 1 1 1 1 2 First, assume that each contour is defined so that the winding number is 0 for each exterior region and 1 for each interior region. (Each contour must not intersect itself.) Under this model, counterclockwise contours define the outer boundary of the polygon, and clockwise contours define holes. Contours may be nested, but a nested contour must be oriented oppositely from the contour that contains it. 1 2 3 1 0 -1 1 2 321 4321 Contours and Winding Numbers Winding Rules Odd Nonzero Positive Negative ABS_GEQ_TWO Unfilled Unfilled Unfilled Unfilled If the original polygons do not satisfy this description, they can be converted to this form by first running the tessellator with the GLU_TESS_ BOUNDARY_ONLY property turned on. This returns a list of contours satisfying the restriction just described. By creating two tessellator objects, the callbacks from one tessellator can be fed directly as input to the other. Given two or more polygons of the preceding form, CSG operations can be implemented as follows: • UNION—To calculate the union of several contours, draw all input contours as a single polygon. The winding number of each resulting region is the number of original polygons that cover it. The union can be extracted by using the GLU_TESS_WINDING_NONZERO or GLU_TESS_WINDING_POSITIVE winding rule. Note that with the nonzero winding rule, we would get the same result if all contour orientations were reversed. • INTERSECTION—This works only for two contours at a time. Draw a single polygon using two contours. Extract the result using GLU_TESS_ WINDING_ABS_GEQ_TWO. • DIFFERENCE—Suppose you want to compute A diff (B union C union D). Draw a single polygon consisting of the unmodified contours from A, followed by the contours of B, C, and D, with their vertex order reversed. To extract the result, use the GLU_TESS_WINDING_POSITIVE winding rule. (If B, C, and D are the result of a GLU_TESS_BOUNDARY_ ONLY operation, an alternative to reversing the vertex order is to use gluTessNormal() to reverse the sign of the supplied normal.) Other Tessellation Property Routines There are also complementary routines, which work alongside gluTessProperty(). gluGetTessProperty() retrieves the current values of tessellator properties. If the tessellator is being used to generate wireframe outlines instead of filled polygons, gluTessNormal() can be used to determine the winding direction of the tessellated polygons. void gluGetTessProperty(GLUtesselator tessobj, GLenum property, GLdouble value); For the tessellation object tessobj, the current value of property is returned to value. Values for property and value are the same as for gluTessProperty(). If you have some knowledge about the location and orientation of the input data, then using gluTessNormal() can increase the speed of the tessellation. For example, if you know that all polygons lie on the xy-plane, call gluTessNormal(tessobj, 0, 0, 1). As stated above, the default normal is (0, 0, 0), and its effect is not immediately obvious. In this case, it is expected that the input data lies approximately in a plane, and a plane is fitted to the vertices, no matter how they are truly connected. The sign of the normal is chosen so that the sum of the signed areas of all input contours is non-negative (where a counterclockwise contour has a positive area). Note that if the input data does not lie approximately in a plane, then projection perpendicular to the computed normal may substantially change the geometry. After all the tessellation properties have been set and the callback actions have been registered, it is finally time to describe the vertices that comprise input contours and tessellate the polygons. Calls to gluTessBeginPolygon() and gluTessEndPolygon() surround the definition of one or more contours. When gluTessEndPolygon() is called, the tessellation algorithm is implemented, and the tessellated polygons are void gluTessNormal(GLUtesselator tessobj, GLdouble x, GLdouble y, GLdouble z); For the tessellation object tessobj, gluTessNormal() defines a normal vector, which controls the winding direction of generated polygons. Before tessellation, all input data is projected into a plane perpendicular to the normal. Then, all output triangles are oriented counterclockwise, with respect to the normal. (Clockwise orientation can be obtained by reversing the sign of the supplied normal.) The default normal is (0, 0, 0). void gluTessBeginPolygon(GLUtesselator tessobj, void user_data); void gluTessEndPolygon(GLUtesselator tessobj); Begins and ends the specification of a polygon to be tessellated and associates a tessellation object, tessobj, with it. user_data points to a userdefined data structure, which is passed along all the GLU_TESS__DATA callback functions that have been bound. generated and rendered. The callback functions and tessellation properties that were bound and set to the tessellation object using gluTessCallback() and gluTessProperty() are used. In practice, a minimum of three vertices is needed for a meaningful contour. In the program tess.c, a portion of which is shown in Example 11-3, two polygons are defined. One polygon is a rectangular contour with a triangular hole inside, and the other is a smooth-shaded, self-intersecting, five-pointed star. For efficiency, both polygons are stored in display lists. The first polygon consists of two contours; the outer one is wound counterclockwise, and the “hole” is wound clockwise. For the second polygon, the star array contains both the coordinate and color data, and its tessellation callback, vertexCallback(), uses both. It is important that each vertex is in a different memory location because the vertex data is not copied by gluTessVertex(); only the pointer (vertex_ data) is saved. A program that reuses the same memory for several vertices may not get the desired result. Note: In gluTessVertex(), it may seem redundant to specify the vertex coordinate data twice, for both the coords and vertex_data parameters; however, both are necessary. coords refers only to the vertex coordinates. vertex_data uses the coordinate data, but may also use other information for each vertex. void gluTessBeginContour(GLUtesselator tessobj); void gluTessEndContour(GLUtesselator tessobj); Begins and ends the specification of a closed contour, which is a portion of a polygon. A closed contour consists of zero or more calls to gluTessVertex(), which defines the vertices. The last vertex of each contour is automatically linked to the first. void gluTessVertex(GLUtesselator tessobj, GLdouble coords[3], void vertex_data); Specifies a vertex in the current contour for the tessellation object. coords contains the three-dimensional vertex coordinates, and vertex_data is a pointer that’s sent to the callback associated with GLU_TESS_VERTEX or GLU_TESS_VERTEX_DATA. Typically, vertex_data contains vertex coordinates, surface normals, texture coordinates, color information, or whatever else the application may find useful. Deleting a Tessellation Object If you no longer need a tessellation object, you can delete it and free all associated memory with gluDeleteTess(). Tessellation Performance Tips For best performance, remember these rules: • Cache the output of the tessellator in a display list or other user structure. To obtain the post-tessellation vertex coordinates, tessellate the polygons while in feedback mode. (See “Feedback” in Chapter 13.) • Use gluTessNormal() to supply the polygon normal. • Use the same tessellator object to render many polygons, rather than allocate a new tessellator for each one. (In a multithreaded, multiprocessor environment, you may get better performance using several tessellators.) Describing GLU Errors The GLU provides a routine for obtaining a descriptive string for an error code. This routine is not limited to tessellation but is also used for NURBS and quadrics errors, as well as for errors in the base GL. (See “Error void gluDeleteTess(GLUtesselator tessobj); Deletes the specified tessellation object, tessobj, and frees all associated memory. Handling” in Chapter 14 for information about OpenGL’s error-handling facility.) Backward Compatibility If you are using the 1.0 or 1.1 version of GLU, you have a much less powerful tessellator. The 1.0/1.1 tessellator handles only simple nonconvex polygons or simple polygons containing holes. It does not properly tessellate intersecting contours (no COMBINE callback) or process per-polygon data. The 1.0/1.1 tessellator still works in either GLU 1.2 or 1.3, but its use is no longer recommended. The 1.0/1.1 tessellator has some similarities to the current tessellator. gluNewTess() and gluDeleteTess() are used for both tessellators. The main vertex specification routine remains gluTessVertex(). The callback mechanism is controlled by gluTessCallback(), although only five callback functions can be registered, a subset of the current 12. Here are the prototypes for the 1.0/1.1 tessellator: void gluBeginPolygon(GLUtriangulatorObj tessobj); void gluNextContour(GLUtriangulatorObj tessobj, GLenum type); void gluEndPolygon(GLUtriangulatorObj tessobj); The outermost contour must be specified first, and it does not require an initial call to gluNextContour(). For polygons without holes, only one contour is defined, and gluNextContour() is not used. If a polygon has multiple contours (that is, holes or holes within holes), the contours are specified one after the other, each preceded by gluNextContour(). gluTessVertex() is called for each vertex of a contour. For gluNextContour(), type can be GLU_EXTERIOR, GLU_INTERIOR, GLU_CCW, GLU_CW, or GLU_UNKNOWN. These serve only as hints to the tessellation. If you get them right, the tessellation might go faster. If you get them wrong, they’re ignored, and the tessellation still works. For polygons with holes, one contour is the exterior contour and the other is the interior. The first contour is assumed to be of type GLU_EXTERIOR. Choosing clockwise or counterclockwise orientation is arbitrary in three dimensions; however, there are two different orientations in any plane, and the GLU_CCW and GLU_CW types should be used consistently. Use GLU_UNKNOWN if you don’t have a clue. Quadrics: Rendering Spheres, Cylinders, and Disks 559 It is highly recommended that you convert GLU 1.0/1.1 code to the new tessellation interface for GLU 1.2 by following these steps: 1. Change references to the major data structure type from GLUtriangulatorObj to GLUtesselator. In GLU 1.2, GLUtriangulatorObj and GLUtesselator are defined to be the same type. 2. Convert gluBeginPolygon() to two commands: gluTessBeginPolygon() and gluTessBeginContour(). All contours must be explicitly started, including the first one. 3. Convert gluNextContour() to both gluTessEndContour() and gluTessBeginContour(). You have to end the previous contour before starting the next one. 4. Convert gluEndPolygon() to both gluTessEndContour() and gluTessEndPolygon(). The final contour must be closed. 5. Change references to constants to gluTessCallback(). In GLU 1.2, GLU_BEGIN, GLU_VERTEX, GLU_END, GLU_ERROR, and GLU_EDGE_FLAG are defined as synonyms for GLU_TESS_BEGIN, GLU_TESS_VERTEX, GLU_TESS_END, GLU_TESS_ERROR, and GLU_TESS_EDGE_FLAG.	Up to this point, all of our discussion regarding buffers has focused on the buffers provided by the windowing system, as you requested when you called glutCreateWindow() (and configured by your call to glutInitDisplayMode()). Although you can quite successfully use any technique with just those buffers, quite often various operations require moving data between buffers superfluously. This is where framebuffer objects enter the picture (as part of OpenGL Version 3.0). Using framebuffer objects, you can create our own framebuffers and use their attached renderbuffers to minimize data copies and optimize performance. Framebuffer objects are quite useful for performing off-screen-rendering, updating texture maps, and engaging in buffer ping-ponging (a data-transfer techniques used in GPGPU). The framebuffer that is provided by the windowing system is the only framebuffer that is available to the display system of your graphics server— that is, it is the only one you can see on your screen. It also places restrictions on the use of the buffers that were created when your window opened. By comparison, the framebuffers that your application creates cannot be displayed on your monitor; they support only off-screen rendering. Another difference between window-system-provided framebuffers and framebuffers you create is that those managed by the window system allocate their buffers—color, depth, stencil, and accumulation—when your window is created. When you create an application-managed framebuffer object, you need to create additional renderbuffers that you associate with the framebuffer objects you created. The buffers with the window-systemprovided buffers can never be associated with an application-created framebuffer object, and vice versa. To allocate an application-generated framebuffer object name, you need to call glGenFramebuffers() which will allocate an unused identifier for the framebuffer object. As compared to some other objects within OpenGL (e.g., texture objects and display lists), you always need to use an name returned from glGenFramebuffers(). Allocating a framebuffer object name doesn’t actually create the framebuffer object or allocate any storage for it. Those tasks are handled through a call to glBindFramebuffer(). glBindFramebuffer() operates in a similar manner to many of the other glBind() routines you’ve seen in OpenGL. The first time it is called for a particular framebuffer, it causes void glGenFramebuffers(GLsize n, GLuint ids); Allocate n unused framebuffer object names, and return those names in ids. storage for the object to be allocated and initialized. Any subsequent calls will bind the provided framebuffer object name as the active one. As with all of the other objects you have encountered in OpenGL, you can release an application-allocated framebuffer by calling glDeleteFramebuffers(). That function will mark the framebuffer object’s name as unallocated and release any resources associated with the framebuffer object. For completeness, you can determine whether a particular unsigned integer is an application-allocated framebuffer object by calling glIsFramebuffer():. void glBindFramebuffer(GLenum target, GLuint framebuffer); Specifies either a framebuffer for either reading or writing. When target is GL_DRAW_FRAMEBUFFER, framebuffer specifies the destination framebuffer for rendering. Similarly, when target is set to GL_READ_ FRAMEBUFFER, framebuffer specifies the source of read operations. Passing GL_FRAMEBUFFER for target sets both the read and write framebuffer bindings to framebuffer. framebuffer must either be zero, which binds target to the default; a window-system provided framebuffer; or a framebuffer object generated by a call to glGenFramebuffers(). A GL_INVALID_OPERATION error is generated if framebuffer is neither zero nor a valid framebuffer object previously generated by calling glGenFramebuffers(), but not deleted by calling glDeleteFramebuffers(). void glDeleteFramebuffers(GLsize n, const GLuint ids); Deallocates the n framebuffer objects associated with the names provided in ids. If a framebuffer object is currently bound (i.e., its name was passed to the most recent call to glBindFramebuffer()), and is deleted, the framebuffer target is immediately bound to id zero (the window-system provided framebuffer), and the framebuffer object is released. No errors are generated by glDeleteFramebuffers(). Unused names or zero are simply ignored. GLboolean glIsFramebuffer(GLuint framebuffer); Framebuffer Objects 529 Once a framebuffer object is created, you still can’t do much with it. You need to provide a place for drawing to go and reading to come from; those places are called framebuffer attachments. We’ll discuss those in more detail after we examine renderbuffers, which are one type of buffer you can attach to a framebuffer object. Renderbuffers Renderbuffers are effectively memory managed by OpenGL that contains formatted image data. The data that a renderbuffer holds takes meaning once it is attached to a framebuffer object, assuming that the format of the image buffer matches what OpenGL is expecting to render into (e.g., you can’t render colors into the depth buffer). As with many other buffers in OpenGL, the process of allocating and deleting buffers is similar to what you’ve seen before. To create a new renderbuffer, you would call glGenRenderbuffers(). Likewise, a call to glDeleteRenderbuffers() will release the storage associated with a renderbuffer. Returns GL_TRUE if framebuffer is the name of a framebuffer returned from glGenFramebuffers(). Returns GL_FALSE if framebuffer is zero (the window-system default framebuffer) or a value that’s either unallocated or been deleted by a call to glDeleteFramebuffers(). void glGenRenderbuffers(GLsizei n, GLuint ids); Allocate n unused renderbuffer object names, and return those names in ids. Names are unused until bound with a call to glBindRenderbuffer(). void glDeleteRenderbuffers(GLsizei n, const GLuint ids); Deallocates the n renderbuffer objects associated with the names provided in ids. If one of the renderbuffers is currently bound and passed to glDeleteRenderbuffers(), a binding of zero replaces the binding at the current framebuffer attachment point, in addition to the renderbuffer being released. No errors are generated by glDeleteRenderbuffers(). Unused names or zero are simply ignored. Likewise, you can determine whether a name represents a valid renderbuffer by calling glIsRenderbuffer(). Similar to the process of binding a framebuffer object so that you can modify its state, you call glBindRenderbuffer() to affect a renderbuffer’s creation and to modify the state associated with it, which includes the format of the image data that it contains. Creating Renderbuffer Storage When you first call glBindRenderbuffer() with an unused renderbuffer name, the OpenGL server creates a renderbuffer with all its state information set to the default values. In this configuration, no storage has been allocated to store image data. Before you can attach a renderbuffer to a framebuffer and render into it, you need to allocate storage and specify its image format. This is done by calling either glRenderbufferStorage() or glRenderbufferStorageMultisample(). void glIsRenderbuffer(GLuint renderbuffer); Returns GL_TRUE if renderbuffer is the name of a renderbuffer returned from glGenRenderbuffers(). Returns GL_FALSE if renderbuffer is zero (the window-system default framebuffer) or a value that’s either unallocated or been deleted by a call to glDeleteRenderbuffers(). void glBindRenderbuffer(GLenum target, GLuint renderbuffer); Creates a renderbuffer and associates it with the name renderbuffer. target must be GL_RENDERBUFFER. renderbuffer must either be zero, which removes any renderbuffer binding, or a name that was generated by a call to glGenRenderbuffers(); otherwise, a GL_INVALID_OPERATION error will be generated. void glRenderbufferStorage(GLenum target, GLenum internalformat, GLsizei width, GLsizei height); void glRenderbufferStorageMultisample(GLenum target, GLsizei samples, GLenum internalformat, GLsizei width, GLsizei height); Framebuffer Objects 531 Allocates storage for image data for the bound renderbuffer. target must be GL_RENDERBUFFER. For a color-renderable buffer, internalformat must be one of: GL_RED, GL_R8, GL_R16, GL_RG, GL_RG8, GL_RG16, GL_RGB, GL_R3_G3_B2, GL_RGB4, GL_RGB5, GL_RGB8, GL_RGB10, GL_RGB12, GL_RGB16, GL_RGBA, GL_RGBA2, GL_RGBA4, GL_RGB5_A1, GL_RGBA8, GL_RGB10_A2, GL_RGBA12, GL_RGBA16, GL_SRGB, GL_SRGB8, GL_SRGB_ALPHA, GL_SRGB8_ALPHA8,GL_R16F, GL_R32F, GL_RG16F, GL_RG32F, GL_RGB16F, GL_RGB32F, GL_RGBA16F, GL_RGBA32F, GL_R11F_G11F_B10F, GL_RGB9_E5, GL_R8I, GL_R8UI, GL_R16I, GL_R16UI, GL_R32I, GL_R32UI, GL_RG8I, GL_RG8UI, GL_RG16I, GL_RG16UI, GL_RG32I, GL_RG32UI, GL_RGB8I, GL_RGB8UI, GL_RGB16I, GL_RGB16UI, GL_RGB32I, GL_RGB32UI, GL_RGBA8I, GL_RGBA8UI, GL_RGBA16I, GL_RGBA16UI, GL_RGBA32I. OpenGL version 3.1 adds the additional following formats: GL_R8_SNORM, GL_R16_SNORM, GL_RG8_SNORM, GL_RG16_SNORM, GL_RGB8_ SNORM, GL_RGB16_SNORM, GL_RGBA8_SNORM, GL_RGBA16_SNORM. To use a renderbuffer as a depth buffer, it must be depth-renderable, which is specified by setting internalformat to either GL_DEPTH_COMPONENT, GL_DEPTH_COMPONENT16, GL_DEPTH_COMPONENT32, GL_DEPTH_ COMPONENT32, or GL_DEPTH_COMPONENT32F. For use exclusively as a stencil buffer, internalformat should be specified as either GL_STENCIL_INDEX, GL_STENCIL_INDEX1, GL_STENCIL_ INDEX4, GL_STENCIL_INDEX8, or GL_STENCIL_INDEX16. For packed depth-stencil storage, internalformat must be GL_DEPTH_ STENCIL, which allows the renderbuffer to be attached as the depth buffer, stencil buffer, or at the combined depth-stencil attachment point. width and height specify the size of the renderbuffer in pixels, and samples specifies the number of multisample samples per pixel. Setting samples to zero in a call to glRenderbufferStorageMultisample() is identical to calling glRenderbufferStorage(). A GL_INVALID_VALUE is generated if width or height is greater than the value returned when querying GL_MAX_RENDERBUFFER_SIZE, or if samples is greater than the value returned when querying GL_MAX_ SAMPLES. A GL_INVALID_OPERATION is generated if internalformat is a signed- or unsigned-integer format (e.g., a format containing a “I”, or “UI” in its token), and samples is not zero, and the implementation doesn’t support multisampled integer buffers. Finally, if the renderbuffer size and format combined exceed the available memory able to be allocated, then a GL_OUT_OF_MEMORY error is generated. Example 10-6 Creating an RGBA Color Renderbuffer: fbo.c glGenRenderbuffers( 1, &color ); glBindRenderbuffer( GL_RENDERBUFFER, color ); glRenderbufferStorage( GL_RENDERBUFFER, GL_RGBA, 256, 256 ); Once you have created storage for your renderbuffer, you need to attach it to a framebuffer object before you can render into it. Framebuffer Attachments When you render, you can send the results of that rendering to a number of places: • The color buffer to create an image, or even multiple color buffers if you’re using multiple render targets (see “Special Output Values” in Chapter 15) • The depth buffer to store occlusion information • The stencil buffer for storing per-pixel masks to control rendering Each of those buffers represents a framebuffer attachment, to which you can attach suitable image buffers that you later render into, or read from. Currently, there are two types of rendering surfaces you can associate with one of those attachments: renderbuffers and a level of a texture image. Attachment Name Description GL_COLOR_ATTACHMENTi The ith color buffer. i can range from zero (the default color buffer) to GL_MAX_COLOR_ATTACHMENTS–1 GL_DEPTH_ATTACHMENT The depth buffer GL_STENCIL_ATTACHMENT The stencil buffer GL_DEPTH_STENCIL_ATTACHMENT A special attachment for packed depthstencil buffers (which require the renderbuffer to have been allocated as a GL_DEPTH_STENCIL pixel format) We’ll first discuss attaching a renderbuffer to a framebuffer object, which is done by calling glFramebufferRenderbuffer(). In Example 10-7, we create and attach two renderbuffers: one for color, and the other for depth. We then proceed to render, and finally copy the results back to the window-system-provided framebuffer to display the results. You might use this technique to generate frames for a movie rendering offscreen, where you don’t have to worry about the visible framebuffer being corrupted by overlapping windows or someone resizing the window and interrupting rendering. One important point to remember is that you might need to reset the viewport for each framebuffer before rendering, particularly if the size of your application-defined framebuffers differs from the window-system provided framebuffer. Another very common use for framebuffer objects is to update textures dynamically. You might do this to indicate changes in a surface’s appearance (such as bullet holes in a wall in a game) or to update values in a lookup table if you’re doing GPGPU-like computations. In these cases, you bind a level of a texture map as the framebuffer attachment, as compared to a renderbuffer. After rendering, the texture map can be detached from the framebuffer so that it can be used in subsequent rendering. Note: Nothing prevents you from reading from a texture that is simultaneously bound as a framebuffer attachment for writing. In this scenario, called a framebuffer rendering loop, the results are undefined for both operations. That is, the values returned from sampling the bound texture map, as well as the values written into the texture level while bound, will likely be incorrect. void glFramebufferTexture1D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level); void glFramebufferTexture2D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level); void glFramebufferTexture3D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level, GLint layer); Attaches a level of a texture objects as a rendering attachment to a framebuffer object. target must be either GL_READ_FRAMEBUFFER, GL_DRAW_FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_FRAMEBUFFER). attachment must be one of the framebuffer attachment points: GL_COLOR_ATTACHMENTi, GL_DEPTH_ ATTACHMENT, GL_STENCIL_ATTACHMENT, or GL_DEPTH_STENCIL_ ATTACHMENT (in which case, the internal format of the texture must be GL_DEPTH_STENCIL). For glFramebufferTexture1D(), texturetarget must be GL_TEXTURE_1D, if texture is not zero. For glFramebufferTexture2D(), texturetarget must be GL_TEXTURE_2D, GL_TEXTURE_RECTANGLE, GL_TEXTURE_CUBE_ MAP_POSITIVE_X, GL_TEXTURE_CUBE_MAP_POSITIVE_Y, GL_ TEXTURE_CUBE_MAP_POSITIVE_Z, GL_TEXTURE_CUBE_MAP_ NEGATIVE_X, GL_TEXTURE_CUBE_MAP_NEGATIVE_Y, GL_TEXTURE_ CUBE_MAP_NEGATIVE_Z, and for glFramebufferTexture3D() texturetarget must be GL_TEXTURE_3D. Similar to the previous example, Example 10-8 demonstrates the process of dynamically updating a texture, using the texture after its update is completed, and then rendering with it later. Framebuffer Completeness Given the myriad of combinations between texture and buffer formats, and between framebuffer attachments, various situations can arise that prevent the completion of rendering when you are using applicationdefined framebuffer objects. After modifying the attachments to a framebuffer object, it’s best to check the framebuffer’s status by calling glCheckFramebufferStatus(). The errors representing the various violations of framebuffer configurations are listed in Table 10-7. Of the listed errors, GL_FRAMEBUFFER_UNSUPPORTED is very implementation dependent, and may be the most complicated to debug. void glFramebufferTextureLayer(GLenum target, GLenum attachment, GLuint texture, GLint level, GLint layer); Attaches a layer of a three-dimensional texture, or a one- or twodimensional array texture as a framebuffer attachment, in a similar manner to glFramebufferTexture3D(). target must be one of GL_READ_FRAMEBUFFER, GL_DRAW_ FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_ FRAMEBUFFER). attachment must be one of GL_COLOR_ATTACHMENTi, GL_DEPTH_ATTACHMENT, GL_STENCIL_ATTACHMENT, or GL_DEPTH_ STENCIL_ATTACHMENT. texture must be either zero, indicating that the current binding for the attachment should be released, or a texture object name (as returned from glGenTextures()). level indicates the mipmap level of the texture object, and layer represents which layer of the texture (or array element) should be bound as an attachment. GLenum glCheckFramebufferStatus(GLenum target); Returns one of the framebuffer completeness status enums listed in Table 10-7. target must be one of GL_READ_FRAMEBUFFER, GL_DRAW_ FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_ FRAMEBUFFER). If glCheckFramebufferStatus() generates an error, zero is returned. Framebuffer Objects 539 Copying Pixel Rectangles While glCopyPixels() has been the default routine for replicating blocks of pixels since OpenGL Version 1.0, as OpenGL expanded its rendering facilities, a more substantial pixel-copying routine was required. glBlitFramebuffer(), described below, subsumes the operations of glCopyPixels() and glPixelZoom() in a single, enhanced call. glBlitFramebuffer() allows greater pixel filtering during the copy operation, much in the same manner as texture mapping (in fact, the same filtering operations, GL_NEAREST and GL_LINEAR are used during the copy). Additionally, this routine is aware of multisampled buffers, and supports copying between different framebuffers (as controlled by framebuffer objects). Framebuffer Completeness Status Enum Description GL_FRAMEBUFFER_COMPLETE The framebuffer and its attachments match the rendering or reading state required. GL_FRAMEBUFFER_UNDEFINED The bound framebuffer is specified to be the default framebuffer (i.e., glBindFramebuffer() with zero specified as the framebuffer), and the default framebuffer doesn’t exist. GL_FRAMEBUFFER_ INCOMPLETE_ATTACHMENT A necessary attachment to the bound framebuffer is uninitialized GL_FRAMEBUFFER_ INCOMPLETE_MISSING_ ATTACHMENT There are no images (e.g., texture layers or renderbuffers) attached to the framebuffer. GL_FRAMEBUFFER_ INCOMPLETE_DRAW_BUFFER Every drawing buffer (e.g., GL_DRAW_BUFFERi as specified by glDrawBuffers()) has an attachment. GL_FRAMEBUFFER_ INCOMPLETE_READ_BUFFER An attachment exists for the buffer specified for the buffer specified by glReadBuffer(). GL_FRAMEBUFFER_ UNSUPPORTED The combination of images attached to the framebuffer object is incompatible with the requirements of the OpenGL implementation. GL_FRAMEBUFFER_ INCOMPLETE_MULTISAMPLE The number of samples for all images across the framebuffer’s attachments do not match. void glBlitFramebuffer(GLint srcX0, GLint srcY0, GLint srcX1, GLint srcY1, GLint dstX0, GLint dstY0, GLint dstX1, GLint dstY1, GLbitfield buffers, GLenum filter); Copies a rectangle of pixel values from one region of the read framebuffer to another region of the draw framebuffer, potentially resizing, reversing, converting, and filtering the pixels in the process. srcX0, srcY0, srcX1, srcY1 represent the source region where pixels are sourced from, and written to the rectangular region specified by dstX0, dstY0, dstX1, dstY1. buffers is the bitwise-or of GL_COLOR_BUFFER_BIT, GL_DEPTH_BUFFER_ BIT, and GL_STENCIL_BUFFER_BIT, which represent the buffers in which the copy should occur. Finally, filter specifies the method of interpolation done if the two rectangular regions are different sizes, and must be one of GL_NEAREST or GL_LINEAR; no filtering is applied if the regions are the same size. If there are multiple color draw buffers (See “Rendering to Multiple Output Buffers” on page 729), each buffer receives a copy of the source region. If srcX1 < srcX0, or dstX1 < dstX0, the image is reversed in the horizontal direction. Likewise, if srcY1 < srcY0 or dstY1 < dstY0, the image is reverse in the vertical direction. However, If both the source and destination sizes are negative in the same direction, no reversal is done. If the source and destination buffers are of different formats, conversion of the pixel values is done in most situations. However, if the read color buffer is a floating-point format, and any of the write color buffers are not, or vice verse; and if the read color buffer is a signed (unsigned) integer format and not all of the draw buffers are signed (unsigned) integer values, the call will generate a GL_INVALID_OPERATION, and no pixels will be copied. Multisampled buffers also have an effect on the copying of pixels. If the source buffer is multisampled, and the destination is not, the samples are resolved to a single pixel value for the destination buffer. Conversely, if the source buffer is not multisampled, and the destination is, the source pixel’s data is replicated for each sample. Finally, if both buffers are multisampled and the number of samples for each buffer is the same, the samples are copied without modification. However, if the buffers have a different number of samples, no pixels are copied, and a GL_INVALID_ OPERATION error is generated. A GL_INVALID_VALUE error is generated if buffers has other bits set than those permitted, or if filter is other than GL_LINEAR or GL_NEAREST Chapter Objectives After reading this chapter, you’ll be able to do the following: • Render concave filled polygons by first tessellating them into convex polygons, which can be rendered using standard OpenGL routines • Use the OpenGL Utility Library to create quadrics objects to render and model the surfaces of spheres and cylinders, and to tessellate disks (circles) and partial disks (arcs) Note: In OpenGL Version 3.1, some of the techniques and functions described in this chapter—particularly those relating to quadric objects—were likely affected by deprecation. While many of these features can be found in the GLU library, they rely on OpenGL functions that were removed. The OpenGL Library (GL) is designed for low-level operations, both streamlined and accessible to hardware acceleration. The OpenGL Utility Library (GLU) complements the OpenGL library, supporting higher-level operations. Some of the GLU operations are covered in other chapters. Mipmapping (gluBuildDMipmaps()) and image scaling (gluScaleImage()) are discussed along with other facets of texture mapping in Chapter 9. Several matrix transformation GLU routines (gluOrtho2D(), gluPerspective(), gluLookAt(), gluProject(), gluUnProject(), and gluUnProject4()) are described in Chapter 3. The use of gluPickMatrix() is explained in Chapter 13. The GLU NURBS facilities, which are built atop OpenGL evaluators, are covered in Chapter 12. Only two GLU topics remain: polygon tessellators and quadric surfaces; these topics are discussed in this chapter. To optimize performance, the basic OpenGL renders only convex polygons, but the GLU contains routines for tessellating concave polygons into convex ones, which the basic OpenGL can handle. Where the basic OpenGL operates on simple primitives, such as points, lines, and filled polygons, the GLU can create higher-level objects, such as the surfaces of spheres, cylinders, and cones. This chapter has the following major sections. • “Polygon Tessellation” explains how to tessellate concave polygons into easier-to-render convex polygons. • “Quadrics: Rendering Spheres, Cylinders, and Disks” describes how to generate spheres, cylinders, circles and arcs, including data such as surface normals and texture coordinates. Polygon Tessellation As discussed in “Describing Points, Lines, and Polygons” in Chapter 2, OpenGL can directly display only simple convex polygons. A polygon is simple if the edges intersect only at vertices, there are no duplicate vertices, and exactly two edges meet at any vertex. If your application requires the display of concave polygons, polygons containing holes, or polygons with intersecting edges, these polygons must first be subdivided into simple convex polygons before they can be displayed. Such subdivision is called tessellation, and the GLU provides a collection of routines that perform tessellation. These routines take as input arbitrary contours, which describe hard-to-render polygons, and they return some combination of triangles, triangle meshes, triangle fans, and lines. If you think a polygon may need tessellation, follow these typical steps: 1. Create a new tessellation object with gluNewTess(). 2. Use gluTessCallback() several times to register callback functions to perform operations during the tessellation. The trickiest case for a callback function is when the tessellation algorithm detects an intersection and must call the function registered for the GLU_TESS_ COMBINE callback. 3. Specify tessellation properties by calling gluTessProperty(). The most important property is the winding rule, which determines the regions that should be filled and those that should remain unshaded. 4. Create and render tessellated polygons by specifying the contours of one or more closed polygons. If the data for the object is static, encapsulate the tessellated polygons in a display list. (If you don’t have to recalculate the tessellation repeatedly, using display lists is more efficient.) 5. If you need to tessellate something else, you may reuse your tessellation object. If you are forever finished with your tessellation object, you may delete it with gluDeleteTess(). Note: The tessellator described here was introduced in Version 1.2 of the GLU. If you are using an older version of the GLU, you must use routines described in “Describing GLU Errors” on page 557. To query which version of GLU you have, use gluGetString(GLU_VERSION), which returns a string with your GLU version number. If you don’t seem to have gluGetString() in your GLU, then you have GLU 1.0, which did not yet have the gluGetString() routine. Creating a Tessellation Object As a complex polygon is being described and tessellated, it has associated data, such as the vertices, edges, and callback functions. All this data is tied to a single tessellation object. To perform tessellation, your program first has to create a tessellation object using the routine gluNewTess(). A single tessellation object can be reused for all your tessellations. This object is required only because library routines might need to do their own tessellations, and they should be able to do so without interfering with any tessellation that your program is doing. It might also be useful to have multiple tessellation objects if you want to use different sets of callbacks for different tessellations. A typical program, however, allocates a single tessellation object and uses it for all its tessellations. There’s no real need to free it, because it uses a small amount of memory. On the other hand, it never hurts to be tidy. Tessellation Callback Routines After you create a tessellation object, you must provide a series of callback routines to be called at appropriate times during the tessellation. After specifying the callbacks, you describe the contours of one or more polygons using GLU routines. When the description of the contours is complete, the tessellation facility invokes your callback routines as necessary. Any functions that are omitted are simply not called during the tessellation, and any information they might have returned to your program is lost. All are specified by the single routine gluTessCallback(). GLUtesselator* gluNewTess(void); Creates a new tessellation object and returns a pointer to it. A null pointer is returned if the creation fails. Polygon Tessellation 545 void gluTessCallback(GLUtesselator tessobj, GLenum type, void (fn)()); Associates the callback function fn with the tessellation object tessobj. The type of the callback is determined by the parameter type, which can be GLU_TESS_BEGIN, GLU_TESS_BEGIN_DATA, GLU_TESS_EDGE_FLAG, GLU_TESS_EDGE_FLAG_DATA, GLU_TESS_VERTEX, GLU_TESS_VERTEX_ DATA, GLU_TESS_END, GLU_TESS_END_DATA, GLU_TESS_COMBINE, GLU_TESS_COMBINE_DATA, GLU_TESS_ERROR, or GLU_TESS_ERROR_ DATA. The 12 possible callback functions have the following prototypes: GLU_TESS_BEGIN void begin(GLenum type); GLU_TESS_BEGIN_DATA void begin(GLenum type, void user_data); GLU_TESS_EDGE_FLAG void edgeFlag(GLboolean flag); GLU_TESS_EDGE_FLAG_DATA void edgeFlag(GLboolean flag, void user_data); GLU_TESS_VERTEX void vertex(void vertex_data); GLU_TESS_VERTEX_DATA void vertex(void vertex_data, void user_data); GLU_TESS_END void end(void); GLU_TESS_END_DATA void end(void user_data); GLU_TESS_COMBINE void combine( GLdouble coords[3], voidvertex_data[4], GLfloat weight[4], void outData); GLU_TESS_COMBINE_DATA void combine( GLdouble coords[3], voidvertex_data[4], GLfloat weight[4], void *outData, void user_data); GLU_TESS_ERROR void error(GLenum errno); GLU_TESS_ERROR_DATA void error(GLenum errno, void user_data); To change a callback routine, simply call gluTessCallback() with the new routine. To eliminate a callback routine without replacing it with a new one, pass gluTessCallback() a null pointer for the appropriate function. As tessellation proceeds, the callback routines are called in a manner similar to how you use the OpenGL commands glBegin(), glEdgeFlag(), glVertex(), and glEnd(). (See “Marking Polygon Boundary Edges” in Chapter 2 for more information about glEdgeFlag().) The combine callback is used to create new vertices where edges intersect. The error callback is invoked during the tessellation only if something goes wrong. For every tessellator object created, a GLU_TESS_BEGIN callback is invoked with one of four possible parameters: GL_TRIANGLE_FAN, GL_TRIANGLE_ STRIP, GL_TRIANGLES, or GL_LINE_LOOP. When the tessellator decomposes the polygons, the tessellation algorithm decides which type of triangle primitive is most efficient to use. (If the GLU_TESS_BOUNDARY_ONLY property is enabled, then GL_LINE_LOOP is used for rendering.) Since edge flags make no sense in a triangle fan or triangle strip, if there is a callback associated with GLU_TESS_EDGE_FLAG that enables edge flags, the GLU_TESS_BEGIN callback is called only with GL_TRIANGLES. The GLU_TESS_EDGE_FLAG callback works exactly analogously to the OpenGL glEdgeFlag() call. After the GLU_TESS_BEGIN callback routine is called and before the callback associated with GLU_TESS_END is called, some combination of the GLU_TESS_EDGE_FLAG and GLU_TESS_VERTEX callbacks is invoked (usually by calls to gluTessVertex(), which is described on page 555). The associated edge flags and vertices are interpreted exactly as they are in OpenGL between glBegin() and the matching glEnd(). If something goes wrong, the error callback is passed a GLU error number. A character string describing the error is obtained using the routine gluErrorString(). (See “Describing GLU Errors” on page 557 for more information about this routine.) Example 11-1 shows a portion of tess.c, in which a tessellation object is created and several callbacks are registered. Example 11-1 Registering Tessellation Callbacks: tess.c #ifndef CALLBACK #define CALLBACK #endif Polygon Tessellation 547 / a portion of init() / tobj = gluNewTess(); gluTessCallback(tobj, GLU_TESS_VERTEX, glVertex3dv); gluTessCallback(tobj, GLU_TESS_BEGIN, beginCallback); gluTessCallback(tobj, GLU_TESS_END, endCallback); gluTessCallback(tobj, GLU_TESS_ERROR, errorCallback); / the callback routines registered by gluTessCallback() / void CALLBACK beginCallback(GLenum which) { glBegin(which); } void CALLBACK endCallback(void) { glEnd(); } void CALLBACK errorCallback(GLenum errorCode) { const GLubyte estring; estring = gluErrorString(errorCode); fprintf(stderr, "Tessellation Error: %s\n", estring); exit(0); } Note: Type casting of callback functions is tricky, especially if you wish to make code that runs equally well on Microsoft Windows and UNIX. To run on Microsoft Windows, programs that declare callback functions, such as tess.c, need the symbol CALLBACK in the declarations of functions. The trick of using an empty definition for CALLBACK (as demonstrated below) allows the code to run well on both Microsoft Windows and UNIX: #ifndef CALLBACK #define CALLBACK #endif void CALLBACK callbackFunction(...) { .... } In Example 11-1, the registered GLU_TESS_VERTEX callback is simply glVertex3dv(), and only the coordinates at each vertex are passed along. However, if you want to specify more information at every vertex, such as a color value, a surface normal vector, or a texture coordinate, you’ll have to make a more complex callback routine. Example 11-2 shows the start of another tessellated object, further along in program tess.c. The registered function vertexCallback() expects to receive a parameter that is a pointer to six double-length floating-point values: the x-, y-, and z-coordinates and the red, green, and blue color values for that vertex. Example 11-2 Vertex and Combine Callbacks: tess.c /* a different portion of init() / gluTessCallback(tobj, GLU_TESS_VERTEX, vertexCallback); gluTessCallback(tobj, GLU_TESS_BEGIN, beginCallback); gluTessCallback(tobj, GLU_TESS_END, endCallback); gluTessCallback(tobj, GLU_TESS_ERROR, errorCallback); gluTessCallback(tobj, GLU_TESS_COMBINE, combineCallback); / new callback routines registered by these calls / void CALLBACK vertexCallback(GLvoid vertex) { const GLdouble pointer; pointer = (GLdouble ) vertex; glColor3dv(pointer+3); glVertex3dv(vertex); } void CALLBACK combineCallback(GLdouble coords[3], GLdouble vertex_data[4], GLfloat weight[4], GLdouble dataOut ) { GLdouble vertex; int i; vertex = (GLdouble ) malloc(6 sizeof(GLdouble)); vertex[0] = coords[0]; vertex[1] = coords[1]; vertex[2] = coords[2]; for (i = 3; i < 6; i++) vertex[i] = weight[0] * vertex_data[0][i] + weight[1] * vertex_data[1][i] + weight[2] * vertex_data[2][i] + weight[3] * vertex_data[3][i]; dataOut = vertex; } Polygon Tessellation 549 Example 11-2 also shows the use of the GLU_TESS_COMBINE callback. Whenever the tessellation algorithm examines the input contours, detects an intersection, and decides it must create a new vertex, the GLU_TESS_ COMBINE callback is invoked. The callback is also called when the tessellator decides to merge features of two vertices that are very close to one another. The newly created vertex is a linear combination of up to four existing vertices, referenced by vertex_data[0..3] in Example 11-2. The coefficients of the linear combination are given by weight[0..3]; these weights sum to 1.0. coords gives the location of the new vertex. The registered callback routine must allocate memory for another vertex, perform a weighted interpolation of data using vertex_data and weight, and return the new vertex pointer as dataOut. combineCallback() in Example 11-2 interpolates the RGB color value. The function allocates a six-element array, puts the x-, y-, and z-coordinates in the first three elements, and then puts the weighted average of the RGB color values in the last three elements. User-Specified Data Six kinds of callbacks can be registered. Since there are two versions of each kind of callback, there are 12 callbacks in all. For each kind of callback, there is one with user-specified data and one without. The user-specified data is given by the application to gluTessBeginPolygon() and is then passed, unaltered, to each DATA callback routine. With GLU_TESS_BEGIN_DATA, the user-specified data may be used for “per-polygon” data. If you specify both versions of a particular callback, the callback with user_data is used, and the other is ignored. Therefore, although there are 12 callbacks, you can have a maximum of six callback functions active at any one time. For instance, Example 11-2 uses smooth shading, so vertexCallback() specifies an RGB color for every vertex. If you want to do lighting and smooth shading, the callback would specify a surface normal for every vertex. However, if you want lighting and flat shading, you might specify only one surface normal for every polygon, not for every vertex. In that case, you might choose to use the GLU_TESS_BEGIN_DATA callback and pass the vertex coordinates and surface normal in the user_data pointer. Tessellation Properties Prior to tessellation and rendering, you may use gluTessProperty() to set several properties to affect the tessellation algorithm. The most important and complicated of these properties is the winding rule, which determines what is considered “interior” and “exterior.” Winding Numbers and Winding Rules For a single contour, the winding number of a point is the signed number of revolutions we make around that point while traveling once around the contour (where a counterclockwise revolution is positive and a clockwise revolution is negative). When there are several contours, the individual winding numbers are summed. This procedure associates a signed integer value with each point in the plane. Note that the winding number is the same for all points in a single region. void gluTessProperty(GLUtesselator tessobj, GLenum property, GLdouble value); For the tessellation object tessobj, the current value of property is set to value. property is GLU_TESS_BOUNDARY_ONLY, GLU_TESS_TOLERANCE, or GLU_TESS_WINDING_RULE. If property is GLU_TESS_BOUNDARY_ONLY, value is either GL_TRUE or GL_FALSE. When it is set to GL_TRUE, polygons are no longer tessellated into filled polygons; line loops are drawn to outline the contours that separate the polygon interior and exterior. The default value is GL_FALSE. (See gluTessNormal() to see how to control the winding direction of the contours.) If property is GLU_TESS_TOLERANCE, value is a distance used to calculate whether two vertices are close enough together to be merged by the GLU_TESS_COMBINE callback. The tolerance value is multiplied by the largest coordinate magnitude of an input vertex to determine the maximum distance any feature can move as a result of a single merge operation. Feature merging may not be supported by your implementation, and the tolerance value is only a hint. The default tolerance value is zero. The GLU_TESS_WINDING_RULE property determines which parts of the polygon are on the interior and which are on the exterior and should not be filled. value can be GLU_TESS_WINDING_ODD (the default), GLU_ TESS_WINDING_NONZERO, GLU_TESS_WINDING_POSITIVE, GLU_ TESS_WINDING_NEGATIVE, or GLU_TESS_WINDING_ABS_GEQ_TWO. In the set at the left, all three contours are counterclockwise, so each nested interior region adds 1 to the winding number. In the middle set, the two interior contours are drawn clockwise, so the winding number decreases and actually becomes negative. The winding rule classifies a region as inside if its winding number belongs to the chosen category (odd, nonzero, positive, negative, or “absolute value greater than or equal to 2”). The odd and nonzero rules are common ways to define the interior. The positive, negative, and “absolute value t 2” winding rules have some limited use for polygon CSG (computational solid geometry) operations. The program tesswind.c demonstrates the effects of winding rules. The four sets of contours shown in Figure 11-3 are rendered. The user can then cycle through the different winding rule properties to see their effects. For each winding rule, the dark areas represent interiors. Note the effects of clockwise and counterclockwise winding. CSG Uses for Winding Rules GLU_TESS_WINDING_ODD and GLU_TESS_WINDING_NONZERO are the most commonly used winding rules. They work for the most typical cases of shading. The winding rules are also designed for CSG operations, making it easy to find the union, difference, or intersection (Boolean operations) of several contours. 1 2 3 1 0 -1 1 1 1 1 1 2 First, assume that each contour is defined so that the winding number is 0 for each exterior region and 1 for each interior region. (Each contour must not intersect itself.) Under this model, counterclockwise contours define the outer boundary of the polygon, and clockwise contours define holes. Contours may be nested, but a nested contour must be oriented oppositely from the contour that contains it. 1 2 3 1 0 -1 1 2 321 4321 Contours and Winding Numbers Winding Rules Odd Nonzero Positive Negative ABS_GEQ_TWO Unfilled Unfilled Unfilled Unfilled If the original polygons do not satisfy this description, they can be converted to this form by first running the tessellator with the GLU_TESS_ BOUNDARY_ONLY property turned on. This returns a list of contours satisfying the restriction just described. By creating two tessellator objects, the callbacks from one tessellator can be fed directly as input to the other. Given two or more polygons of the preceding form, CSG operations can be implemented as follows: • UNION—To calculate the union of several contours, draw all input contours as a single polygon. The winding number of each resulting region is the number of original polygons that cover it. The union can be extracted by using the GLU_TESS_WINDING_NONZERO or GLU_TESS_WINDING_POSITIVE winding rule. Note that with the nonzero winding rule, we would get the same result if all contour orientations were reversed. • INTERSECTION—This works only for two contours at a time. Draw a single polygon using two contours. Extract the result using GLU_TESS_ WINDING_ABS_GEQ_TWO. • DIFFERENCE—Suppose you want to compute A diff (B union C union D). Draw a single polygon consisting of the unmodified contours from A, followed by the contours of B, C, and D, with their vertex order reversed. To extract the result, use the GLU_TESS_WINDING_POSITIVE winding rule. (If B, C, and D are the result of a GLU_TESS_BOUNDARY_ ONLY operation, an alternative to reversing the vertex order is to use gluTessNormal() to reverse the sign of the supplied normal.) Other Tessellation Property Routines There are also complementary routines, which work alongside gluTessProperty(). gluGetTessProperty() retrieves the current values of tessellator properties. If the tessellator is being used to generate wireframe outlines instead of filled polygons, gluTessNormal() can be used to determine the winding direction of the tessellated polygons. void gluGetTessProperty(GLUtesselator tessobj, GLenum property, GLdouble value); For the tessellation object tessobj, the current value of property is returned to value. Values for property and value are the same as for gluTessProperty(). If you have some knowledge about the location and orientation of the input data, then using gluTessNormal() can increase the speed of the tessellation. For example, if you know that all polygons lie on the xy-plane, call gluTessNormal(tessobj, 0, 0, 1). As stated above, the default normal is (0, 0, 0), and its effect is not immediately obvious. In this case, it is expected that the input data lies approximately in a plane, and a plane is fitted to the vertices, no matter how they are truly connected. The sign of the normal is chosen so that the sum of the signed areas of all input contours is non-negative (where a counterclockwise contour has a positive area). Note that if the input data does not lie approximately in a plane, then projection perpendicular to the computed normal may substantially change the geometry. After all the tessellation properties have been set and the callback actions have been registered, it is finally time to describe the vertices that comprise input contours and tessellate the polygons. Calls to gluTessBeginPolygon() and gluTessEndPolygon() surround the definition of one or more contours. When gluTessEndPolygon() is called, the tessellation algorithm is implemented, and the tessellated polygons are void gluTessNormal(GLUtesselator tessobj, GLdouble x, GLdouble y, GLdouble z); For the tessellation object tessobj, gluTessNormal() defines a normal vector, which controls the winding direction of generated polygons. Before tessellation, all input data is projected into a plane perpendicular to the normal. Then, all output triangles are oriented counterclockwise, with respect to the normal. (Clockwise orientation can be obtained by reversing the sign of the supplied normal.) The default normal is (0, 0, 0). void gluTessBeginPolygon(GLUtesselator tessobj, void user_data); void gluTessEndPolygon(GLUtesselator tessobj); Begins and ends the specification of a polygon to be tessellated and associates a tessellation object, tessobj, with it. user_data points to a userdefined data structure, which is passed along all the GLU_TESS__DATA callback functions that have been bound. generated and rendered. The callback functions and tessellation properties that were bound and set to the tessellation object using gluTessCallback() and gluTessProperty() are used. In practice, a minimum of three vertices is needed for a meaningful contour. In the program tess.c, a portion of which is shown in Example 11-3, two polygons are defined. One polygon is a rectangular contour with a triangular hole inside, and the other is a smooth-shaded, self-intersecting, five-pointed star. For efficiency, both polygons are stored in display lists. The first polygon consists of two contours; the outer one is wound counterclockwise, and the “hole” is wound clockwise. For the second polygon, the star array contains both the coordinate and color data, and its tessellation callback, vertexCallback(), uses both. It is important that each vertex is in a different memory location because the vertex data is not copied by gluTessVertex(); only the pointer (vertex_ data) is saved. A program that reuses the same memory for several vertices may not get the desired result. Note: In gluTessVertex(), it may seem redundant to specify the vertex coordinate data twice, for both the coords and vertex_data parameters; however, both are necessary. coords refers only to the vertex coordinates. vertex_data uses the coordinate data, but may also use other information for each vertex. void gluTessBeginContour(GLUtesselator tessobj); void gluTessEndContour(GLUtesselator tessobj); Begins and ends the specification of a closed contour, which is a portion of a polygon. A closed contour consists of zero or more calls to gluTessVertex(), which defines the vertices. The last vertex of each contour is automatically linked to the first. void gluTessVertex(GLUtesselator tessobj, GLdouble coords[3], void vertex_data); Specifies a vertex in the current contour for the tessellation object. coords contains the three-dimensional vertex coordinates, and vertex_data is a pointer that’s sent to the callback associated with GLU_TESS_VERTEX or GLU_TESS_VERTEX_DATA. Typically, vertex_data contains vertex coordinates, surface normals, texture coordinates, color information, or whatever else the application may find useful. Deleting a Tessellation Object If you no longer need a tessellation object, you can delete it and free all associated memory with gluDeleteTess(). Tessellation Performance Tips For best performance, remember these rules: • Cache the output of the tessellator in a display list or other user structure. To obtain the post-tessellation vertex coordinates, tessellate the polygons while in feedback mode. (See “Feedback” in Chapter 13.) • Use gluTessNormal() to supply the polygon normal. • Use the same tessellator object to render many polygons, rather than allocate a new tessellator for each one. (In a multithreaded, multiprocessor environment, you may get better performance using several tessellators.) Describing GLU Errors The GLU provides a routine for obtaining a descriptive string for an error code. This routine is not limited to tessellation but is also used for NURBS and quadrics errors, as well as for errors in the base GL. (See “Error void gluDeleteTess(GLUtesselator tessobj); Deletes the specified tessellation object, tessobj, and frees all associated memory. Handling” in Chapter 14 for information about OpenGL’s error-handling facility.) Backward Compatibility If you are using the 1.0 or 1.1 version of GLU, you have a much less powerful tessellator. The 1.0/1.1 tessellator handles only simple nonconvex polygons or simple polygons containing holes. It does not properly tessellate intersecting contours (no COMBINE callback) or process per-polygon data. The 1.0/1.1 tessellator still works in either GLU 1.2 or 1.3, but its use is no longer recommended. The 1.0/1.1 tessellator has some similarities to the current tessellator. gluNewTess() and gluDeleteTess() are used for both tessellators. The main vertex specification routine remains gluTessVertex(). The callback mechanism is controlled by gluTessCallback(), although only five callback functions can be registered, a subset of the current 12. Here are the prototypes for the 1.0/1.1 tessellator: void gluBeginPolygon(GLUtriangulatorObj tessobj); void gluNextContour(GLUtriangulatorObj tessobj, GLenum type); void gluEndPolygon(GLUtriangulatorObj tessobj); The outermost contour must be specified first, and it does not require an initial call to gluNextContour(). For polygons without holes, only one contour is defined, and gluNextContour() is not used. If a polygon has multiple contours (that is, holes or holes within holes), the contours are specified one after the other, each preceded by gluNextContour(). gluTessVertex() is called for each vertex of a contour. For gluNextContour(), type can be GLU_EXTERIOR, GLU_INTERIOR, GLU_CCW, GLU_CW, or GLU_UNKNOWN. These serve only as hints to the tessellation. If you get them right, the tessellation might go faster. If you get them wrong, they’re ignored, and the tessellation still works. For polygons with holes, one contour is the exterior contour and the other is the interior. The first contour is assumed to be of type GLU_EXTERIOR. Choosing clockwise or counterclockwise orientation is arbitrary in three dimensions; however, there are two different orientations in any plane, and the GLU_CCW and GLU_CW types should be used consistently. Use GLU_UNKNOWN if you don’t have a clue. Quadrics: Rendering Spheres, Cylinders, and Disks 559 It is highly recommended that you convert GLU 1.0/1.1 code to the new tessellation interface for GLU 1.2 by following these steps: 1. Change references to the major data structure type from GLUtriangulatorObj to GLUtesselator. In GLU 1.2, GLUtriangulatorObj and GLUtesselator are defined to be the same type. 2. Convert gluBeginPolygon() to two commands: gluTessBeginPolygon() and gluTessBeginContour(). All contours must be explicitly started, including the first one. 3. Convert gluNextContour() to both gluTessEndContour() and gluTessBeginContour(). You have to end the previous contour before starting the next one. 4. Convert gluEndPolygon() to both gluTessEndContour() and gluTessEndPolygon(). The final contour must be closed. 5. Change references to constants to gluTessCallback(). In GLU 1.2, GLU_BEGIN, GLU_VERTEX, GLU_END, GLU_ERROR, and GLU_EDGE_FLAG are defined as synonyms for GLU_TESS_BEGIN, GLU_TESS_VERTEX, GLU_TESS_END, GLU_TESS_ERROR, and GLU_TESS_EDGE_FLAG. Please respond using only information provided in the context block. If the information needed to answer the question is not within the context block, state that you cannot answer. I am interested in what context one would use the glGenFrameBuffers() function. What does this function do exactly? Please include any extra information to help understand the function.	Please respond using only information provided in the context block. If the information needed to answer the question is not within the context block, state that you cannot answer. EVIDENCE: Up to this point, all of our discussion regarding buffers has focused on the buffers provided by the windowing system, as you requested when you called glutCreateWindow() (and configured by your call to glutInitDisplayMode()). Although you can quite successfully use any technique with just those buffers, quite often various operations require moving data between buffers superfluously. This is where framebuffer objects enter the picture (as part of OpenGL Version 3.0). Using framebuffer objects, you can create our own framebuffers and use their attached renderbuffers to minimize data copies and optimize performance. Framebuffer objects are quite useful for performing off-screen-rendering, updating texture maps, and engaging in buffer ping-ponging (a data-transfer techniques used in GPGPU). The framebuffer that is provided by the windowing system is the only framebuffer that is available to the display system of your graphics server— that is, it is the only one you can see on your screen. It also places restrictions on the use of the buffers that were created when your window opened. By comparison, the framebuffers that your application creates cannot be displayed on your monitor; they support only off-screen rendering. Another difference between window-system-provided framebuffers and framebuffers you create is that those managed by the window system allocate their buffers—color, depth, stencil, and accumulation—when your window is created. When you create an application-managed framebuffer object, you need to create additional renderbuffers that you associate with the framebuffer objects you created. The buffers with the window-systemprovided buffers can never be associated with an application-created framebuffer object, and vice versa. To allocate an application-generated framebuffer object name, you need to call glGenFramebuffers() which will allocate an unused identifier for the framebuffer object. As compared to some other objects within OpenGL (e.g., texture objects and display lists), you always need to use an name returned from glGenFramebuffers(). Allocating a framebuffer object name doesn’t actually create the framebuffer object or allocate any storage for it. Those tasks are handled through a call to glBindFramebuffer(). glBindFramebuffer() operates in a similar manner to many of the other glBind() routines you’ve seen in OpenGL. The first time it is called for a particular framebuffer, it causes void glGenFramebuffers(GLsize n, GLuint ids); Allocate n unused framebuffer object names, and return those names in ids. storage for the object to be allocated and initialized. Any subsequent calls will bind the provided framebuffer object name as the active one. As with all of the other objects you have encountered in OpenGL, you can release an application-allocated framebuffer by calling glDeleteFramebuffers(). That function will mark the framebuffer object’s name as unallocated and release any resources associated with the framebuffer object. For completeness, you can determine whether a particular unsigned integer is an application-allocated framebuffer object by calling glIsFramebuffer():. void glBindFramebuffer(GLenum target, GLuint framebuffer); Specifies either a framebuffer for either reading or writing. When target is GL_DRAW_FRAMEBUFFER, framebuffer specifies the destination framebuffer for rendering. Similarly, when target is set to GL_READ_ FRAMEBUFFER, framebuffer specifies the source of read operations. Passing GL_FRAMEBUFFER for target sets both the read and write framebuffer bindings to framebuffer. framebuffer must either be zero, which binds target to the default; a window-system provided framebuffer; or a framebuffer object generated by a call to glGenFramebuffers(). A GL_INVALID_OPERATION error is generated if framebuffer is neither zero nor a valid framebuffer object previously generated by calling glGenFramebuffers(), but not deleted by calling glDeleteFramebuffers(). void glDeleteFramebuffers(GLsize n, const GLuint ids); Deallocates the n framebuffer objects associated with the names provided in ids. If a framebuffer object is currently bound (i.e., its name was passed to the most recent call to glBindFramebuffer()), and is deleted, the framebuffer target is immediately bound to id zero (the window-system provided framebuffer), and the framebuffer object is released. No errors are generated by glDeleteFramebuffers(). Unused names or zero are simply ignored. GLboolean glIsFramebuffer(GLuint framebuffer); Framebuffer Objects 529 Once a framebuffer object is created, you still can’t do much with it. You need to provide a place for drawing to go and reading to come from; those places are called framebuffer attachments. We’ll discuss those in more detail after we examine renderbuffers, which are one type of buffer you can attach to a framebuffer object. Renderbuffers Renderbuffers are effectively memory managed by OpenGL that contains formatted image data. The data that a renderbuffer holds takes meaning once it is attached to a framebuffer object, assuming that the format of the image buffer matches what OpenGL is expecting to render into (e.g., you can’t render colors into the depth buffer). As with many other buffers in OpenGL, the process of allocating and deleting buffers is similar to what you’ve seen before. To create a new renderbuffer, you would call glGenRenderbuffers(). Likewise, a call to glDeleteRenderbuffers() will release the storage associated with a renderbuffer. Returns GL_TRUE if framebuffer is the name of a framebuffer returned from glGenFramebuffers(). Returns GL_FALSE if framebuffer is zero (the window-system default framebuffer) or a value that’s either unallocated or been deleted by a call to glDeleteFramebuffers(). void glGenRenderbuffers(GLsizei n, GLuint ids); Allocate n unused renderbuffer object names, and return those names in ids. Names are unused until bound with a call to glBindRenderbuffer(). void glDeleteRenderbuffers(GLsizei n, const GLuint ids); Deallocates the n renderbuffer objects associated with the names provided in ids. If one of the renderbuffers is currently bound and passed to glDeleteRenderbuffers(), a binding of zero replaces the binding at the current framebuffer attachment point, in addition to the renderbuffer being released. No errors are generated by glDeleteRenderbuffers(). Unused names or zero are simply ignored. Likewise, you can determine whether a name represents a valid renderbuffer by calling glIsRenderbuffer(). Similar to the process of binding a framebuffer object so that you can modify its state, you call glBindRenderbuffer() to affect a renderbuffer’s creation and to modify the state associated with it, which includes the format of the image data that it contains. Creating Renderbuffer Storage When you first call glBindRenderbuffer() with an unused renderbuffer name, the OpenGL server creates a renderbuffer with all its state information set to the default values. In this configuration, no storage has been allocated to store image data. Before you can attach a renderbuffer to a framebuffer and render into it, you need to allocate storage and specify its image format. This is done by calling either glRenderbufferStorage() or glRenderbufferStorageMultisample(). void glIsRenderbuffer(GLuint renderbuffer); Returns GL_TRUE if renderbuffer is the name of a renderbuffer returned from glGenRenderbuffers(). Returns GL_FALSE if renderbuffer is zero (the window-system default framebuffer) or a value that’s either unallocated or been deleted by a call to glDeleteRenderbuffers(). void glBindRenderbuffer(GLenum target, GLuint renderbuffer); Creates a renderbuffer and associates it with the name renderbuffer. target must be GL_RENDERBUFFER. renderbuffer must either be zero, which removes any renderbuffer binding, or a name that was generated by a call to glGenRenderbuffers(); otherwise, a GL_INVALID_OPERATION error will be generated. void glRenderbufferStorage(GLenum target, GLenum internalformat, GLsizei width, GLsizei height); void glRenderbufferStorageMultisample(GLenum target, GLsizei samples, GLenum internalformat, GLsizei width, GLsizei height); Framebuffer Objects 531 Allocates storage for image data for the bound renderbuffer. target must be GL_RENDERBUFFER. For a color-renderable buffer, internalformat must be one of: GL_RED, GL_R8, GL_R16, GL_RG, GL_RG8, GL_RG16, GL_RGB, GL_R3_G3_B2, GL_RGB4, GL_RGB5, GL_RGB8, GL_RGB10, GL_RGB12, GL_RGB16, GL_RGBA, GL_RGBA2, GL_RGBA4, GL_RGB5_A1, GL_RGBA8, GL_RGB10_A2, GL_RGBA12, GL_RGBA16, GL_SRGB, GL_SRGB8, GL_SRGB_ALPHA, GL_SRGB8_ALPHA8,GL_R16F, GL_R32F, GL_RG16F, GL_RG32F, GL_RGB16F, GL_RGB32F, GL_RGBA16F, GL_RGBA32F, GL_R11F_G11F_B10F, GL_RGB9_E5, GL_R8I, GL_R8UI, GL_R16I, GL_R16UI, GL_R32I, GL_R32UI, GL_RG8I, GL_RG8UI, GL_RG16I, GL_RG16UI, GL_RG32I, GL_RG32UI, GL_RGB8I, GL_RGB8UI, GL_RGB16I, GL_RGB16UI, GL_RGB32I, GL_RGB32UI, GL_RGBA8I, GL_RGBA8UI, GL_RGBA16I, GL_RGBA16UI, GL_RGBA32I. OpenGL version 3.1 adds the additional following formats: GL_R8_SNORM, GL_R16_SNORM, GL_RG8_SNORM, GL_RG16_SNORM, GL_RGB8_ SNORM, GL_RGB16_SNORM, GL_RGBA8_SNORM, GL_RGBA16_SNORM. To use a renderbuffer as a depth buffer, it must be depth-renderable, which is specified by setting internalformat to either GL_DEPTH_COMPONENT, GL_DEPTH_COMPONENT16, GL_DEPTH_COMPONENT32, GL_DEPTH_ COMPONENT32, or GL_DEPTH_COMPONENT32F. For use exclusively as a stencil buffer, internalformat should be specified as either GL_STENCIL_INDEX, GL_STENCIL_INDEX1, GL_STENCIL_ INDEX4, GL_STENCIL_INDEX8, or GL_STENCIL_INDEX16. For packed depth-stencil storage, internalformat must be GL_DEPTH_ STENCIL, which allows the renderbuffer to be attached as the depth buffer, stencil buffer, or at the combined depth-stencil attachment point. width and height specify the size of the renderbuffer in pixels, and samples specifies the number of multisample samples per pixel. Setting samples to zero in a call to glRenderbufferStorageMultisample() is identical to calling glRenderbufferStorage(). A GL_INVALID_VALUE is generated if width or height is greater than the value returned when querying GL_MAX_RENDERBUFFER_SIZE, or if samples is greater than the value returned when querying GL_MAX_ SAMPLES. A GL_INVALID_OPERATION is generated if internalformat is a signed- or unsigned-integer format (e.g., a format containing a “I”, or “UI” in its token), and samples is not zero, and the implementation doesn’t support multisampled integer buffers. Finally, if the renderbuffer size and format combined exceed the available memory able to be allocated, then a GL_OUT_OF_MEMORY error is generated. Example 10-6 Creating an RGBA Color Renderbuffer: fbo.c glGenRenderbuffers( 1, &color ); glBindRenderbuffer( GL_RENDERBUFFER, color ); glRenderbufferStorage( GL_RENDERBUFFER, GL_RGBA, 256, 256 ); Once you have created storage for your renderbuffer, you need to attach it to a framebuffer object before you can render into it. Framebuffer Attachments When you render, you can send the results of that rendering to a number of places: • The color buffer to create an image, or even multiple color buffers if you’re using multiple render targets (see “Special Output Values” in Chapter 15) • The depth buffer to store occlusion information • The stencil buffer for storing per-pixel masks to control rendering Each of those buffers represents a framebuffer attachment, to which you can attach suitable image buffers that you later render into, or read from. Currently, there are two types of rendering surfaces you can associate with one of those attachments: renderbuffers and a level of a texture image. Attachment Name Description GL_COLOR_ATTACHMENTi The ith color buffer. i can range from zero (the default color buffer) to GL_MAX_COLOR_ATTACHMENTS–1 GL_DEPTH_ATTACHMENT The depth buffer GL_STENCIL_ATTACHMENT The stencil buffer GL_DEPTH_STENCIL_ATTACHMENT A special attachment for packed depthstencil buffers (which require the renderbuffer to have been allocated as a GL_DEPTH_STENCIL pixel format) We’ll first discuss attaching a renderbuffer to a framebuffer object, which is done by calling glFramebufferRenderbuffer(). In Example 10-7, we create and attach two renderbuffers: one for color, and the other for depth. We then proceed to render, and finally copy the results back to the window-system-provided framebuffer to display the results. You might use this technique to generate frames for a movie rendering offscreen, where you don’t have to worry about the visible framebuffer being corrupted by overlapping windows or someone resizing the window and interrupting rendering. One important point to remember is that you might need to reset the viewport for each framebuffer before rendering, particularly if the size of your application-defined framebuffers differs from the window-system provided framebuffer. Another very common use for framebuffer objects is to update textures dynamically. You might do this to indicate changes in a surface’s appearance (such as bullet holes in a wall in a game) or to update values in a lookup table if you’re doing GPGPU-like computations. In these cases, you bind a level of a texture map as the framebuffer attachment, as compared to a renderbuffer. After rendering, the texture map can be detached from the framebuffer so that it can be used in subsequent rendering. Note: Nothing prevents you from reading from a texture that is simultaneously bound as a framebuffer attachment for writing. In this scenario, called a framebuffer rendering loop, the results are undefined for both operations. That is, the values returned from sampling the bound texture map, as well as the values written into the texture level while bound, will likely be incorrect. void glFramebufferTexture1D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level); void glFramebufferTexture2D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level); void glFramebufferTexture3D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level, GLint layer); Attaches a level of a texture objects as a rendering attachment to a framebuffer object. target must be either GL_READ_FRAMEBUFFER, GL_DRAW_FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_FRAMEBUFFER). attachment must be one of the framebuffer attachment points: GL_COLOR_ATTACHMENTi, GL_DEPTH_ ATTACHMENT, GL_STENCIL_ATTACHMENT, or GL_DEPTH_STENCIL_ ATTACHMENT (in which case, the internal format of the texture must be GL_DEPTH_STENCIL). For glFramebufferTexture1D(), texturetarget must be GL_TEXTURE_1D, if texture is not zero. For glFramebufferTexture2D(), texturetarget must be GL_TEXTURE_2D, GL_TEXTURE_RECTANGLE, GL_TEXTURE_CUBE_ MAP_POSITIVE_X, GL_TEXTURE_CUBE_MAP_POSITIVE_Y, GL_ TEXTURE_CUBE_MAP_POSITIVE_Z, GL_TEXTURE_CUBE_MAP_ NEGATIVE_X, GL_TEXTURE_CUBE_MAP_NEGATIVE_Y, GL_TEXTURE_ CUBE_MAP_NEGATIVE_Z, and for glFramebufferTexture3D() texturetarget must be GL_TEXTURE_3D. Similar to the previous example, Example 10-8 demonstrates the process of dynamically updating a texture, using the texture after its update is completed, and then rendering with it later. Framebuffer Completeness Given the myriad of combinations between texture and buffer formats, and between framebuffer attachments, various situations can arise that prevent the completion of rendering when you are using applicationdefined framebuffer objects. After modifying the attachments to a framebuffer object, it’s best to check the framebuffer’s status by calling glCheckFramebufferStatus(). The errors representing the various violations of framebuffer configurations are listed in Table 10-7. Of the listed errors, GL_FRAMEBUFFER_UNSUPPORTED is very implementation dependent, and may be the most complicated to debug. void glFramebufferTextureLayer(GLenum target, GLenum attachment, GLuint texture, GLint level, GLint layer); Attaches a layer of a three-dimensional texture, or a one- or twodimensional array texture as a framebuffer attachment, in a similar manner to glFramebufferTexture3D(). target must be one of GL_READ_FRAMEBUFFER, GL_DRAW_ FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_ FRAMEBUFFER). attachment must be one of GL_COLOR_ATTACHMENTi, GL_DEPTH_ATTACHMENT, GL_STENCIL_ATTACHMENT, or GL_DEPTH_ STENCIL_ATTACHMENT. texture must be either zero, indicating that the current binding for the attachment should be released, or a texture object name (as returned from glGenTextures()). level indicates the mipmap level of the texture object, and layer represents which layer of the texture (or array element) should be bound as an attachment. GLenum glCheckFramebufferStatus(GLenum target); Returns one of the framebuffer completeness status enums listed in Table 10-7. target must be one of GL_READ_FRAMEBUFFER, GL_DRAW_ FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_ FRAMEBUFFER). If glCheckFramebufferStatus() generates an error, zero is returned. Framebuffer Objects 539 Copying Pixel Rectangles While glCopyPixels() has been the default routine for replicating blocks of pixels since OpenGL Version 1.0, as OpenGL expanded its rendering facilities, a more substantial pixel-copying routine was required. glBlitFramebuffer(), described below, subsumes the operations of glCopyPixels() and glPixelZoom() in a single, enhanced call. glBlitFramebuffer() allows greater pixel filtering during the copy operation, much in the same manner as texture mapping (in fact, the same filtering operations, GL_NEAREST and GL_LINEAR are used during the copy). Additionally, this routine is aware of multisampled buffers, and supports copying between different framebuffers (as controlled by framebuffer objects). Framebuffer Completeness Status Enum Description GL_FRAMEBUFFER_COMPLETE The framebuffer and its attachments match the rendering or reading state required. GL_FRAMEBUFFER_UNDEFINED The bound framebuffer is specified to be the default framebuffer (i.e., glBindFramebuffer() with zero specified as the framebuffer), and the default framebuffer doesn’t exist. GL_FRAMEBUFFER_ INCOMPLETE_ATTACHMENT A necessary attachment to the bound framebuffer is uninitialized GL_FRAMEBUFFER_ INCOMPLETE_MISSING_ ATTACHMENT There are no images (e.g., texture layers or renderbuffers) attached to the framebuffer. GL_FRAMEBUFFER_ INCOMPLETE_DRAW_BUFFER Every drawing buffer (e.g., GL_DRAW_BUFFERi as specified by glDrawBuffers()) has an attachment. GL_FRAMEBUFFER_ INCOMPLETE_READ_BUFFER An attachment exists for the buffer specified for the buffer specified by glReadBuffer(). GL_FRAMEBUFFER_ UNSUPPORTED The combination of images attached to the framebuffer object is incompatible with the requirements of the OpenGL implementation. GL_FRAMEBUFFER_ INCOMPLETE_MULTISAMPLE The number of samples for all images across the framebuffer’s attachments do not match. void glBlitFramebuffer(GLint srcX0, GLint srcY0, GLint srcX1, GLint srcY1, GLint dstX0, GLint dstY0, GLint dstX1, GLint dstY1, GLbitfield buffers, GLenum filter); Copies a rectangle of pixel values from one region of the read framebuffer to another region of the draw framebuffer, potentially resizing, reversing, converting, and filtering the pixels in the process. srcX0, srcY0, srcX1, srcY1 represent the source region where pixels are sourced from, and written to the rectangular region specified by dstX0, dstY0, dstX1, dstY1. buffers is the bitwise-or of GL_COLOR_BUFFER_BIT, GL_DEPTH_BUFFER_ BIT, and GL_STENCIL_BUFFER_BIT, which represent the buffers in which the copy should occur. Finally, filter specifies the method of interpolation done if the two rectangular regions are different sizes, and must be one of GL_NEAREST or GL_LINEAR; no filtering is applied if the regions are the same size. If there are multiple color draw buffers (See “Rendering to Multiple Output Buffers” on page 729), each buffer receives a copy of the source region. If srcX1 < srcX0, or dstX1 < dstX0, the image is reversed in the horizontal direction. Likewise, if srcY1 < srcY0 or dstY1 < dstY0, the image is reverse in the vertical direction. However, If both the source and destination sizes are negative in the same direction, no reversal is done. If the source and destination buffers are of different formats, conversion of the pixel values is done in most situations. However, if the read color buffer is a floating-point format, and any of the write color buffers are not, or vice verse; and if the read color buffer is a signed (unsigned) integer format and not all of the draw buffers are signed (unsigned) integer values, the call will generate a GL_INVALID_OPERATION, and no pixels will be copied. Multisampled buffers also have an effect on the copying of pixels. If the source buffer is multisampled, and the destination is not, the samples are resolved to a single pixel value for the destination buffer. Conversely, if the source buffer is not multisampled, and the destination is, the source pixel’s data is replicated for each sample. Finally, if both buffers are multisampled and the number of samples for each buffer is the same, the samples are copied without modification. However, if the buffers have a different number of samples, no pixels are copied, and a GL_INVALID_ OPERATION error is generated. A GL_INVALID_VALUE error is generated if buffers has other bits set than those permitted, or if filter is other than GL_LINEAR or GL_NEAREST Chapter Objectives After reading this chapter, you’ll be able to do the following: • Render concave filled polygons by first tessellating them into convex polygons, which can be rendered using standard OpenGL routines • Use the OpenGL Utility Library to create quadrics objects to render and model the surfaces of spheres and cylinders, and to tessellate disks (circles) and partial disks (arcs) Note: In OpenGL Version 3.1, some of the techniques and functions described in this chapter—particularly those relating to quadric objects—were likely affected by deprecation. While many of these features can be found in the GLU library, they rely on OpenGL functions that were removed. The OpenGL Library (GL) is designed for low-level operations, both streamlined and accessible to hardware acceleration. The OpenGL Utility Library (GLU) complements the OpenGL library, supporting higher-level operations. Some of the GLU operations are covered in other chapters. Mipmapping (gluBuildDMipmaps()) and image scaling (gluScaleImage()) are discussed along with other facets of texture mapping in Chapter 9. Several matrix transformation GLU routines (gluOrtho2D(), gluPerspective(), gluLookAt(), gluProject(), gluUnProject(), and gluUnProject4()) are described in Chapter 3. The use of gluPickMatrix() is explained in Chapter 13. The GLU NURBS facilities, which are built atop OpenGL evaluators, are covered in Chapter 12. Only two GLU topics remain: polygon tessellators and quadric surfaces; these topics are discussed in this chapter. To optimize performance, the basic OpenGL renders only convex polygons, but the GLU contains routines for tessellating concave polygons into convex ones, which the basic OpenGL can handle. Where the basic OpenGL operates on simple primitives, such as points, lines, and filled polygons, the GLU can create higher-level objects, such as the surfaces of spheres, cylinders, and cones. This chapter has the following major sections. • “Polygon Tessellation” explains how to tessellate concave polygons into easier-to-render convex polygons. • “Quadrics: Rendering Spheres, Cylinders, and Disks” describes how to generate spheres, cylinders, circles and arcs, including data such as surface normals and texture coordinates. Polygon Tessellation As discussed in “Describing Points, Lines, and Polygons” in Chapter 2, OpenGL can directly display only simple convex polygons. A polygon is simple if the edges intersect only at vertices, there are no duplicate vertices, and exactly two edges meet at any vertex. If your application requires the display of concave polygons, polygons containing holes, or polygons with intersecting edges, these polygons must first be subdivided into simple convex polygons before they can be displayed. Such subdivision is called tessellation, and the GLU provides a collection of routines that perform tessellation. These routines take as input arbitrary contours, which describe hard-to-render polygons, and they return some combination of triangles, triangle meshes, triangle fans, and lines. If you think a polygon may need tessellation, follow these typical steps: 1. Create a new tessellation object with gluNewTess(). 2. Use gluTessCallback() several times to register callback functions to perform operations during the tessellation. The trickiest case for a callback function is when the tessellation algorithm detects an intersection and must call the function registered for the GLU_TESS_ COMBINE callback. 3. Specify tessellation properties by calling gluTessProperty(). The most important property is the winding rule, which determines the regions that should be filled and those that should remain unshaded. 4. Create and render tessellated polygons by specifying the contours of one or more closed polygons. If the data for the object is static, encapsulate the tessellated polygons in a display list. (If you don’t have to recalculate the tessellation repeatedly, using display lists is more efficient.) 5. If you need to tessellate something else, you may reuse your tessellation object. If you are forever finished with your tessellation object, you may delete it with gluDeleteTess(). Note: The tessellator described here was introduced in Version 1.2 of the GLU. If you are using an older version of the GLU, you must use routines described in “Describing GLU Errors” on page 557. To query which version of GLU you have, use gluGetString(GLU_VERSION), which returns a string with your GLU version number. If you don’t seem to have gluGetString() in your GLU, then you have GLU 1.0, which did not yet have the gluGetString() routine. Creating a Tessellation Object As a complex polygon is being described and tessellated, it has associated data, such as the vertices, edges, and callback functions. All this data is tied to a single tessellation object. To perform tessellation, your program first has to create a tessellation object using the routine gluNewTess(). A single tessellation object can be reused for all your tessellations. This object is required only because library routines might need to do their own tessellations, and they should be able to do so without interfering with any tessellation that your program is doing. It might also be useful to have multiple tessellation objects if you want to use different sets of callbacks for different tessellations. A typical program, however, allocates a single tessellation object and uses it for all its tessellations. There’s no real need to free it, because it uses a small amount of memory. On the other hand, it never hurts to be tidy. Tessellation Callback Routines After you create a tessellation object, you must provide a series of callback routines to be called at appropriate times during the tessellation. After specifying the callbacks, you describe the contours of one or more polygons using GLU routines. When the description of the contours is complete, the tessellation facility invokes your callback routines as necessary. Any functions that are omitted are simply not called during the tessellation, and any information they might have returned to your program is lost. All are specified by the single routine gluTessCallback(). GLUtesselator* gluNewTess(void); Creates a new tessellation object and returns a pointer to it. A null pointer is returned if the creation fails. Polygon Tessellation 545 void gluTessCallback(GLUtesselator tessobj, GLenum type, void (fn)()); Associates the callback function fn with the tessellation object tessobj. The type of the callback is determined by the parameter type, which can be GLU_TESS_BEGIN, GLU_TESS_BEGIN_DATA, GLU_TESS_EDGE_FLAG, GLU_TESS_EDGE_FLAG_DATA, GLU_TESS_VERTEX, GLU_TESS_VERTEX_ DATA, GLU_TESS_END, GLU_TESS_END_DATA, GLU_TESS_COMBINE, GLU_TESS_COMBINE_DATA, GLU_TESS_ERROR, or GLU_TESS_ERROR_ DATA. The 12 possible callback functions have the following prototypes: GLU_TESS_BEGIN void begin(GLenum type); GLU_TESS_BEGIN_DATA void begin(GLenum type, void user_data); GLU_TESS_EDGE_FLAG void edgeFlag(GLboolean flag); GLU_TESS_EDGE_FLAG_DATA void edgeFlag(GLboolean flag, void user_data); GLU_TESS_VERTEX void vertex(void vertex_data); GLU_TESS_VERTEX_DATA void vertex(void vertex_data, void user_data); GLU_TESS_END void end(void); GLU_TESS_END_DATA void end(void user_data); GLU_TESS_COMBINE void combine( GLdouble coords[3], voidvertex_data[4], GLfloat weight[4], void outData); GLU_TESS_COMBINE_DATA void combine( GLdouble coords[3], voidvertex_data[4], GLfloat weight[4], void *outData, void user_data); GLU_TESS_ERROR void error(GLenum errno); GLU_TESS_ERROR_DATA void error(GLenum errno, void user_data); To change a callback routine, simply call gluTessCallback() with the new routine. To eliminate a callback routine without replacing it with a new one, pass gluTessCallback() a null pointer for the appropriate function. As tessellation proceeds, the callback routines are called in a manner similar to how you use the OpenGL commands glBegin(), glEdgeFlag(), glVertex(), and glEnd(). (See “Marking Polygon Boundary Edges” in Chapter 2 for more information about glEdgeFlag().) The combine callback is used to create new vertices where edges intersect. The error callback is invoked during the tessellation only if something goes wrong. For every tessellator object created, a GLU_TESS_BEGIN callback is invoked with one of four possible parameters: GL_TRIANGLE_FAN, GL_TRIANGLE_ STRIP, GL_TRIANGLES, or GL_LINE_LOOP. When the tessellator decomposes the polygons, the tessellation algorithm decides which type of triangle primitive is most efficient to use. (If the GLU_TESS_BOUNDARY_ONLY property is enabled, then GL_LINE_LOOP is used for rendering.) Since edge flags make no sense in a triangle fan or triangle strip, if there is a callback associated with GLU_TESS_EDGE_FLAG that enables edge flags, the GLU_TESS_BEGIN callback is called only with GL_TRIANGLES. The GLU_TESS_EDGE_FLAG callback works exactly analogously to the OpenGL glEdgeFlag() call. After the GLU_TESS_BEGIN callback routine is called and before the callback associated with GLU_TESS_END is called, some combination of the GLU_TESS_EDGE_FLAG and GLU_TESS_VERTEX callbacks is invoked (usually by calls to gluTessVertex(), which is described on page 555). The associated edge flags and vertices are interpreted exactly as they are in OpenGL between glBegin() and the matching glEnd(). If something goes wrong, the error callback is passed a GLU error number. A character string describing the error is obtained using the routine gluErrorString(). (See “Describing GLU Errors” on page 557 for more information about this routine.) Example 11-1 shows a portion of tess.c, in which a tessellation object is created and several callbacks are registered. Example 11-1 Registering Tessellation Callbacks: tess.c #ifndef CALLBACK #define CALLBACK #endif Polygon Tessellation 547 / a portion of init() / tobj = gluNewTess(); gluTessCallback(tobj, GLU_TESS_VERTEX, glVertex3dv); gluTessCallback(tobj, GLU_TESS_BEGIN, beginCallback); gluTessCallback(tobj, GLU_TESS_END, endCallback); gluTessCallback(tobj, GLU_TESS_ERROR, errorCallback); / the callback routines registered by gluTessCallback() / void CALLBACK beginCallback(GLenum which) { glBegin(which); } void CALLBACK endCallback(void) { glEnd(); } void CALLBACK errorCallback(GLenum errorCode) { const GLubyte estring; estring = gluErrorString(errorCode); fprintf(stderr, "Tessellation Error: %s\n", estring); exit(0); } Note: Type casting of callback functions is tricky, especially if you wish to make code that runs equally well on Microsoft Windows and UNIX. To run on Microsoft Windows, programs that declare callback functions, such as tess.c, need the symbol CALLBACK in the declarations of functions. The trick of using an empty definition for CALLBACK (as demonstrated below) allows the code to run well on both Microsoft Windows and UNIX: #ifndef CALLBACK #define CALLBACK #endif void CALLBACK callbackFunction(...) { .... } In Example 11-1, the registered GLU_TESS_VERTEX callback is simply glVertex3dv(), and only the coordinates at each vertex are passed along. However, if you want to specify more information at every vertex, such as a color value, a surface normal vector, or a texture coordinate, you’ll have to make a more complex callback routine. Example 11-2 shows the start of another tessellated object, further along in program tess.c. The registered function vertexCallback() expects to receive a parameter that is a pointer to six double-length floating-point values: the x-, y-, and z-coordinates and the red, green, and blue color values for that vertex. Example 11-2 Vertex and Combine Callbacks: tess.c /* a different portion of init() / gluTessCallback(tobj, GLU_TESS_VERTEX, vertexCallback); gluTessCallback(tobj, GLU_TESS_BEGIN, beginCallback); gluTessCallback(tobj, GLU_TESS_END, endCallback); gluTessCallback(tobj, GLU_TESS_ERROR, errorCallback); gluTessCallback(tobj, GLU_TESS_COMBINE, combineCallback); / new callback routines registered by these calls / void CALLBACK vertexCallback(GLvoid vertex) { const GLdouble pointer; pointer = (GLdouble ) vertex; glColor3dv(pointer+3); glVertex3dv(vertex); } void CALLBACK combineCallback(GLdouble coords[3], GLdouble vertex_data[4], GLfloat weight[4], GLdouble dataOut ) { GLdouble vertex; int i; vertex = (GLdouble ) malloc(6 sizeof(GLdouble)); vertex[0] = coords[0]; vertex[1] = coords[1]; vertex[2] = coords[2]; for (i = 3; i < 6; i++) vertex[i] = weight[0] * vertex_data[0][i] + weight[1] * vertex_data[1][i] + weight[2] * vertex_data[2][i] + weight[3] * vertex_data[3][i]; dataOut = vertex; } Polygon Tessellation 549 Example 11-2 also shows the use of the GLU_TESS_COMBINE callback. Whenever the tessellation algorithm examines the input contours, detects an intersection, and decides it must create a new vertex, the GLU_TESS_ COMBINE callback is invoked. The callback is also called when the tessellator decides to merge features of two vertices that are very close to one another. The newly created vertex is a linear combination of up to four existing vertices, referenced by vertex_data[0..3] in Example 11-2. The coefficients of the linear combination are given by weight[0..3]; these weights sum to 1.0. coords gives the location of the new vertex. The registered callback routine must allocate memory for another vertex, perform a weighted interpolation of data using vertex_data and weight, and return the new vertex pointer as dataOut. combineCallback() in Example 11-2 interpolates the RGB color value. The function allocates a six-element array, puts the x-, y-, and z-coordinates in the first three elements, and then puts the weighted average of the RGB color values in the last three elements. User-Specified Data Six kinds of callbacks can be registered. Since there are two versions of each kind of callback, there are 12 callbacks in all. For each kind of callback, there is one with user-specified data and one without. The user-specified data is given by the application to gluTessBeginPolygon() and is then passed, unaltered, to each DATA callback routine. With GLU_TESS_BEGIN_DATA, the user-specified data may be used for “per-polygon” data. If you specify both versions of a particular callback, the callback with user_data is used, and the other is ignored. Therefore, although there are 12 callbacks, you can have a maximum of six callback functions active at any one time. For instance, Example 11-2 uses smooth shading, so vertexCallback() specifies an RGB color for every vertex. If you want to do lighting and smooth shading, the callback would specify a surface normal for every vertex. However, if you want lighting and flat shading, you might specify only one surface normal for every polygon, not for every vertex. In that case, you might choose to use the GLU_TESS_BEGIN_DATA callback and pass the vertex coordinates and surface normal in the user_data pointer. Tessellation Properties Prior to tessellation and rendering, you may use gluTessProperty() to set several properties to affect the tessellation algorithm. The most important and complicated of these properties is the winding rule, which determines what is considered “interior” and “exterior.” Winding Numbers and Winding Rules For a single contour, the winding number of a point is the signed number of revolutions we make around that point while traveling once around the contour (where a counterclockwise revolution is positive and a clockwise revolution is negative). When there are several contours, the individual winding numbers are summed. This procedure associates a signed integer value with each point in the plane. Note that the winding number is the same for all points in a single region. void gluTessProperty(GLUtesselator tessobj, GLenum property, GLdouble value); For the tessellation object tessobj, the current value of property is set to value. property is GLU_TESS_BOUNDARY_ONLY, GLU_TESS_TOLERANCE, or GLU_TESS_WINDING_RULE. If property is GLU_TESS_BOUNDARY_ONLY, value is either GL_TRUE or GL_FALSE. When it is set to GL_TRUE, polygons are no longer tessellated into filled polygons; line loops are drawn to outline the contours that separate the polygon interior and exterior. The default value is GL_FALSE. (See gluTessNormal() to see how to control the winding direction of the contours.) If property is GLU_TESS_TOLERANCE, value is a distance used to calculate whether two vertices are close enough together to be merged by the GLU_TESS_COMBINE callback. The tolerance value is multiplied by the largest coordinate magnitude of an input vertex to determine the maximum distance any feature can move as a result of a single merge operation. Feature merging may not be supported by your implementation, and the tolerance value is only a hint. The default tolerance value is zero. The GLU_TESS_WINDING_RULE property determines which parts of the polygon are on the interior and which are on the exterior and should not be filled. value can be GLU_TESS_WINDING_ODD (the default), GLU_ TESS_WINDING_NONZERO, GLU_TESS_WINDING_POSITIVE, GLU_ TESS_WINDING_NEGATIVE, or GLU_TESS_WINDING_ABS_GEQ_TWO. In the set at the left, all three contours are counterclockwise, so each nested interior region adds 1 to the winding number. In the middle set, the two interior contours are drawn clockwise, so the winding number decreases and actually becomes negative. The winding rule classifies a region as inside if its winding number belongs to the chosen category (odd, nonzero, positive, negative, or “absolute value greater than or equal to 2”). The odd and nonzero rules are common ways to define the interior. The positive, negative, and “absolute value t 2” winding rules have some limited use for polygon CSG (computational solid geometry) operations. The program tesswind.c demonstrates the effects of winding rules. The four sets of contours shown in Figure 11-3 are rendered. The user can then cycle through the different winding rule properties to see their effects. For each winding rule, the dark areas represent interiors. Note the effects of clockwise and counterclockwise winding. CSG Uses for Winding Rules GLU_TESS_WINDING_ODD and GLU_TESS_WINDING_NONZERO are the most commonly used winding rules. They work for the most typical cases of shading. The winding rules are also designed for CSG operations, making it easy to find the union, difference, or intersection (Boolean operations) of several contours. 1 2 3 1 0 -1 1 1 1 1 1 2 First, assume that each contour is defined so that the winding number is 0 for each exterior region and 1 for each interior region. (Each contour must not intersect itself.) Under this model, counterclockwise contours define the outer boundary of the polygon, and clockwise contours define holes. Contours may be nested, but a nested contour must be oriented oppositely from the contour that contains it. 1 2 3 1 0 -1 1 2 321 4321 Contours and Winding Numbers Winding Rules Odd Nonzero Positive Negative ABS_GEQ_TWO Unfilled Unfilled Unfilled Unfilled If the original polygons do not satisfy this description, they can be converted to this form by first running the tessellator with the GLU_TESS_ BOUNDARY_ONLY property turned on. This returns a list of contours satisfying the restriction just described. By creating two tessellator objects, the callbacks from one tessellator can be fed directly as input to the other. Given two or more polygons of the preceding form, CSG operations can be implemented as follows: • UNION—To calculate the union of several contours, draw all input contours as a single polygon. The winding number of each resulting region is the number of original polygons that cover it. The union can be extracted by using the GLU_TESS_WINDING_NONZERO or GLU_TESS_WINDING_POSITIVE winding rule. Note that with the nonzero winding rule, we would get the same result if all contour orientations were reversed. • INTERSECTION—This works only for two contours at a time. Draw a single polygon using two contours. Extract the result using GLU_TESS_ WINDING_ABS_GEQ_TWO. • DIFFERENCE—Suppose you want to compute A diff (B union C union D). Draw a single polygon consisting of the unmodified contours from A, followed by the contours of B, C, and D, with their vertex order reversed. To extract the result, use the GLU_TESS_WINDING_POSITIVE winding rule. (If B, C, and D are the result of a GLU_TESS_BOUNDARY_ ONLY operation, an alternative to reversing the vertex order is to use gluTessNormal() to reverse the sign of the supplied normal.) Other Tessellation Property Routines There are also complementary routines, which work alongside gluTessProperty(). gluGetTessProperty() retrieves the current values of tessellator properties. If the tessellator is being used to generate wireframe outlines instead of filled polygons, gluTessNormal() can be used to determine the winding direction of the tessellated polygons. void gluGetTessProperty(GLUtesselator tessobj, GLenum property, GLdouble value); For the tessellation object tessobj, the current value of property is returned to value. Values for property and value are the same as for gluTessProperty(). If you have some knowledge about the location and orientation of the input data, then using gluTessNormal() can increase the speed of the tessellation. For example, if you know that all polygons lie on the xy-plane, call gluTessNormal(tessobj, 0, 0, 1). As stated above, the default normal is (0, 0, 0), and its effect is not immediately obvious. In this case, it is expected that the input data lies approximately in a plane, and a plane is fitted to the vertices, no matter how they are truly connected. The sign of the normal is chosen so that the sum of the signed areas of all input contours is non-negative (where a counterclockwise contour has a positive area). Note that if the input data does not lie approximately in a plane, then projection perpendicular to the computed normal may substantially change the geometry. After all the tessellation properties have been set and the callback actions have been registered, it is finally time to describe the vertices that comprise input contours and tessellate the polygons. Calls to gluTessBeginPolygon() and gluTessEndPolygon() surround the definition of one or more contours. When gluTessEndPolygon() is called, the tessellation algorithm is implemented, and the tessellated polygons are void gluTessNormal(GLUtesselator tessobj, GLdouble x, GLdouble y, GLdouble z); For the tessellation object tessobj, gluTessNormal() defines a normal vector, which controls the winding direction of generated polygons. Before tessellation, all input data is projected into a plane perpendicular to the normal. Then, all output triangles are oriented counterclockwise, with respect to the normal. (Clockwise orientation can be obtained by reversing the sign of the supplied normal.) The default normal is (0, 0, 0). void gluTessBeginPolygon(GLUtesselator tessobj, void user_data); void gluTessEndPolygon(GLUtesselator tessobj); Begins and ends the specification of a polygon to be tessellated and associates a tessellation object, tessobj, with it. user_data points to a userdefined data structure, which is passed along all the GLU_TESS__DATA callback functions that have been bound. generated and rendered. The callback functions and tessellation properties that were bound and set to the tessellation object using gluTessCallback() and gluTessProperty() are used. In practice, a minimum of three vertices is needed for a meaningful contour. In the program tess.c, a portion of which is shown in Example 11-3, two polygons are defined. One polygon is a rectangular contour with a triangular hole inside, and the other is a smooth-shaded, self-intersecting, five-pointed star. For efficiency, both polygons are stored in display lists. The first polygon consists of two contours; the outer one is wound counterclockwise, and the “hole” is wound clockwise. For the second polygon, the star array contains both the coordinate and color data, and its tessellation callback, vertexCallback(), uses both. It is important that each vertex is in a different memory location because the vertex data is not copied by gluTessVertex(); only the pointer (vertex_ data) is saved. A program that reuses the same memory for several vertices may not get the desired result. Note: In gluTessVertex(), it may seem redundant to specify the vertex coordinate data twice, for both the coords and vertex_data parameters; however, both are necessary. coords refers only to the vertex coordinates. vertex_data uses the coordinate data, but may also use other information for each vertex. void gluTessBeginContour(GLUtesselator tessobj); void gluTessEndContour(GLUtesselator tessobj); Begins and ends the specification of a closed contour, which is a portion of a polygon. A closed contour consists of zero or more calls to gluTessVertex(), which defines the vertices. The last vertex of each contour is automatically linked to the first. void gluTessVertex(GLUtesselator tessobj, GLdouble coords[3], void vertex_data); Specifies a vertex in the current contour for the tessellation object. coords contains the three-dimensional vertex coordinates, and vertex_data is a pointer that’s sent to the callback associated with GLU_TESS_VERTEX or GLU_TESS_VERTEX_DATA. Typically, vertex_data contains vertex coordinates, surface normals, texture coordinates, color information, or whatever else the application may find useful. Deleting a Tessellation Object If you no longer need a tessellation object, you can delete it and free all associated memory with gluDeleteTess(). Tessellation Performance Tips For best performance, remember these rules: • Cache the output of the tessellator in a display list or other user structure. To obtain the post-tessellation vertex coordinates, tessellate the polygons while in feedback mode. (See “Feedback” in Chapter 13.) • Use gluTessNormal() to supply the polygon normal. • Use the same tessellator object to render many polygons, rather than allocate a new tessellator for each one. (In a multithreaded, multiprocessor environment, you may get better performance using several tessellators.) Describing GLU Errors The GLU provides a routine for obtaining a descriptive string for an error code. This routine is not limited to tessellation but is also used for NURBS and quadrics errors, as well as for errors in the base GL. (See “Error void gluDeleteTess(GLUtesselator tessobj); Deletes the specified tessellation object, tessobj, and frees all associated memory. Handling” in Chapter 14 for information about OpenGL’s error-handling facility.) Backward Compatibility If you are using the 1.0 or 1.1 version of GLU, you have a much less powerful tessellator. The 1.0/1.1 tessellator handles only simple nonconvex polygons or simple polygons containing holes. It does not properly tessellate intersecting contours (no COMBINE callback) or process per-polygon data. The 1.0/1.1 tessellator still works in either GLU 1.2 or 1.3, but its use is no longer recommended. The 1.0/1.1 tessellator has some similarities to the current tessellator. gluNewTess() and gluDeleteTess() are used for both tessellators. The main vertex specification routine remains gluTessVertex(). The callback mechanism is controlled by gluTessCallback(), although only five callback functions can be registered, a subset of the current 12. Here are the prototypes for the 1.0/1.1 tessellator: void gluBeginPolygon(GLUtriangulatorObj tessobj); void gluNextContour(GLUtriangulatorObj tessobj, GLenum type); void gluEndPolygon(GLUtriangulatorObj tessobj); The outermost contour must be specified first, and it does not require an initial call to gluNextContour(). For polygons without holes, only one contour is defined, and gluNextContour() is not used. If a polygon has multiple contours (that is, holes or holes within holes), the contours are specified one after the other, each preceded by gluNextContour(). gluTessVertex() is called for each vertex of a contour. For gluNextContour(), type can be GLU_EXTERIOR, GLU_INTERIOR, GLU_CCW, GLU_CW, or GLU_UNKNOWN. These serve only as hints to the tessellation. If you get them right, the tessellation might go faster. If you get them wrong, they’re ignored, and the tessellation still works. For polygons with holes, one contour is the exterior contour and the other is the interior. The first contour is assumed to be of type GLU_EXTERIOR. Choosing clockwise or counterclockwise orientation is arbitrary in three dimensions; however, there are two different orientations in any plane, and the GLU_CCW and GLU_CW types should be used consistently. Use GLU_UNKNOWN if you don’t have a clue. Quadrics: Rendering Spheres, Cylinders, and Disks 559 It is highly recommended that you convert GLU 1.0/1.1 code to the new tessellation interface for GLU 1.2 by following these steps: 1. Change references to the major data structure type from GLUtriangulatorObj to GLUtesselator. In GLU 1.2, GLUtriangulatorObj and GLUtesselator are defined to be the same type. 2. Convert gluBeginPolygon() to two commands: gluTessBeginPolygon() and gluTessBeginContour(). All contours must be explicitly started, including the first one. 3. Convert gluNextContour() to both gluTessEndContour() and gluTessBeginContour(). You have to end the previous contour before starting the next one. 4. Convert gluEndPolygon() to both gluTessEndContour() and gluTessEndPolygon(). The final contour must be closed. 5. Change references to constants to gluTessCallback(). In GLU 1.2, GLU_BEGIN, GLU_VERTEX, GLU_END, GLU_ERROR, and GLU_EDGE_FLAG are defined as synonyms for GLU_TESS_BEGIN, GLU_TESS_VERTEX, GLU_TESS_END, GLU_TESS_ERROR, and GLU_TESS_EDGE_FLAG. USER: I am interested in what context one would use the glGenFrameBuffers() function. What does this function do exactly? Please include any extra information to help understand the function. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	29	28	7,277	null	405
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]	How are Senators and Representatives being compensated? Who is excluded from the compensation and why? Can a senator or representative be arrested during their attendance at any house session? What other authority or place can question a representative or a senator? When the passage was written, how many Senators would be required to be in attendance to establish a quorum?	Section. 5. Each House shall be the judge of the elections, returns and qualifications of its own members, and a majority of each shall constitute a quorum to do business; but a smaller number may adjourn from day to day, and may be authorized to compel the attendance of absent members, in such manner, and under such penalties as each House may provide. Each House may determine the rules of its proceedings, punish its members for disorderly behavior, and, with the concurrence of two thirds, expel a member. Each House shall keep a Journal of its proceedings, and from time to time publish the same, excepting such parts as may in their judgment require secrecy; and the yeas and nays of the members of either house on any question shall, at the desire of one fifth of those present, be entered on the journal. Neither House, during the session of Congress, shall, without the consent of the other, adjourn for more than three days, nor to any other place than that in which the two Houses shall be sitting. Section. 6. The Senators and Representatives shall receive a Compensation for their Services, to be ascertained by law, and paid out of the Treasury of the United States. They shall in all cases, except treason, felony and breach of the peace, be privileged from arrest during their attendance at the session of their respective Houses, and in going to and returning from the same; and for any speech or debate in either, they shall not be questioned in any other place. No Senator or Representative shall, during the time for which he was elected, be appointed to any civil office under the authority of the United States, which shall have been created, or the emoluments whereof shall have been increased during such time; and no person holding any office under the United States, shall be a member of either House during his continuance in office. Section. 7. All Bills for raising revenue shall originate in the House of Representatives; but the Senate may propose or concur with amendments as on other Bills. Every bill which shall have passed the House of Representatives and the Senate, shall, before it become a law, be presented to the President of the United States; If he approve he shall sign it, but if not he shall return it, with his objections to that House in which it shall have originated, who shall enter the objections at large on their journal, and proceed to reconsider it. If after such reconsideration two thirds of that House shall agree to pass the bill, it shall be sent, together with the objections, to the other House, by which it shall likewise be reconsidered, and if approved by two thirds of that House, it shall become a law. But in all such cases the votes of both houses shall be determined by yeas and nays, and the names of the persons voting for and against the bill shall be entered on the journal of each house respectively. If any bill shall not be returned by the President within ten days (Sundays excepted) after it shall have been presented to him, the same shall be a law, in like manner as if he had signed it, unless the Congress by their adjournment prevent its return, in which case it shall not be a law.	Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. How are Senators and Representatives being compensated? Who is excluded from the compensation and why? Can a senator or representative be arrested during their attendance at any house session? What other authority or place can question a representative or a senator? When the passage was written, how many Senators would be required to be in attendance to establish a quorum? Section. 5. Each House shall be the judge of the elections, returns and qualifications of its own members, and a majority of each shall constitute a quorum to do business; but a smaller number may adjourn from day to day, and may be authorized to compel the attendance of absent members, in such manner, and under such penalties as each House may provide. Each House may determine the rules of its proceedings, punish its members for disorderly behavior, and, with the concurrence of two thirds, expel a member. Each House shall keep a Journal of its proceedings, and from time to time publish the same, excepting such parts as may in their judgment require secrecy; and the yeas and nays of the members of either house on any question shall, at the desire of one fifth of those present, be entered on the journal. Neither House, during the session of Congress, shall, without the consent of the other, adjourn for more than three days, nor to any other place than that in which the two Houses shall be sitting. Section. 6. The Senators and Representatives shall receive a Compensation for their Services, to be ascertained by law, and paid out of the Treasury of the United States. They shall in all cases, except treason, felony and breach of the peace, be privileged from arrest during their attendance at the session of their respective Houses, and in going to and returning from the same; and for any speech or debate in either, they shall not be questioned in any other place. No Senator or Representative shall, during the time for which he was elected, be appointed to any civil office under the authority of the United States, which shall have been created, or the emoluments whereof shall have been increased during such time; and no person holding any office under the United States, shall be a member of either House during his continuance in office. Section. 7. All Bills for raising revenue shall originate in the House of Representatives; but the Senate may propose or concur with amendments as on other Bills. Every bill which shall have passed the House of Representatives and the Senate, shall, before it become a law, be presented to the President of the United States; If he approve he shall sign it, but if not he shall return it, with his objections to that House in which it shall have originated, who shall enter the objections at large on their journal, and proceed to reconsider it. If after such reconsideration two thirds of that House shall agree to pass the bill, it shall be sent, together with the objections, to the other House, by which it shall likewise be reconsidered, and if approved by two thirds of that House, it shall become a law. But in all such cases the votes of both houses shall be determined by yeas and nays, and the names of the persons voting for and against the bill shall be entered on the journal of each house respectively. If any bill shall not be returned by the President within ten days (Sundays excepted) after it shall have been presented to him, the same shall be a law, in like manner as if he had signed it, unless the Congress by their adjournment prevent its return, in which case it shall not be a law. https://billofrightsinstitute.org/primary-sources/constitution?url=https%3A%2F%2Fbillofrightsinstitute.org%2Fprimary-sources%2Fconstitution%3Fhttps%3A%2F%2Fbillofrightsinstitute.org%2Fprimary-sources%2Fconstitution%2F%26gad_source%3D1&gclid=Cj0KCQjwi5q3BhCiARIsAJCfuZlS51M2jNwFgSQNypBoPmVf9pkBSp-fWw3ZKSCQFfIfKAEGErDBk-QaAgvxEALw_wcB	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: Section. 5. Each House shall be the judge of the elections, returns and qualifications of its own members, and a majority of each shall constitute a quorum to do business; but a smaller number may adjourn from day to day, and may be authorized to compel the attendance of absent members, in such manner, and under such penalties as each House may provide. Each House may determine the rules of its proceedings, punish its members for disorderly behavior, and, with the concurrence of two thirds, expel a member. Each House shall keep a Journal of its proceedings, and from time to time publish the same, excepting such parts as may in their judgment require secrecy; and the yeas and nays of the members of either house on any question shall, at the desire of one fifth of those present, be entered on the journal. Neither House, during the session of Congress, shall, without the consent of the other, adjourn for more than three days, nor to any other place than that in which the two Houses shall be sitting. Section. 6. The Senators and Representatives shall receive a Compensation for their Services, to be ascertained by law, and paid out of the Treasury of the United States. They shall in all cases, except treason, felony and breach of the peace, be privileged from arrest during their attendance at the session of their respective Houses, and in going to and returning from the same; and for any speech or debate in either, they shall not be questioned in any other place. No Senator or Representative shall, during the time for which he was elected, be appointed to any civil office under the authority of the United States, which shall have been created, or the emoluments whereof shall have been increased during such time; and no person holding any office under the United States, shall be a member of either House during his continuance in office. Section. 7. All Bills for raising revenue shall originate in the House of Representatives; but the Senate may propose or concur with amendments as on other Bills. Every bill which shall have passed the House of Representatives and the Senate, shall, before it become a law, be presented to the President of the United States; If he approve he shall sign it, but if not he shall return it, with his objections to that House in which it shall have originated, who shall enter the objections at large on their journal, and proceed to reconsider it. If after such reconsideration two thirds of that House shall agree to pass the bill, it shall be sent, together with the objections, to the other House, by which it shall likewise be reconsidered, and if approved by two thirds of that House, it shall become a law. But in all such cases the votes of both houses shall be determined by yeas and nays, and the names of the persons voting for and against the bill shall be entered on the journal of each house respectively. If any bill shall not be returned by the President within ten days (Sundays excepted) after it shall have been presented to him, the same shall be a law, in like manner as if he had signed it, unless the Congress by their adjournment prevent its return, in which case it shall not be a law. USER: How are Senators and Representatives being compensated? Who is excluded from the compensation and why? Can a senator or representative be arrested during their attendance at any house session? What other authority or place can question a representative or a senator? When the passage was written, how many Senators would be required to be in attendance to establish a quorum? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	24	60	563	null	391
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]	What is the purpose of the medication Amlodipine and what are some of the potential side effects of its usage? Make your response no less than 150 words.	Why is this medication prescribed? Amlodipine is used alone or in combination with other medications to treat high blood pressure in adults and children 6 years and older. It is also used to treat certain types of angina (chest pain) and coronary artery disease (narrowing of the blood vessels that supply blood to the heart). Amlodipine is in a class of medications called calcium channel blockers. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. It controls chest pain by increasing the supply of blood to the heart. If taken regularly, amlodipine controls chest pain, but it does not stop chest pain once it starts. Your doctor may prescribe a different medication to take when you have chest pain. High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation. How should this medicine be used? Amlodipine comes as a tablet, an oral solution (liquid), and a suspension (liquid) to take by mouth. It is usually taken once a day with or without food. Take amlodipine around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amlodipine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Shake the suspension well before each use to mix the medication evenly. Your doctor will probably start you on a low dose of amlodipine and gradually increase your dose. Amlodipine helps to control high blood pressure, angina, and coronary artery disease, but does not cure these conditions. Continue to take amlodipine even if you feel well. Do not stop taking amlodipine without talking to your doctor. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking amlodipine, tell your doctor and pharmacist if you are allergic to amlodipine, any other medications, or any ingredients in amlodipine tablets, oral solution, or suspension. Ask your pharmacist for a list of the ingredients. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor if you have or have ever had heart failure or heart or liver disease. tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking amlodipine, call your doctor. What special dietary instructions should I follow? If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully. What should I do if I forget a dose? Take the missed dose as soon as you remember it. However, if it is less than 12 hours until your next scheduled dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? Amlodipine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: swelling of the hands, feet, ankles, or lower legs nausea stomach pain dizziness or lightheadedness muscle stiffness or tremors Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment: more frequent or more severe chest pain rapid, pounding, or irregular heartbeat If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).	{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What is the purpose of the medication Amlodipine and what are some of the potential side effects of its usage? Make your response no less than 150 words. {passage 0} ========== Why is this medication prescribed? Amlodipine is used alone or in combination with other medications to treat high blood pressure in adults and children 6 years and older. It is also used to treat certain types of angina (chest pain) and coronary artery disease (narrowing of the blood vessels that supply blood to the heart). Amlodipine is in a class of medications called calcium channel blockers. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. It controls chest pain by increasing the supply of blood to the heart. If taken regularly, amlodipine controls chest pain, but it does not stop chest pain once it starts. Your doctor may prescribe a different medication to take when you have chest pain. High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation. How should this medicine be used? Amlodipine comes as a tablet, an oral solution (liquid), and a suspension (liquid) to take by mouth. It is usually taken once a day with or without food. Take amlodipine around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amlodipine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Shake the suspension well before each use to mix the medication evenly. Your doctor will probably start you on a low dose of amlodipine and gradually increase your dose. Amlodipine helps to control high blood pressure, angina, and coronary artery disease, but does not cure these conditions. Continue to take amlodipine even if you feel well. Do not stop taking amlodipine without talking to your doctor. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking amlodipine, tell your doctor and pharmacist if you are allergic to amlodipine, any other medications, or any ingredients in amlodipine tablets, oral solution, or suspension. Ask your pharmacist for a list of the ingredients. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor if you have or have ever had heart failure or heart or liver disease. tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking amlodipine, call your doctor. What special dietary instructions should I follow? If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully. What should I do if I forget a dose? Take the missed dose as soon as you remember it. However, if it is less than 12 hours until your next scheduled dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? Amlodipine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: swelling of the hands, feet, ankles, or lower legs nausea stomach pain dizziness or lightheadedness muscle stiffness or tremors Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment: more frequent or more severe chest pain rapid, pounding, or irregular heartbeat If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). https://medlineplus.gov/druginfo/meds/a692044.html	{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document] EVIDENCE: Why is this medication prescribed? Amlodipine is used alone or in combination with other medications to treat high blood pressure in adults and children 6 years and older. It is also used to treat certain types of angina (chest pain) and coronary artery disease (narrowing of the blood vessels that supply blood to the heart). Amlodipine is in a class of medications called calcium channel blockers. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. It controls chest pain by increasing the supply of blood to the heart. If taken regularly, amlodipine controls chest pain, but it does not stop chest pain once it starts. Your doctor may prescribe a different medication to take when you have chest pain. High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation. How should this medicine be used? Amlodipine comes as a tablet, an oral solution (liquid), and a suspension (liquid) to take by mouth. It is usually taken once a day with or without food. Take amlodipine around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amlodipine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Shake the suspension well before each use to mix the medication evenly. Your doctor will probably start you on a low dose of amlodipine and gradually increase your dose. Amlodipine helps to control high blood pressure, angina, and coronary artery disease, but does not cure these conditions. Continue to take amlodipine even if you feel well. Do not stop taking amlodipine without talking to your doctor. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking amlodipine, tell your doctor and pharmacist if you are allergic to amlodipine, any other medications, or any ingredients in amlodipine tablets, oral solution, or suspension. Ask your pharmacist for a list of the ingredients. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor if you have or have ever had heart failure or heart or liver disease. tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking amlodipine, call your doctor. What special dietary instructions should I follow? If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully. What should I do if I forget a dose? Take the missed dose as soon as you remember it. However, if it is less than 12 hours until your next scheduled dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? Amlodipine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: swelling of the hands, feet, ankles, or lower legs nausea stomach pain dizziness or lightheadedness muscle stiffness or tremors Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment: more frequent or more severe chest pain rapid, pounding, or irregular heartbeat If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). USER: What is the purpose of the medication Amlodipine and what are some of the potential side effects of its usage? Make your response no less than 150 words. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	true	26	28	711	null	165
Draw your answer from the prompt text only.	What examples does the text give of government interests that are important enough to justify regulating speech related to strict and intermediate scrutiny?	Levels of Scrutiny and Key Concepts Most often, a court adjudicating a free speech challenge will analyze the constitutionality of a law or government action by applying a level of scrutiny derived from the Supreme Court’s First Amendment precedents. The two most common levels of scrutiny in free speech analysis are strict and intermediate scrutiny.35 Strict scrutiny generally applies to laws that regulate speech on the basis of its content or message. 36 It is a “demanding standard” that the government is rarely able to meet.37 Intermediate scrutiny has several different formulations but generally applies to content-neutral laws and commercial speech restrictions. 38 Intermediate scrutiny too presents a high bar for the government, but regulations of speech are more likely to survive intermediate than strict scrutiny. To varying degrees, each level of scrutiny requires the government to prove that it has a sufficiently important interest in regulating the speech at issue and that the law directly advances and is narrowly tailored to that interest. While laws that fail strict or intermediate scrutiny often do so on lack-of-tailoring grounds, the government sometimes fails to show that its interests are “real” and “not merely conjectural.”39 For example, it may be insufficient for the government to cite an interest that is significant in the abstract if the government lacks evidence of a concrete harm threatening that interest.40 For “prophylactic” speech restrictions in particular, the government must “demonstrate that it is regulating speech in order to address what is in fact a serious problem and that the preventative measure it proposes will contribute in a material way to solving that problem.”41 For more information on the levels of scrutiny and other key First Amendment concepts, readers of this report’s HTML and PDF formats can click on a term or phrase in the text box titled “Free Speech Terminology” to navigate to a discussion of that concept. Strict Scrutiny Strict scrutiny generally applies to content-based laws—laws that regulate speech on the basis of its subject matter, topic, or substantive message.42 A law can be content based on its face or in its design or purpose.43 The Supreme Court considers viewpoint discrimination—distinctions based on a “specific motivating ideology,” opinion, or perspective—to be “an egregious form of content discrimination.”44 For this reason, courts sometimes invalidate viewpoint-based laws summarily, without undertaking a strict scrutiny analysis.45 Under strict scrutiny, the government must prove that its law is narrowly tailored to advance a compelling governmental interest and that the law is the least restrictive means of serving that interest.46 While not an exhaustive list, the Supreme Court has identified the following interests as compelling, at least in certain contexts: • “national security”; 47 • “public confidence in judicial integrity”; 48 • “protecting the physical and psychological well-being of minors”; 49 • “ensur[ing] the basic human rights of members of groups that have historically been subjected to discrimination”; 50 • “eradicating discrimination against [a state’s] female citizens”; 51 and • “depriving criminals of the profits of their crimes, and in using these funds to compensate victims.” 52 Both strict and intermediate scrutiny require narrow tailoring, 53 meaning that the government must “pursue its legitimate interests through ‘means that are neither seriously underinclusive nor seriously overinclusive.’” 54 The precise degree of tailoring required under each standard differs. Under strict scrutiny, the challenged law or action must be the “least restrictive means” of satisfying the government’s compelling interest. In other words, “[i]f a less restrictive alternative would serve the Government’s purpose, the legislature must use that alternative.”55 Intermediate Scrutiny Intermediate scrutiny typically applies to content-neutral laws and commercial speech restrictions, albeit following different lines of Supreme Court precedent. 56 A law is content neutral if it “serves purposes unrelated to the content of expression”57 and does not, on its face, regulate speech on the basis of its subject matter, topic, or viewpoint.58 The Supreme Court has established an intermediate scrutiny standard for content-neutral time, place, or manner regulations.59 Specifically, the Court has held that “[e]xpression, whether oral or written or symbolized by conduct, is subject to reasonable time, place, or manner restrictions,” 60 such as a regulation to control the volume of music played at a bandshell in a public park.61 Time, place, or manner restrictions “are valid provided that they are justified without reference to the content of the regulated speech, that they are narrowly tailored to serve a significant governmental interest, and that they leave open ample alternative channels for communication of the information.” 62 A similar test set out in United States v. O’Brien is used to evaluate restrictions on certain types of expressive conduct, such as “when ‘speech’ and ‘nonspeech’ elements are combined in the same course of conduct.”63 Intermediate scrutiny is also the standard applied to commercial speech restrictions. Commercial speech is (1) speech that “does no more than propose a commercial transaction” (e.g., an advertisement for a product or service); 64 or (2) “expression related solely to the economic interests of the speaker and its audience.”65 To sustain a restriction on lawful, nonmisleading commercial speech, the government must meet the standard set out in Central Hudson Gas and Electric Corp. v. Public Service Commission. 66 Specifically, the government must show that its law “directly advances” a “substantial” governmental interest and is narrowly tailored—that is, “not more extensive than necessary”—to serve that interest. 67 Examples of substantial or important governmental interests include • protecting the public from deceptive and misleading trade practices;68 • “maintaining standards of ethical conduct in the licensed professions”; 69 • “energy conservation”; 70 • preventing “quid pro quo” corruption or its appearance in election campaigns;71 and “promoting fair competition in the market for television programming.” 72 The tailoring requirement for intermediate scrutiny is less rigorous than for strict scrutiny. Under intermediate scrutiny, a law “need not be the least restrictive or least intrusive means” of advancing the government’s interest.73 Nevertheless, the government “still ‘may not regulate expression in such a manner that a substantial portion of the burden on speech does not serve to advance its goals.’” 74 Narrow tailoring for commercial speech restrictions, for example, requires “a fit that is not necessarily perfect, but reasonable; that represents not necessarily the single best disposition but one whose scope is in proportion to the interest served.”	Draw your answer from the prompt text only. What examples does the text give of government interests that are important enough to justify regulating speech related to strict and intermediate scrutiny? Levels of Scrutiny and Key Concepts Most often, a court adjudicating a free speech challenge will analyze the constitutionality of a law or government action by applying a level of scrutiny derived from the Supreme Court’s First Amendment precedents. The two most common levels of scrutiny in free speech analysis are strict and intermediate scrutiny.35 Strict scrutiny generally applies to laws that regulate speech on the basis of its content or message. 36 It is a “demanding standard” that the government is rarely able to meet.37 Intermediate scrutiny has several different formulations but generally applies to content-neutral laws and commercial speech restrictions. 38 Intermediate scrutiny too presents a high bar for the government, but regulations of speech are more likely to survive intermediate than strict scrutiny. To varying degrees, each level of scrutiny requires the government to prove that it has a sufficiently important interest in regulating the speech at issue and that the law directly advances and is narrowly tailored to that interest. While laws that fail strict or intermediate scrutiny often do so on lack-of-tailoring grounds, the government sometimes fails to show that its interests are “real” and “not merely conjectural.”39 For example, it may be insufficient for the government to cite an interest that is significant in the abstract if the government lacks evidence of a concrete harm threatening that interest.40 For “prophylactic” speech restrictions in particular, the government must “demonstrate that it is regulating speech in order to address what is in fact a serious problem and that the preventative measure it proposes will contribute in a material way to solving that problem.”41 For more information on the levels of scrutiny and other key First Amendment concepts, readers of this report’s HTML and PDF formats can click on a term or phrase in the text box titled “Free Speech Terminology” to navigate to a discussion of that concept. Strict Scrutiny Strict scrutiny generally applies to content-based laws—laws that regulate speech on the basis of its subject matter, topic, or substantive message.42 A law can be content based on its face or in its design or purpose.43 The Supreme Court considers viewpoint discrimination—distinctions based on a “specific motivating ideology,” opinion, or perspective—to be “an egregious form of content discrimination.”44 For this reason, courts sometimes invalidate viewpoint-based laws summarily, without undertaking a strict scrutiny analysis.45 Under strict scrutiny, the government must prove that its law is narrowly tailored to advance a compelling governmental interest and that the law is the least restrictive means of serving that interest.46 While not an exhaustive list, the Supreme Court has identified the following interests as compelling, at least in certain contexts: • “national security”;47 • “public confidence in judicial integrity”;48 • “protecting the physical and psychological well-being of minors”; 49 • “ensur[ing] the basic human rights of members of groups that have historically been subjected to discrimination”; 50 • “eradicating discrimination against [a state’s] female citizens”; 51 and • “depriving criminals of the profits of their crimes, and in using these funds to compensate victims.” 52 Both strict and intermediate scrutiny require narrow tailoring, 53 meaning that the government must “pursue its legitimate interests through ‘means that are neither seriously underinclusive nor seriously overinclusive.’” 54 The precise degree of tailoring required under each standard differs. Under strict scrutiny, the challenged law or action must be the “least restrictive means” of satisfying the government’s compelling interest. In other words, “[i]f a less restrictive alternative would serve the Government’s purpose, the legislature must use that alternative.”55 Intermediate Scrutiny Intermediate scrutiny typically applies to content-neutral laws and commercial speech restrictions, albeit following different lines of Supreme Court precedent. 56 A law is content neutral if it “serves purposes unrelated to the content of expression”57 and does not, on its face, regulate speech on the basis of its subject matter, topic, or viewpoint.58 The Supreme Court has established an intermediate scrutiny standard for content-neutral time, place, or manner regulations.59 Specifically, the Court has held that “[e]xpression, whether oral or written or symbolized by conduct, is subject to reasonable time, place, or manner restrictions,”60 such as a regulation to control the volume of music played at a bandshell in a public park.61 Time, place, or manner restrictions “are valid provided that they are justified without reference to the content of the regulated speech, that they are narrowly tailored to serve a significant governmental interest, and that they leave open ample alternative channels for communication of the information.”62 A similar test set out in United States v. O’Brien is used to evaluate restrictions on certain types of expressive conduct, such as “when ‘speech’ and ‘nonspeech’ elements are combined in the same course of conduct.”63 Intermediate scrutiny is also the standard applied to commercial speech restrictions. Commercial speech is (1) speech that “does no more than propose a commercial transaction” (e.g., an advertisement for a product or service); 64 or (2) “expression related solely to the economic interests of the speaker and its audience.”65 To sustain a restriction on lawful, nonmisleading commercial speech, the government must meet the standard set out in Central Hudson Gas and Electric Corp. v. Public Service Commission. 66 Specifically, the government must show that its law “directly advances” a “substantial” governmental interest and is narrowly tailored—that is, “not more extensive than necessary”—to serve that interest.67 Examples of substantial or important governmental interests include • protecting the public from deceptive and misleading trade practices;68 • “maintaining standards of ethical conduct in the licensed professions”;69 • “energy conservation”;70 • preventing “quid pro quo” corruption or its appearance in election campaigns;71 and “promoting fair competition in the market for television programming.”72 The tailoring requirement for intermediate scrutiny is less rigorous than for strict scrutiny. Under intermediate scrutiny, a law “need not be the least restrictive or least intrusive means” of advancing the government’s interest.73 Nevertheless, the government “still ‘may not regulate expression in such a manner that a substantial portion of the burden on speech does not serve to advance its goals.’” 74 Narrow tailoring for commercial speech restrictions, for example, requires “a fit that is not necessarily perfect, but reasonable; that represents not necessarily the single best disposition but one whose scope is in proportion to the interest served.”	Draw your answer from the prompt text only. EVIDENCE: Levels of Scrutiny and Key Concepts Most often, a court adjudicating a free speech challenge will analyze the constitutionality of a law or government action by applying a level of scrutiny derived from the Supreme Court’s First Amendment precedents. The two most common levels of scrutiny in free speech analysis are strict and intermediate scrutiny.35 Strict scrutiny generally applies to laws that regulate speech on the basis of its content or message. 36 It is a “demanding standard” that the government is rarely able to meet.37 Intermediate scrutiny has several different formulations but generally applies to content-neutral laws and commercial speech restrictions. 38 Intermediate scrutiny too presents a high bar for the government, but regulations of speech are more likely to survive intermediate than strict scrutiny. To varying degrees, each level of scrutiny requires the government to prove that it has a sufficiently important interest in regulating the speech at issue and that the law directly advances and is narrowly tailored to that interest. While laws that fail strict or intermediate scrutiny often do so on lack-of-tailoring grounds, the government sometimes fails to show that its interests are “real” and “not merely conjectural.”39 For example, it may be insufficient for the government to cite an interest that is significant in the abstract if the government lacks evidence of a concrete harm threatening that interest.40 For “prophylactic” speech restrictions in particular, the government must “demonstrate that it is regulating speech in order to address what is in fact a serious problem and that the preventative measure it proposes will contribute in a material way to solving that problem.”41 For more information on the levels of scrutiny and other key First Amendment concepts, readers of this report’s HTML and PDF formats can click on a term or phrase in the text box titled “Free Speech Terminology” to navigate to a discussion of that concept. Strict Scrutiny Strict scrutiny generally applies to content-based laws—laws that regulate speech on the basis of its subject matter, topic, or substantive message.42 A law can be content based on its face or in its design or purpose.43 The Supreme Court considers viewpoint discrimination—distinctions based on a “specific motivating ideology,” opinion, or perspective—to be “an egregious form of content discrimination.”44 For this reason, courts sometimes invalidate viewpoint-based laws summarily, without undertaking a strict scrutiny analysis.45 Under strict scrutiny, the government must prove that its law is narrowly tailored to advance a compelling governmental interest and that the law is the least restrictive means of serving that interest.46 While not an exhaustive list, the Supreme Court has identified the following interests as compelling, at least in certain contexts: • “national security”; 47 • “public confidence in judicial integrity”; 48 • “protecting the physical and psychological well-being of minors”; 49 • “ensur[ing] the basic human rights of members of groups that have historically been subjected to discrimination”; 50 • “eradicating discrimination against [a state’s] female citizens”; 51 and • “depriving criminals of the profits of their crimes, and in using these funds to compensate victims.” 52 Both strict and intermediate scrutiny require narrow tailoring, 53 meaning that the government must “pursue its legitimate interests through ‘means that are neither seriously underinclusive nor seriously overinclusive.’” 54 The precise degree of tailoring required under each standard differs. Under strict scrutiny, the challenged law or action must be the “least restrictive means” of satisfying the government’s compelling interest. In other words, “[i]f a less restrictive alternative would serve the Government’s purpose, the legislature must use that alternative.”55 Intermediate Scrutiny Intermediate scrutiny typically applies to content-neutral laws and commercial speech restrictions, albeit following different lines of Supreme Court precedent. 56 A law is content neutral if it “serves purposes unrelated to the content of expression”57 and does not, on its face, regulate speech on the basis of its subject matter, topic, or viewpoint.58 The Supreme Court has established an intermediate scrutiny standard for content-neutral time, place, or manner regulations.59 Specifically, the Court has held that “[e]xpression, whether oral or written or symbolized by conduct, is subject to reasonable time, place, or manner restrictions,” 60 such as a regulation to control the volume of music played at a bandshell in a public park.61 Time, place, or manner restrictions “are valid provided that they are justified without reference to the content of the regulated speech, that they are narrowly tailored to serve a significant governmental interest, and that they leave open ample alternative channels for communication of the information.” 62 A similar test set out in United States v. O’Brien is used to evaluate restrictions on certain types of expressive conduct, such as “when ‘speech’ and ‘nonspeech’ elements are combined in the same course of conduct.”63 Intermediate scrutiny is also the standard applied to commercial speech restrictions. Commercial speech is (1) speech that “does no more than propose a commercial transaction” (e.g., an advertisement for a product or service); 64 or (2) “expression related solely to the economic interests of the speaker and its audience.”65 To sustain a restriction on lawful, nonmisleading commercial speech, the government must meet the standard set out in Central Hudson Gas and Electric Corp. v. Public Service Commission. 66 Specifically, the government must show that its law “directly advances” a “substantial” governmental interest and is narrowly tailored—that is, “not more extensive than necessary”—to serve that interest. 67 Examples of substantial or important governmental interests include • protecting the public from deceptive and misleading trade practices;68 • “maintaining standards of ethical conduct in the licensed professions”; 69 • “energy conservation”; 70 • preventing “quid pro quo” corruption or its appearance in election campaigns;71 and “promoting fair competition in the market for television programming.” 72 The tailoring requirement for intermediate scrutiny is less rigorous than for strict scrutiny. Under intermediate scrutiny, a law “need not be the least restrictive or least intrusive means” of advancing the government’s interest.73 Nevertheless, the government “still ‘may not regulate expression in such a manner that a substantial portion of the burden on speech does not serve to advance its goals.’” 74 Narrow tailoring for commercial speech restrictions, for example, requires “a fit that is not necessarily perfect, but reasonable; that represents not necessarily the single best disposition but one whose scope is in proportion to the interest served.” USER: What examples does the text give of government interests that are important enough to justify regulating speech related to strict and intermediate scrutiny? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	8	23	1,041	null	449
You are to answer based solely on the provided text. You are not allowed to use any external resources or prior knowledge.	When can someone with BMI of 29 kg/m2 be recommended for bariatric surgery?	A broad range of drugs are under investigation, but there are currently no drugs approved by regulatory agencies for the treatment of NAFLD. This is a field of very active research. As an increasing number of clinical studies are running and results are reported, recommendations may rapidly change. Information on which clinical trials are ongoing can be found on www.clinicaltrials.gov and you should ask your physician for newest updates. Some drugs that are used to treat other conditions have also been tested for NASH. Based on their effects demonstrated by liver biopsy, the following drugs seem to have some efficacy. – Vitamin E showed promise, but only in patients without cirrhosis and without T2D. Given long-term and at high doses, however, vitamin E potentially had negative effects and some data indicate that it could increase the risk of early death and certain cancers. – Pioglitazone, which is approved for the treatment of diabetes, showed promise for NASH in patients with diabetes and pre-diabetes. Side effects such as weight gain and bone fractures should be considered. – Liraglutide and semaglutide are approved for the treatment of obesity and for diabetes. They have also shown promise in reducing liver fat and inflammation in NASH and will be evaluated further. Important: all these drugs must be discussed with your doctor and can harm when self-administered. Future available drugs will be an add-on therapy because lifestyle changes are essential as NAFLD is mainly a lifestyle-related disease. Bariatric surgery very effectively achieves weight loss and weight loss maintenance in patients with obesity. The agreed criteria for the surgical management of obesity and metabolic disorders (BMI ≥40kg/m2 or BMI ≥35kg/m2 with complicating disorders, no resolution after medical treatment) are also applicable for NAFLD. Patients with a BMI of 30–35 kg/m2 who also have T2D that is not adequately controlled by medical therapy may also be candidates for surgery. It is important to know that the change in the anatomy by bariatric surgery can lead to the need of lifelong follow up and this should be considered in discussing this option for patients. If you wonder whether vitamin E, the above-mentioned drugs or bariatric surgery could be helpful for you, please consult your doctor and discuss the potential risks and benefits. Any treatment decision should be based on your individual situation and medical history	You are to answer based solely on the provided text. You are not allowed to use any external resources or prior knowledge. When can someone with BMI of 29 kg/m2 be recommended for bariatric surgery? A broad range of drugs are under investigation, but there are currently no drugs approved by regulatory agencies for the treatment of NAFLD. This is a field of very active research. As an increasing number of clinical studies are running and results are reported, recommendations may rapidly change. Information on which clinical trials are ongoing can be found on www.clinicaltrials.gov and you should ask your physician for newest updates. Some drugs that are used to treat other conditions have also been tested for NASH. Based on their effects demonstrated by liver biopsy, the following drugs seem to have some efficacy. – Vitamin E showed promise, but only in patients without cirrhosis and without T2D. Given long-term and at high doses, however, vitamin E potentially had negative effects and some data indicate that it could increase the risk of early death and certain cancers. – Pioglitazone, which is approved for the treatment of diabetes, showed promise for NASH in patients with diabetes and pre-diabetes. Side effects such as weight gain and bone fractures should be considered. – Liraglutide and semaglutide are approved for the treatment of obesity and for diabetes. They have also shown promise in reducing liver fat and inflammation in NASH and will be evaluated further. Important: all these drugs must be discussed with your doctor and can harm when self-administered. Future available drugs will be an add-on therapy because lifestyle changes are essential as NAFLD is mainly a lifestyle-related disease. Bariatric surgery very effectively achieves weight loss and weight loss maintenance in patients with obesity. The agreed criteria for the surgical management of obesity and metabolic disorders (BMI ≥40kg/m2 or BMI ≥35kg/m2 with complicating disorders, no resolution after medical treatment) are also applicable for NAFLD. Patients with a BMI of 30–35 kg/m2 who also have T2D that is not adequately controlled by medical therapy may also be candidates for surgery. It is important to know that the change in the anatomy by bariatric surgery can lead to the need of lifelong follow up and this should be considered in discussing this option for patients. If you wonder whether vitamin E, the above-mentioned drugs or bariatric surgery could be helpful for you, please consult your doctor and discuss the potential risks and benefits. Any treatment decision should be based on your individual situation and medical history	You are to answer based solely on the provided text. You are not allowed to use any external resources or prior knowledge. EVIDENCE: A broad range of drugs are under investigation, but there are currently no drugs approved by regulatory agencies for the treatment of NAFLD. This is a field of very active research. As an increasing number of clinical studies are running and results are reported, recommendations may rapidly change. Information on which clinical trials are ongoing can be found on www.clinicaltrials.gov and you should ask your physician for newest updates. Some drugs that are used to treat other conditions have also been tested for NASH. Based on their effects demonstrated by liver biopsy, the following drugs seem to have some efficacy. – Vitamin E showed promise, but only in patients without cirrhosis and without T2D. Given long-term and at high doses, however, vitamin E potentially had negative effects and some data indicate that it could increase the risk of early death and certain cancers. – Pioglitazone, which is approved for the treatment of diabetes, showed promise for NASH in patients with diabetes and pre-diabetes. Side effects such as weight gain and bone fractures should be considered. – Liraglutide and semaglutide are approved for the treatment of obesity and for diabetes. They have also shown promise in reducing liver fat and inflammation in NASH and will be evaluated further. Important: all these drugs must be discussed with your doctor and can harm when self-administered. Future available drugs will be an add-on therapy because lifestyle changes are essential as NAFLD is mainly a lifestyle-related disease. Bariatric surgery very effectively achieves weight loss and weight loss maintenance in patients with obesity. The agreed criteria for the surgical management of obesity and metabolic disorders (BMI ≥40kg/m2 or BMI ≥35kg/m2 with complicating disorders, no resolution after medical treatment) are also applicable for NAFLD. Patients with a BMI of 30–35 kg/m2 who also have T2D that is not adequately controlled by medical therapy may also be candidates for surgery. It is important to know that the change in the anatomy by bariatric surgery can lead to the need of lifelong follow up and this should be considered in discussing this option for patients. If you wonder whether vitamin E, the above-mentioned drugs or bariatric surgery could be helpful for you, please consult your doctor and discuss the potential risks and benefits. Any treatment decision should be based on your individual situation and medical history USER: When can someone with BMI of 29 kg/m2 be recommended for bariatric surgery? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	22	13	387	null	724
Don't rely on information outside of the provided text. Use paragraphs. If you can't form an answer, just say "I can't answer that."	Describe the DoD's defense-specific areas.	2. Effective Adoption Areas - where there is existing vibrant commercial sector activity Trusted AI and Autonomy Artificial Intelligence (Al) is the software engineering discipline of expanding capabilities of software applications to perform tasks that currently require human intelligence. Machine learning is an engineering subfield of AI that trains software models using example data, simulations, or real-world experiences rather than by direct programming or coding. Autonomy is the engineering discipline that expands robots' abilities to perform tasks while limiting the need for human interaction. AI holds tremendous promise to improve the ability and function of nearly all systems and operations. Trusted AI with trusted autonomous systems are imperative to dominate future conflicts. As AI, machine learning, and autonomous operations continue to mature, the DoD will focus on evidence-based AI-assurance and enabling operational effectiveness. Integrated Network Systems-of-Systems Integrated Network Systems-of-Systems technology encompasses the capability to communicate, provide real-time dissemination of information across the Department, and effective command and control in a contested electromagnetic environment. Integrated Network Systems-of-Systems capability must enable engagements by any sensor and shooter, with the ability to integrate disparate systems. An interoperable network that leverages emerging capabilities across the electromagnetic spectrum such as 5G, software defined networking and radios, and modern information exchange techniques will allow the Department to better integrate many diverse mission systems and provide fully networked command, control, and communication that is capable, resilient, and secure. Microelectronics Microelectronics are circuits and components that serve as the "brain" to human-made electronic functional systems. Virtually every military and commercial system relies on microelectronics. Diminishing microelectronics manufacturing in the United States and supply chain concerns have highlighted national economic and security risks. Working closely with industry, academia, and across the Government, the Department is addressing the need for secure microelectronics sources and will leverage state-of-the-art commercial development and production for defense microelectronic solutions. Space Technology Space technologies include space flight, Space communication and other technologies needed to maintain space operations. With rising threats and increasing dependence on space-based systems, the Department's space strategy must shift away from exquisite satellites to a more robust and proliferated architecture. Novel space technologies are necessary to enable resilient cross-domain operations. The space strategy must incorporate technologies that enhance the Department's adaptive and reconfigurable capabilities in space situational awareness, space control, communication path diversity, on-orbit processing, and autonomy. Renewable Energy Generation and Storage Renewable energy generation and storage includes solar wind, bio-based and geothermal technologies, advanced energy storage, electronic engines, and power grid integration. Renewable energy generation and storage promises to decrease warfighter vulnerability and deliver new operational capabilities for the Department. From more efficient batteries to diversifying energy sources and reduced fuel transportation risks, renewable energy generation and storage will add resilience and flexibility in a contested logistics environment. Advanced Computing and Software Advanced computing and software technologies include supercomputing, cloud computing, data storage, computing architectures, and data processing. Software is ubiquitous throughout the Department, but the speed at which software develops outpaces the Department's ability to stay up to date. The Department must rapidly modernize its legacy software systems with resilient, affordable, and assured new software that has been designed, developed, and tested using processes that establish confidence in its performance. The Department must migrate to a Development-Security-Operations (DevSecOps) approach in its software development and evolve to a model of continuous development, continuous test, and continuous delivery. The Department must leverage modular open system architecture approaches to isolate hardware from software and enable rapid upgrades to secure processors. Human-Machine Interfaces Human-Machine Interface refers to technologies related to human-machine teaming and augmented and virtual reality. Rapid advancements in this technology will have a multitude of benefits for our service members. Highly immersive realistic training environments provide real-time feedback to enhance warfighter performance. Intuitive interactive human-machine interfaces enable rapid mission planning and mission command by providing a common operational picture to geographically distributed operations. 3. Defense-Specific Areas Directed Energy Directed Energy Weapons utilize lasers, high power microwaves, and high energy particle beams to produce precision disruption, damage, or destruction of military targets at range. Directed energy systems will allow the Department to counter a wide variety of current and emerging threats with rapid responses and engagement at the speed of light. High-power lasers and high-power microwave technologies both offer new ways to counter diverse sets of threats. Hypersonics Hypersonic systems fly within the atmosphere for significant portions of their flight at or above 5 times the speed of sound, or approximately 3700 miles per hour. Hypersonics dramatically shorten the timeline to strike a target and increase unpredictability. While strategic competitors are pursuing and rapidly fielding advanced hypersonic missiles, the DoD will develop leap-ahead and cost-effective technologies for our air, land, and sea operational forces. Integrated Sensing and Cyber To provide advantage for the joint force in highly contested environments, the Department must develop wideband sensors to operate at the intersection of cyber space, electronic warfare, radar, and communications. Sensors must be able to counter advanced threats and can no longer be stove-piped and single function.	Don't rely on information outside of the provided text. Use paragraphs. If you can't form an answer, just say "I can't answer that." Describe the DoD's defense-specific areas. 2. Effective Adoption Areas - where there is existing vibrant commercial sector activity Trusted AI and Autonomy Artificial Intelligence (Al) is the software engineering discipline of expanding capabilities of software applications to perform tasks that currently require human intelligence. Machine learning is an engineering subfield of AI that trains software models using example data, simulations, or real-world experiences rather than by direct programming or coding. Autonomy is the engineering discipline that expands robots' abilities to perform tasks while limiting the need for human interaction. AI holds tremendous promise to improve the ability and function of nearly all systems and operations. Trusted AI with trusted autonomous systems are imperative to dominate future conflicts. As AI, machine learning, and autonomous operations continue to mature, the DoD will focus on evidence-based AI-assurance and enabling operational effectiveness. Integrated Network Systems-of-Systems Integrated Network Systems-of-Systems technology encompasses the capability to communicate, provide real-time dissemination of information across the Department, and effective command and control in a contested electromagnetic environment. Integrated Network Systems-of-Systems capability must enable engagements by any sensor and shooter, with the ability to integrate disparate systems. An interoperable network that leverages emerging capabilities across the electromagnetic spectrum such as 5G, software defined networking and radios, and modern information exchange techniques will allow the Department to better integrate many diverse mission systems and provide fully networked command, control, and communication that is capable, resilient, and secure. Microelectronics Microelectronics are circuits and components that serve as the "brain" to human-made electronic functional systems. Virtually every military and commercial system relies on microelectronics. Diminishing microelectronics manufacturing in the United States and supply chain concerns have highlighted national economic and security risks. Working closely with industry, academia, and across the Government, the Department is addressing the need for secure microelectronics sources and will leverage state-of-the-art commercial development and production for defense microelectronic solutions. Space Technology Space technologies include space flight, Space communication and other technologies needed to maintain space operations. With rising threats and increasing dependence on space-based systems, the Department's space strategy must shift away from exquisite satellites to a more robust and proliferated architecture. Novel space technologies are necessary to enable resilient cross-domain operations. The space strategy must incorporate technologies that enhance the Department's adaptive and reconfigurable capabilities in space situational awareness, space control, communication path diversity, on-orbit processing, and autonomy. Renewable Energy Generation and Storage Renewable energy generation and storage includes solar wind, bio-based and geothermal technologies, advanced energy storage, electronic engines, and power grid integration. Renewable energy generation and storage promises to decrease warfighter vulnerability and deliver new operational capabilities for the Department. From more efficient batteries to diversifying energy sources and reduced fuel transportation risks, renewable energy generation and storage will add resilience and flexibility in a contested logistics environment. Advanced Computing and Software Advanced computing and software technologies include supercomputing, cloud computing, data storage, computing architectures, and data processing. Software is ubiquitous throughout the Department, but the speed at which software develops outpaces the Department's ability to stay up to date. The Department must rapidly modernize its legacy software systems with resilient, affordable, and assured new software that has been designed, developed, and tested using processes that establish confidence in its performance. The Department must migrate to a Development-Security-Operations (DevSecOps) approach in its software development and evolve to a model of continuous development, continuous test, and continuous delivery. The Department must leverage modular open system architecture approaches to isolate hardware from software and enable rapid upgrades to secure processors. Human-Machine Interfaces Human-Machine Interface refers to technologies related to human-machine teaming and augmented and virtual reality. Rapid advancements in this technology will have a multitude of benefits for our service members. Highly immersive realistic training environments provide real-time feedback to enhance warfighter performance. Intuitive interactive human-machine interfaces enable rapid mission planning and mission command by providing a common operational picture to geographically distributed operations. 3. Defense-Specific Areas Directed Energy Directed Energy Weapons utilize lasers, high power microwaves, and high energy particle beams to produce precision disruption, damage, or destruction of military targets at range. Directed energy systems will allow the Department to counter a wide variety of current and emerging threats with rapid responses and engagement at the speed of light. High-power lasers and high-power microwave technologies both offer new ways to counter diverse sets of threats. Hypersonics Hypersonic systems fly within the atmosphere for significant portions of their flight at or above 5 times the speed of sound, or approximately 3700 miles per hour. Hypersonics dramatically shorten the timeline to strike a target and increase unpredictability. While strategic competitors are pursuing and rapidly fielding advanced hypersonic missiles, the DoD will develop leap-ahead and cost-effective technologies for our air, land, and sea operational forces. Integrated Sensing and Cyber To provide advantage for the joint force in highly contested environments, the Department must develop wideband sensors to operate at the intersection of cyber space, electronic warfare, radar, and communications. Sensors must be able to counter advanced threats and can no longer be stove-piped and single function.	Don't rely on information outside of the provided text. Use paragraphs. If you can't form an answer, just say "I can't answer that." EVIDENCE: 2. Effective Adoption Areas - where there is existing vibrant commercial sector activity Trusted AI and Autonomy Artificial Intelligence (Al) is the software engineering discipline of expanding capabilities of software applications to perform tasks that currently require human intelligence. Machine learning is an engineering subfield of AI that trains software models using example data, simulations, or real-world experiences rather than by direct programming or coding. Autonomy is the engineering discipline that expands robots' abilities to perform tasks while limiting the need for human interaction. AI holds tremendous promise to improve the ability and function of nearly all systems and operations. Trusted AI with trusted autonomous systems are imperative to dominate future conflicts. As AI, machine learning, and autonomous operations continue to mature, the DoD will focus on evidence-based AI-assurance and enabling operational effectiveness. Integrated Network Systems-of-Systems Integrated Network Systems-of-Systems technology encompasses the capability to communicate, provide real-time dissemination of information across the Department, and effective command and control in a contested electromagnetic environment. Integrated Network Systems-of-Systems capability must enable engagements by any sensor and shooter, with the ability to integrate disparate systems. An interoperable network that leverages emerging capabilities across the electromagnetic spectrum such as 5G, software defined networking and radios, and modern information exchange techniques will allow the Department to better integrate many diverse mission systems and provide fully networked command, control, and communication that is capable, resilient, and secure. Microelectronics Microelectronics are circuits and components that serve as the "brain" to human-made electronic functional systems. Virtually every military and commercial system relies on microelectronics. Diminishing microelectronics manufacturing in the United States and supply chain concerns have highlighted national economic and security risks. Working closely with industry, academia, and across the Government, the Department is addressing the need for secure microelectronics sources and will leverage state-of-the-art commercial development and production for defense microelectronic solutions. Space Technology Space technologies include space flight, Space communication and other technologies needed to maintain space operations. With rising threats and increasing dependence on space-based systems, the Department's space strategy must shift away from exquisite satellites to a more robust and proliferated architecture. Novel space technologies are necessary to enable resilient cross-domain operations. The space strategy must incorporate technologies that enhance the Department's adaptive and reconfigurable capabilities in space situational awareness, space control, communication path diversity, on-orbit processing, and autonomy. Renewable Energy Generation and Storage Renewable energy generation and storage includes solar wind, bio-based and geothermal technologies, advanced energy storage, electronic engines, and power grid integration. Renewable energy generation and storage promises to decrease warfighter vulnerability and deliver new operational capabilities for the Department. From more efficient batteries to diversifying energy sources and reduced fuel transportation risks, renewable energy generation and storage will add resilience and flexibility in a contested logistics environment. Advanced Computing and Software Advanced computing and software technologies include supercomputing, cloud computing, data storage, computing architectures, and data processing. Software is ubiquitous throughout the Department, but the speed at which software develops outpaces the Department's ability to stay up to date. The Department must rapidly modernize its legacy software systems with resilient, affordable, and assured new software that has been designed, developed, and tested using processes that establish confidence in its performance. The Department must migrate to a Development-Security-Operations (DevSecOps) approach in its software development and evolve to a model of continuous development, continuous test, and continuous delivery. The Department must leverage modular open system architecture approaches to isolate hardware from software and enable rapid upgrades to secure processors. Human-Machine Interfaces Human-Machine Interface refers to technologies related to human-machine teaming and augmented and virtual reality. Rapid advancements in this technology will have a multitude of benefits for our service members. Highly immersive realistic training environments provide real-time feedback to enhance warfighter performance. Intuitive interactive human-machine interfaces enable rapid mission planning and mission command by providing a common operational picture to geographically distributed operations. 3. Defense-Specific Areas Directed Energy Directed Energy Weapons utilize lasers, high power microwaves, and high energy particle beams to produce precision disruption, damage, or destruction of military targets at range. Directed energy systems will allow the Department to counter a wide variety of current and emerging threats with rapid responses and engagement at the speed of light. High-power lasers and high-power microwave technologies both offer new ways to counter diverse sets of threats. Hypersonics Hypersonic systems fly within the atmosphere for significant portions of their flight at or above 5 times the speed of sound, or approximately 3700 miles per hour. Hypersonics dramatically shorten the timeline to strike a target and increase unpredictability. While strategic competitors are pursuing and rapidly fielding advanced hypersonic missiles, the DoD will develop leap-ahead and cost-effective technologies for our air, land, and sea operational forces. Integrated Sensing and Cyber To provide advantage for the joint force in highly contested environments, the Department must develop wideband sensors to operate at the intersection of cyber space, electronic warfare, radar, and communications. Sensors must be able to counter advanced threats and can no longer be stove-piped and single function. USER: Describe the DoD's defense-specific areas. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	23	5	832	null	209
[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.	How does the role of mitochondria influence bone growth and osteoblasts. Please keep this between 200-300 words. Highlight specific cases/pathways of how this works and talk about the mechanism.	Bioenergetics and mitochondrial biogenesis: OXPHOS vs glycolysis The initial metabolic study performed on bone tissues of mice in the 1960s suggested that bones predominantly utilized glycolysis rather than oxidative phosphorylation (OXPHOS) for their metabolism.4 The study reported that compared to other tissues such as the liver, bones exhibited lower oxygen consumption and significantly higher glucose consumption, leading to the abundant production of lactate. Similar findings were observed in rat calvaria,5 emphasizing the importance of glycolysis in bone metabolism. The significance of glycolysis in the regulation of bone mass was further supported by recent data suggesting defective glucose metabolism as the major cause of diabetes-induced bone loss, which showed that elevating glycolysis through administration of metformin or osteoblast-specific overexpression of Hif1a (hypoxia inducible factor 1 subunit alpha) or Pfkfb3 (6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3) in mice improved bone mass in diabetic mice.6,7 In vivo tracing with a stable isotope also demonstrated that glucose was largely metabolized to lactate and minimally contributed to the tricarboxylic acid (TCA) cycle in mouse cortical bones.8 Although glycolysis is evidently critical in the maintenance and growth of bone, evaluation of metabolic activity in isolated osteoblasts has revealed more complex and time-dependent results. Specifically, Komarova et al. closely examined changes in metabolism in differentiating primary calvarial osteoblasts in vitro and showed that OXPHOS was the primary energetic pathway utilized during the early stages (before day 10) of differentiation, but a shift to glycolysis occurred during the later stages (after day 10) when mineralized nodules formed.9 Similarly, Guntur et al. utilized a Seahorse real-time metabolic analyzer to measure oxygen consumption rate (OCR), indicative of OXPHOS, and extracellular acidification rates, indicative of glycolysis in mouse calvarial osteoblast cell line MC3T3-E1 and demonstrated that both OXPHPOS and glycolysis were initially upregulated in differentiating osteoblasts, but glycolysis was favored during the later stages of differentiation.10,11 Using the same method, Lee et al. showed that the contribution of glycolysis in total adenosine triphosphate (ATP) generation increased from approximately 40% at day 0 to 80% at day 7 of differentiation in primary calvarial osteoblasts.8 Our group also recently reported that both OCR and glycolytic proton efflux rate were elevated during the early maturation steps, but only glycolysis remained upregulated, while mitochondrial respiration decreased during the later mineralizing periods in primary calvarial osteoblasts.2 Noteworthily, mitochondrial ATP production may be critical during the early osteoblast maturation period since treatment with oligomycin A (ATP synthase inhibitor), antimycin A (mitochondrial complex III inhibitor), or siRNA targeting Atp5a1 gene, which encodes the alpha subunit of the mitochondrial ATP synthase F1 complex, at the initiation of osteogenic induction significantly impaired osteoblast differentiation.2 A recent review of metabolic activities in osteoblasts has underscored that OXPHOS increases as osteoblast maturation advances, although there are ongoing debates regarding the extent of glycolysis levels during osteoblast differentiation.12 Although further investigation is needed, particularly considering the distinct origins of osteoblasts (calvaria vs long bones), current evidence suggests that differentiating osteoblasts actively utilize both OXPHOS and glycolysis during the initial phases but tend to favor glycolysis as maturation progresses. Because OXPHOS far more efficiently produces ATP than aerobic glycolysis, why mature osteoblasts preferentially utilize glycolysis has remained unclear. It has been suggested that aerobic glycolysis is upregulated to offset the increase in ROS generation by OXPHOS.13 Additionally, Guntur et al. demonstrated that the increase in glycolytic ATP production in mature osteoblasts was the result of a decrease in mitochondrial membrane potential and OXPHOS activity.10 Similarly, using calvarial osteoblasts in which mitochondria were endogenously labelled with GFP, our group showed that mitophagy dramatically increased after differentiation day 14. This was confirmed by the increase in GFP-positive mitochondria co-localized with autophagic-lysosomal markers, LAMP1 (lysosomal-associated membrane protein 1) or LC3 (microtubule-associated protein light chain 3), suggesting that the decreased number of mitochondria after massive mitophagy may be the direct cause of reduced OXPHOS during the late differentiation stages.2 Consistent with the early increase in OXPHOS, mitochondrial biogenesis was found to increase during the initial phases of osteoblast maturation. Protein expression levels of mitochondrial biogenesis markers peroxisome proliferator-activated γ receptor coactivator-1α (PGC-1α) and mitochondrial transcription factor A (mtTFA or TFAM) were upregulated and peaked at day 7 of differentiation in MC3T3-E1 osteoblasts.14 Our group also reported that the expression of Ppargc1a, encoding PGC-1α, peaked at day 3, while the expressions of Tfam, Cox4i1 (cytochrome c oxidase subunit 4I1), and mt-Cytb (cytochrome B) peaked at day 7 in primary calvarial osteoblasts.2 Mitochondrial DNA copy number and expressions of mitochondrial proteins, COX4, and translocase of outer mitochondrial membrane 20, also peaked at day 7, after which the levels gradually declined possibly due to the progressive increase in mitophagy.2 Furthermore, enhancing mitochondrial biogenesis appears to accelerate osteogenic differentiation. For instance, An et al. demonstrated that activation of Wnt signaling pathway in C3H10T1/2 mouse mesenchymal cells promoted their osteoblastic differentiation through stimulating mitochondrial biogenesis.15 Increasing mitochondrial biogenesis through overexpression of Tfam enhanced Wnt-induced osteogenesis, while suppressing mitochondrial biogenesis through treatment with Zidovudine significantly impaired the osteogenic activity of C3H10T1/2 cells.15 In addition, nicotinamide (NAM), a form of vitamin B3, was recently shown to promote the differentiation of MC3T3-E1 osteoblasts partly through increasing the expression of Ppargc1a and mitochondrial biogenesis.16 These results suggest that potential bone therapeutics may target mitochondrial biogenesis in osteoblasts. Controversies persist regarding the metabolic activities during osteogenic differentiation of BMSCs. Shum et al. reported that OXPHOS was significantly enhanced during osteogenic differentiation of human MSCs, while glycolysis was unchanged and more critical during the proliferation of undifferentiated MSCs.17 They described that calvarial osteoblasts and MSCs exhibit distinct metabolic characteristics due to their different embryonic origin.17 Contrastingly, Ma et al. demonstrated that activating glycolysis through treatment with rotenone (complex I inhibitor) significantly promoted the osteogenic differentiation of BMSCs in mice, while inhibiting glycolysis through treatment with dichloroacetate, sodium oxamate, or 2-deoxy-D-glucose significantly impaired their osteogenic differentiation, highlighting the significance of glycolysis in MSC-mediated osteogenesis.18 They also showed that extracellular vesicles delivered lactate dehydrogenase A into BMSCs and stimulated glycolysis, enhancing bone formation in vivo.18 Further investigations are needed to clarify whether metabolic characteristics in osteogenic cells are embryonic origin-specific (neural crest vs mesoderm-derived) and differ between intramembranous and endochondral bone formation. A deeper understanding of osteogenic metabolism will not only advance insights into the mechanisms of metabolic bone diseases but also accelerate the development of strategies that modulate mitochondrial metabolism to promote osteogenesis. Oxidative stress Mitochondria produce most of the cellular ROS through OXPHOS, during which oxygen is reduced to superoxide anions that are subsequently converted to additional ROS such as hydrogen peroxide (H2O2). Accumulation of ROS is normally counterbalanced by the endogenous antioxidant defense system involving both non-enzymatic antioxidants, including ascorbic acid, vitamin E, and glutathione, and enzymatic antioxidants, including superoxide dismutases (SODs), catalase, glutathione peroxidases, and peroxiredoxins. Endogenous ROS, when the levels are controlled, may behave as second messengers to activate signaling pathways related to proliferation, differentiation, and survival, but excessively high levels of ROS can cause multiple pathological conditions, including osteoporosis.19	[question] How does the role of mitochondria influence bone growth and osteoblasts. Please keep this between 200-300 words. Highlight specific cases/pathways of how this works and talk about the mechanism. ===================== [text] Bioenergetics and mitochondrial biogenesis: OXPHOS vs glycolysis The initial metabolic study performed on bone tissues of mice in the 1960s suggested that bones predominantly utilized glycolysis rather than oxidative phosphorylation (OXPHOS) for their metabolism.4 The study reported that compared to other tissues such as the liver, bones exhibited lower oxygen consumption and significantly higher glucose consumption, leading to the abundant production of lactate. Similar findings were observed in rat calvaria,5 emphasizing the importance of glycolysis in bone metabolism. The significance of glycolysis in the regulation of bone mass was further supported by recent data suggesting defective glucose metabolism as the major cause of diabetes-induced bone loss, which showed that elevating glycolysis through administration of metformin or osteoblast-specific overexpression of Hif1a (hypoxia inducible factor 1 subunit alpha) or Pfkfb3 (6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3) in mice improved bone mass in diabetic mice.6,7 In vivo tracing with a stable isotope also demonstrated that glucose was largely metabolized to lactate and minimally contributed to the tricarboxylic acid (TCA) cycle in mouse cortical bones.8 Although glycolysis is evidently critical in the maintenance and growth of bone, evaluation of metabolic activity in isolated osteoblasts has revealed more complex and time-dependent results. Specifically, Komarova et al. closely examined changes in metabolism in differentiating primary calvarial osteoblasts in vitro and showed that OXPHOS was the primary energetic pathway utilized during the early stages (before day 10) of differentiation, but a shift to glycolysis occurred during the later stages (after day 10) when mineralized nodules formed.9 Similarly, Guntur et al. utilized a Seahorse real-time metabolic analyzer to measure oxygen consumption rate (OCR), indicative of OXPHOS, and extracellular acidification rates, indicative of glycolysis in mouse calvarial osteoblast cell line MC3T3-E1 and demonstrated that both OXPHPOS and glycolysis were initially upregulated in differentiating osteoblasts, but glycolysis was favored during the later stages of differentiation.10,11 Using the same method, Lee et al. showed that the contribution of glycolysis in total adenosine triphosphate (ATP) generation increased from approximately 40% at day 0 to 80% at day 7 of differentiation in primary calvarial osteoblasts.8 Our group also recently reported that both OCR and glycolytic proton efflux rate were elevated during the early maturation steps, but only glycolysis remained upregulated, while mitochondrial respiration decreased during the later mineralizing periods in primary calvarial osteoblasts.2 Noteworthily, mitochondrial ATP production may be critical during the early osteoblast maturation period since treatment with oligomycin A (ATP synthase inhibitor), antimycin A (mitochondrial complex III inhibitor), or siRNA targeting Atp5a1 gene, which encodes the alpha subunit of the mitochondrial ATP synthase F1 complex, at the initiation of osteogenic induction significantly impaired osteoblast differentiation.2 A recent review of metabolic activities in osteoblasts has underscored that OXPHOS increases as osteoblast maturation advances, although there are ongoing debates regarding the extent of glycolysis levels during osteoblast differentiation.12 Although further investigation is needed, particularly considering the distinct origins of osteoblasts (calvaria vs long bones), current evidence suggests that differentiating osteoblasts actively utilize both OXPHOS and glycolysis during the initial phases but tend to favor glycolysis as maturation progresses. Because OXPHOS far more efficiently produces ATP than aerobic glycolysis, why mature osteoblasts preferentially utilize glycolysis has remained unclear. It has been suggested that aerobic glycolysis is upregulated to offset the increase in ROS generation by OXPHOS.13 Additionally, Guntur et al. demonstrated that the increase in glycolytic ATP production in mature osteoblasts was the result of a decrease in mitochondrial membrane potential and OXPHOS activity.10 Similarly, using calvarial osteoblasts in which mitochondria were endogenously labelled with GFP, our group showed that mitophagy dramatically increased after differentiation day 14. This was confirmed by the increase in GFP-positive mitochondria co-localized with autophagic-lysosomal markers, LAMP1 (lysosomal-associated membrane protein 1) or LC3 (microtubule-associated protein light chain 3), suggesting that the decreased number of mitochondria after massive mitophagy may be the direct cause of reduced OXPHOS during the late differentiation stages.2 Consistent with the early increase in OXPHOS, mitochondrial biogenesis was found to increase during the initial phases of osteoblast maturation. Protein expression levels of mitochondrial biogenesis markers peroxisome proliferator-activated γ receptor coactivator-1α (PGC-1α) and mitochondrial transcription factor A (mtTFA or TFAM) were upregulated and peaked at day 7 of differentiation in MC3T3-E1 osteoblasts.14 Our group also reported that the expression of Ppargc1a, encoding PGC-1α, peaked at day 3, while the expressions of Tfam, Cox4i1 (cytochrome c oxidase subunit 4I1), and mt-Cytb (cytochrome B) peaked at day 7 in primary calvarial osteoblasts.2 Mitochondrial DNA copy number and expressions of mitochondrial proteins, COX4, and translocase of outer mitochondrial membrane 20, also peaked at day 7, after which the levels gradually declined possibly due to the progressive increase in mitophagy.2 Furthermore, enhancing mitochondrial biogenesis appears to accelerate osteogenic differentiation. For instance, An et al. demonstrated that activation of Wnt signaling pathway in C3H10T1/2 mouse mesenchymal cells promoted their osteoblastic differentiation through stimulating mitochondrial biogenesis.15 Increasing mitochondrial biogenesis through overexpression of Tfam enhanced Wnt-induced osteogenesis, while suppressing mitochondrial biogenesis through treatment with Zidovudine significantly impaired the osteogenic activity of C3H10T1/2 cells.15 In addition, nicotinamide (NAM), a form of vitamin B3, was recently shown to promote the differentiation of MC3T3-E1 osteoblasts partly through increasing the expression of Ppargc1a and mitochondrial biogenesis.16 These results suggest that potential bone therapeutics may target mitochondrial biogenesis in osteoblasts. Controversies persist regarding the metabolic activities during osteogenic differentiation of BMSCs. Shum et al. reported that OXPHOS was significantly enhanced during osteogenic differentiation of human MSCs, while glycolysis was unchanged and more critical during the proliferation of undifferentiated MSCs.17 They described that calvarial osteoblasts and MSCs exhibit distinct metabolic characteristics due to their different embryonic origin.17 Contrastingly, Ma et al. demonstrated that activating glycolysis through treatment with rotenone (complex I inhibitor) significantly promoted the osteogenic differentiation of BMSCs in mice, while inhibiting glycolysis through treatment with dichloroacetate, sodium oxamate, or 2-deoxy-D-glucose significantly impaired their osteogenic differentiation, highlighting the significance of glycolysis in MSC-mediated osteogenesis.18 They also showed that extracellular vesicles delivered lactate dehydrogenase A into BMSCs and stimulated glycolysis, enhancing bone formation in vivo.18 Further investigations are needed to clarify whether metabolic characteristics in osteogenic cells are embryonic origin-specific (neural crest vs mesoderm-derived) and differ between intramembranous and endochondral bone formation. A deeper understanding of osteogenic metabolism will not only advance insights into the mechanisms of metabolic bone diseases but also accelerate the development of strategies that modulate mitochondrial metabolism to promote osteogenesis. Oxidative stress Mitochondria produce most of the cellular ROS through OXPHOS, during which oxygen is reduced to superoxide anions that are subsequently converted to additional ROS such as hydrogen peroxide (H2O2). Accumulation of ROS is normally counterbalanced by the endogenous antioxidant defense system involving both non-enzymatic antioxidants, including ascorbic acid, vitamin E, and glutathione, and enzymatic antioxidants, including superoxide dismutases (SODs), catalase, glutathione peroxidases, and peroxiredoxins. Endogenous ROS, when the levels are controlled, may behave as second messengers to activate signaling pathways related to proliferation, differentiation, and survival, but excessively high levels of ROS can cause multiple pathological conditions, including osteoporosis.19 https://academic.oup.com/jbmr/article/39/9/1205/7697194 ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.	[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: Bioenergetics and mitochondrial biogenesis: OXPHOS vs glycolysis The initial metabolic study performed on bone tissues of mice in the 1960s suggested that bones predominantly utilized glycolysis rather than oxidative phosphorylation (OXPHOS) for their metabolism.4 The study reported that compared to other tissues such as the liver, bones exhibited lower oxygen consumption and significantly higher glucose consumption, leading to the abundant production of lactate. Similar findings were observed in rat calvaria,5 emphasizing the importance of glycolysis in bone metabolism. The significance of glycolysis in the regulation of bone mass was further supported by recent data suggesting defective glucose metabolism as the major cause of diabetes-induced bone loss, which showed that elevating glycolysis through administration of metformin or osteoblast-specific overexpression of Hif1a (hypoxia inducible factor 1 subunit alpha) or Pfkfb3 (6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3) in mice improved bone mass in diabetic mice.6,7 In vivo tracing with a stable isotope also demonstrated that glucose was largely metabolized to lactate and minimally contributed to the tricarboxylic acid (TCA) cycle in mouse cortical bones.8 Although glycolysis is evidently critical in the maintenance and growth of bone, evaluation of metabolic activity in isolated osteoblasts has revealed more complex and time-dependent results. Specifically, Komarova et al. closely examined changes in metabolism in differentiating primary calvarial osteoblasts in vitro and showed that OXPHOS was the primary energetic pathway utilized during the early stages (before day 10) of differentiation, but a shift to glycolysis occurred during the later stages (after day 10) when mineralized nodules formed.9 Similarly, Guntur et al. utilized a Seahorse real-time metabolic analyzer to measure oxygen consumption rate (OCR), indicative of OXPHOS, and extracellular acidification rates, indicative of glycolysis in mouse calvarial osteoblast cell line MC3T3-E1 and demonstrated that both OXPHPOS and glycolysis were initially upregulated in differentiating osteoblasts, but glycolysis was favored during the later stages of differentiation.10,11 Using the same method, Lee et al. showed that the contribution of glycolysis in total adenosine triphosphate (ATP) generation increased from approximately 40% at day 0 to 80% at day 7 of differentiation in primary calvarial osteoblasts.8 Our group also recently reported that both OCR and glycolytic proton efflux rate were elevated during the early maturation steps, but only glycolysis remained upregulated, while mitochondrial respiration decreased during the later mineralizing periods in primary calvarial osteoblasts.2 Noteworthily, mitochondrial ATP production may be critical during the early osteoblast maturation period since treatment with oligomycin A (ATP synthase inhibitor), antimycin A (mitochondrial complex III inhibitor), or siRNA targeting Atp5a1 gene, which encodes the alpha subunit of the mitochondrial ATP synthase F1 complex, at the initiation of osteogenic induction significantly impaired osteoblast differentiation.2 A recent review of metabolic activities in osteoblasts has underscored that OXPHOS increases as osteoblast maturation advances, although there are ongoing debates regarding the extent of glycolysis levels during osteoblast differentiation.12 Although further investigation is needed, particularly considering the distinct origins of osteoblasts (calvaria vs long bones), current evidence suggests that differentiating osteoblasts actively utilize both OXPHOS and glycolysis during the initial phases but tend to favor glycolysis as maturation progresses. Because OXPHOS far more efficiently produces ATP than aerobic glycolysis, why mature osteoblasts preferentially utilize glycolysis has remained unclear. It has been suggested that aerobic glycolysis is upregulated to offset the increase in ROS generation by OXPHOS.13 Additionally, Guntur et al. demonstrated that the increase in glycolytic ATP production in mature osteoblasts was the result of a decrease in mitochondrial membrane potential and OXPHOS activity.10 Similarly, using calvarial osteoblasts in which mitochondria were endogenously labelled with GFP, our group showed that mitophagy dramatically increased after differentiation day 14. This was confirmed by the increase in GFP-positive mitochondria co-localized with autophagic-lysosomal markers, LAMP1 (lysosomal-associated membrane protein 1) or LC3 (microtubule-associated protein light chain 3), suggesting that the decreased number of mitochondria after massive mitophagy may be the direct cause of reduced OXPHOS during the late differentiation stages.2 Consistent with the early increase in OXPHOS, mitochondrial biogenesis was found to increase during the initial phases of osteoblast maturation. Protein expression levels of mitochondrial biogenesis markers peroxisome proliferator-activated γ receptor coactivator-1α (PGC-1α) and mitochondrial transcription factor A (mtTFA or TFAM) were upregulated and peaked at day 7 of differentiation in MC3T3-E1 osteoblasts.14 Our group also reported that the expression of Ppargc1a, encoding PGC-1α, peaked at day 3, while the expressions of Tfam, Cox4i1 (cytochrome c oxidase subunit 4I1), and mt-Cytb (cytochrome B) peaked at day 7 in primary calvarial osteoblasts.2 Mitochondrial DNA copy number and expressions of mitochondrial proteins, COX4, and translocase of outer mitochondrial membrane 20, also peaked at day 7, after which the levels gradually declined possibly due to the progressive increase in mitophagy.2 Furthermore, enhancing mitochondrial biogenesis appears to accelerate osteogenic differentiation. For instance, An et al. demonstrated that activation of Wnt signaling pathway in C3H10T1/2 mouse mesenchymal cells promoted their osteoblastic differentiation through stimulating mitochondrial biogenesis.15 Increasing mitochondrial biogenesis through overexpression of Tfam enhanced Wnt-induced osteogenesis, while suppressing mitochondrial biogenesis through treatment with Zidovudine significantly impaired the osteogenic activity of C3H10T1/2 cells.15 In addition, nicotinamide (NAM), a form of vitamin B3, was recently shown to promote the differentiation of MC3T3-E1 osteoblasts partly through increasing the expression of Ppargc1a and mitochondrial biogenesis.16 These results suggest that potential bone therapeutics may target mitochondrial biogenesis in osteoblasts. Controversies persist regarding the metabolic activities during osteogenic differentiation of BMSCs. Shum et al. reported that OXPHOS was significantly enhanced during osteogenic differentiation of human MSCs, while glycolysis was unchanged and more critical during the proliferation of undifferentiated MSCs.17 They described that calvarial osteoblasts and MSCs exhibit distinct metabolic characteristics due to their different embryonic origin.17 Contrastingly, Ma et al. demonstrated that activating glycolysis through treatment with rotenone (complex I inhibitor) significantly promoted the osteogenic differentiation of BMSCs in mice, while inhibiting glycolysis through treatment with dichloroacetate, sodium oxamate, or 2-deoxy-D-glucose significantly impaired their osteogenic differentiation, highlighting the significance of glycolysis in MSC-mediated osteogenesis.18 They also showed that extracellular vesicles delivered lactate dehydrogenase A into BMSCs and stimulated glycolysis, enhancing bone formation in vivo.18 Further investigations are needed to clarify whether metabolic characteristics in osteogenic cells are embryonic origin-specific (neural crest vs mesoderm-derived) and differ between intramembranous and endochondral bone formation. A deeper understanding of osteogenic metabolism will not only advance insights into the mechanisms of metabolic bone diseases but also accelerate the development of strategies that modulate mitochondrial metabolism to promote osteogenesis. Oxidative stress Mitochondria produce most of the cellular ROS through OXPHOS, during which oxygen is reduced to superoxide anions that are subsequently converted to additional ROS such as hydrogen peroxide (H2O2). Accumulation of ROS is normally counterbalanced by the endogenous antioxidant defense system involving both non-enzymatic antioxidants, including ascorbic acid, vitamin E, and glutathione, and enzymatic antioxidants, including superoxide dismutases (SODs), catalase, glutathione peroxidases, and peroxiredoxins. Endogenous ROS, when the levels are controlled, may behave as second messengers to activate signaling pathways related to proliferation, differentiation, and survival, but excessively high levels of ROS can cause multiple pathological conditions, including osteoporosis.19 USER: How does the role of mitochondria influence bone growth and osteoblasts. Please keep this between 200-300 words. Highlight specific cases/pathways of how this works and talk about the mechanism. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	28	29	1,150	null	401
Your answer should use only the provided text; do not use any external resources. When responding, keep answers brief: your response should be no more than two short paragraphs, with a maximum of 50 words each. Use simple language that anyone could understand; rephrase complicated words and concepts, if necessary.	What are the most common causal side effects of this vaccine?	6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared with rates in the clinical trials of another vaccine and may not reflect the rates observed in practice. Moderna COVID-19 Vaccine (Original Monovalent) Administered as a Two-Dose Primary Series Participants 18 Years of Age and Older The safety of Moderna COVID-19 Vaccine was evaluated in an ongoing Phase 3 clinical trial with multiple parts. The randomized, placebo-controlled, observer-blind phase of the trial was conducted in the United States involving 30,346 participants 18 years of age and older who received at least one dose of Moderna COVID-19 Vaccine (100 mcg mRNA; n=15,184) or placebo (n=15,162) (Study 1, NCT04470427). Upon issuance of the Emergency Use Authorization (December 18, 2020) for Moderna COVID-19 Vaccine, participants were unblinded in a phased manner over a period of months to offer placebo participants Moderna COVID-19 Vaccine. The median duration of follow-up for safety after the second injection during the blinded phase was 4 months. The median duration of follow up for safety after the second injection including both the blinded phase and the open-label phase was 6 months. In Study 1, the median age of the population was 52 years (range 18-95); 75.2% of participants were 18 years through 64 years of age and 24.8% were 65 years of age and older. Overall, 52.6% of the participants were male, 47.4% were female, 20.5% were Hispanic or Latino, 79.2% were White, 10.2% were African American, 4.6% were Asian, 0.8% were American Indian or Alaska Native, 0.2% were Native Hawaiian or Pacific Islander, 2.0% were other races, and 2.1% were Multiracial. Demographic characteristics were similar between participants who received Moderna COVID-19 Vaccine and those who received placebo. Unsolicited Adverse Events Participants were monitored for unsolicited adverse events for 28 days following each dose. Serious adverse events and medically attended adverse events will be recorded for the entire study duration (2 years). Among the 30,346 participants who had received at least 1 dose of vaccine (N=15,184) or placebo (N=15,162), unsolicited adverse events that occurred within 28 days following any vaccination were reported by 31.3% of participants (n=4,752) who received Moderna COVID-19 Vaccine and 28.6% of participants (n=4,338) who received placebo. During the 28-day follow-up period following any dose, lymphadenopathy-related events were reported by 1.7% of vaccine recipients and 0.8% of placebo recipients. These events included lymphadenopathy, lymphadenitis, lymph node pain, vaccination-site lymphadenopathy, injection-site lymphadenopathy, and axillary mass. This imbalance is consistent with the imbalance observed for solicited axillary swelling/tenderness at the injected arm. During the 7-day follow-up period of any vaccination, hypersensitivity events of injection site 10 rash or injection site urticaria, likely related to vaccination, were reported by 6 participants in the Moderna COVID-19 Vaccine group and none in the placebo group. Delayed injection site reactions that began >7 days after vaccination were reported in 1.4% of vaccine recipients and 0.7% of placebo recipients. Delayed injection site reactions included pain, erythema, and swelling and are likely related to vaccination. In the blinded portion of the study, there were 8 reports of facial paralysis (including Bell’s palsy) in the Moderna COVID-19 Vaccine group, and 3 in the placebo group. In the 28-day follow-up period there were two cases of facial paralysis in the Moderna COVID-19 Vaccine group, which occurred on 8 and 22 days, respectively, after vaccination, and one in the placebo group, which occurred 17 days after vaccination. Currently available information on facial paralysis is insufficient to determine a causal relationship with the vaccine. In the blinded portion of the study, there were 50 reports of herpes zoster in the Moderna COVID-19 Vaccine group, and 23 in the placebo group. In the 28-day period after any vaccination, there were 22 cases of herpes zoster in the Moderna COVID-19 Vaccine group, and 15 in the placebo group. Currently available information on herpes zoster infection is insufficient to determine a causal relationship with the vaccine. There were no other notable patterns or numerical imbalances between treatment groups for specific categories of adverse events (including other neurologic, neuro-inflammatory, and thrombotic events) that would suggest a causal relationship to Moderna COVID-19 Vaccine. Serious Adverse Events During the blinded phase of the study, serious adverse events were reported by 1.8% (n=268) of participants who received Moderna COVID-19 Vaccine and 1.9% (n=292) of participants who received placebo. There were three serious adverse events of angioedema/facial swelling in the vaccine group in recipients with a history of injection of dermatological fillers. The onset of swelling was reported 1-2 days after the second dose and was likely related to vaccination. There were no other notable patterns or imbalances between treatment groups for specific categories of serious adverse events (including neurologic, neuro-inflammatory, and thrombotic events) that would suggest a causal relationship to Moderna COVID-19 Vaccine. Participants 12 Years Through 17 Years of Age The safety of Moderna COVID-19 Vaccine was evaluated in an ongoing Phase 3 clinical trial with multiple parts. The randomized, placebo-controlled, observer-blind clinical trial was conducted in the United States involving 3,726 participants 12 years through 17 years of age who received at least one dose of Moderna COVID-19 Vaccine (100 mcg mRNA; n=2,486) or placebo (n=1,240) (Study 3, NCT04649151). Participants started to enter an open-label, observational phase after May 10, 2021. After October 1, 2021, cases of potential myocarditis and/or pericarditis that were identified by the investigator or Applicant were adjudicated by an 11 independent Cardiac Event Adjudication Committee (CEAC) to determine if they met the CDC definition of confirmed or probable myocarditis and/or pericarditis. A safety analysis was conducted in participants who received Moderna COVID-19 Vaccine (n=2,486) with a cut-off date of January 31, 2022. In these analyses, the median duration of follow-up including both the blinded and open-label phases was 312 days after Dose 2 and 95.7% of study participants had at least 6 months of follow-up after Dose 2. Overall, 51.4% were male, 48.6% were female, 11.6% were Hispanic or Latino, 83.8% were White, 3.4% were African American, 6.0% were Asian, 0.5% were American Indian or Alaska Native, <0.1% were Native Hawaiian or Pacific Islander, 1.0% were other races, and 4.5% were Multiracial. Demographic characteristics were similar among participants who received Moderna COVID-19 Vaccine and those who received placebo. Unsolicited Adverse Events Participants were monitored for unsolicited adverse events for 28 days following each dose. Serious adverse events and medically attended adverse events were recorded for the entire study duration. Among the 3,726 participants who had received at least 1 dose of vaccine (n=2,486) or placebo (n=1,240), unsolicited adverse events that occurred within 28 days following any vaccination were reported by 23.4% of participants (n=582) who received Moderna COVID-19 Vaccine and 19.1% of participants (n=237) who received placebo.	Your answer should use only the provided text; do not use any external resources. When responding, keep answers brief: your response should be no more than two short paragraphs, with a maximum of 50 words each. Use simple language that anyone could understand; rephrase complicated words and concepts, if necessary. Provided text: 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared with rates in the clinical trials of another vaccine and may not reflect the rates observed in practice. Moderna COVID-19 Vaccine (Original Monovalent) Administered as a Two-Dose Primary Series Participants 18 Years of Age and Older The safety of Moderna COVID-19 Vaccine was evaluated in an ongoing Phase 3 clinical trial with multiple parts. The randomized, placebo-controlled, observer-blind phase of the trial was conducted in the United States involving 30,346 participants 18 years of age and older who received at least one dose of Moderna COVID-19 Vaccine (100 mcg mRNA; n=15,184) or placebo (n=15,162) (Study 1, NCT04470427). Upon issuance of the Emergency Use Authorization (December 18, 2020) for Moderna COVID-19 Vaccine, participants were unblinded in a phased manner over a period of months to offer placebo participants Moderna COVID-19 Vaccine. The median duration of follow-up for safety after the second injection during the blinded phase was 4 months. The median duration of follow up for safety after the second injection including both the blinded phase and the open-label phase was 6 months. In Study 1, the median age of the population was 52 years (range 18-95); 75.2% of participants were 18 years through 64 years of age and 24.8% were 65 years of age and older. Overall, 52.6% of the participants were male, 47.4% were female, 20.5% were Hispanic or Latino, 79.2% were White, 10.2% were African American, 4.6% were Asian, 0.8% were American Indian or Alaska Native, 0.2% were Native Hawaiian or Pacific Islander, 2.0% were other races, and 2.1% were Multiracial. Demographic characteristics were similar between participants who received Moderna COVID-19 Vaccine and those who received placebo. Unsolicited Adverse Events Participants were monitored for unsolicited adverse events for 28 days following each dose. Serious adverse events and medically attended adverse events will be recorded for the entire study duration (2 years). Among the 30,346 participants who had received at least 1 dose of vaccine (N=15,184) or placebo (N=15,162), unsolicited adverse events that occurred within 28 days following any vaccination were reported by 31.3% of participants (n=4,752) who received Moderna COVID-19 Vaccine and 28.6% of participants (n=4,338) who received placebo. During the 28-day follow-up period following any dose, lymphadenopathy-related events were reported by 1.7% of vaccine recipients and 0.8% of placebo recipients. These events included lymphadenopathy, lymphadenitis, lymph node pain, vaccination-site lymphadenopathy, injection-site lymphadenopathy, and axillary mass. This imbalance is consistent with the imbalance observed for solicited axillary swelling/tenderness at the injected arm. During the 7-day follow-up period of any vaccination, hypersensitivity events of injection site 10 rash or injection site urticaria, likely related to vaccination, were reported by 6 participants in the Moderna COVID-19 Vaccine group and none in the placebo group. Delayed injection site reactions that began >7 days after vaccination were reported in 1.4% of vaccine recipients and 0.7% of placebo recipients. Delayed injection site reactions included pain, erythema, and swelling and are likely related to vaccination. In the blinded portion of the study, there were 8 reports of facial paralysis (including Bell’s palsy) in the Moderna COVID-19 Vaccine group, and 3 in the placebo group. In the 28-day follow-up period there were two cases of facial paralysis in the Moderna COVID-19 Vaccine group, which occurred on 8 and 22 days, respectively, after vaccination, and one in the placebo group, which occurred 17 days after vaccination. Currently available information on facial paralysis is insufficient to determine a causal relationship with the vaccine. In the blinded portion of the study, there were 50 reports of herpes zoster in the Moderna COVID-19 Vaccine group, and 23 in the placebo group. In the 28-day period after any vaccination, there were 22 cases of herpes zoster in the Moderna COVID-19 Vaccine group, and 15 in the placebo group. Currently available information on herpes zoster infection is insufficient to determine a causal relationship with the vaccine. There were no other notable patterns or numerical imbalances between treatment groups for specific categories of adverse events (including other neurologic, neuro-inflammatory, and thrombotic events) that would suggest a causal relationship to Moderna COVID-19 Vaccine. Serious Adverse Events During the blinded phase of the study, serious adverse events were reported by 1.8% (n=268) of participants who received Moderna COVID-19 Vaccine and 1.9% (n=292) of participants who received placebo. There were three serious adverse events of angioedema/facial swelling in the vaccine group in recipients with a history of injection of dermatological fillers. The onset of swelling was reported 1-2 days after the second dose and was likely related to vaccination. There were no other notable patterns or imbalances between treatment groups for specific categories of serious adverse events (including neurologic, neuro-inflammatory, and thrombotic events) that would suggest a causal relationship to Moderna COVID-19 Vaccine. Participants 12 Years Through 17 Years of Age The safety of Moderna COVID-19 Vaccine was evaluated in an ongoing Phase 3 clinical trial with multiple parts. The randomized, placebo-controlled, observer-blind clinical trial was conducted in the United States involving 3,726 participants 12 years through 17 years of age who received at least one dose of Moderna COVID-19 Vaccine (100 mcg mRNA; n=2,486) or placebo (n=1,240) (Study 3, NCT04649151). Participants started to enter an open-label, observational phase after May 10, 2021. After October 1, 2021, cases of potential myocarditis and/or pericarditis that were identified by the investigator or Applicant were adjudicated by an 11 independent Cardiac Event Adjudication Committee (CEAC) to determine if they met the CDC definition of confirmed or probable myocarditis and/or pericarditis. A safety analysis was conducted in participants who received Moderna COVID-19 Vaccine (n=2,486) with a cut-off date of January 31, 2022. In these analyses, the median duration of follow-up including both the blinded and open-label phases was 312 days after Dose 2 and 95.7% of study participants had at least 6 months of follow-up after Dose 2. Overall, 51.4% were male, 48.6% were female, 11.6% were Hispanic or Latino, 83.8% were White, 3.4% were African American, 6.0% were Asian, 0.5% were American Indian or Alaska Native, <0.1% were Native Hawaiian or Pacific Islander, 1.0% were other races, and 4.5% were Multiracial. Demographic characteristics were similar among participants who received Moderna COVID-19 Vaccine and those who received placebo. Unsolicited Adverse Events Participants were monitored for unsolicited adverse events for 28 days following each dose. Serious adverse events and medically attended adverse events were recorded for the entire study duration. Among the 3,726 participants who had received at least 1 dose of vaccine (n=2,486) or placebo (n=1,240), unsolicited adverse events that occurred within 28 days following any vaccination were reported by 23.4% of participants (n=582) who received Moderna COVID-19 Vaccine and 19.1% of participants (n=237) who received placebo. What are the most common causal side effects of this vaccine?	Your answer should use only the provided text; do not use any external resources. When responding, keep answers brief: your response should be no more than two short paragraphs, with a maximum of 50 words each. Use simple language that anyone could understand; rephrase complicated words and concepts, if necessary. EVIDENCE: 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared with rates in the clinical trials of another vaccine and may not reflect the rates observed in practice. Moderna COVID-19 Vaccine (Original Monovalent) Administered as a Two-Dose Primary Series Participants 18 Years of Age and Older The safety of Moderna COVID-19 Vaccine was evaluated in an ongoing Phase 3 clinical trial with multiple parts. The randomized, placebo-controlled, observer-blind phase of the trial was conducted in the United States involving 30,346 participants 18 years of age and older who received at least one dose of Moderna COVID-19 Vaccine (100 mcg mRNA; n=15,184) or placebo (n=15,162) (Study 1, NCT04470427). Upon issuance of the Emergency Use Authorization (December 18, 2020) for Moderna COVID-19 Vaccine, participants were unblinded in a phased manner over a period of months to offer placebo participants Moderna COVID-19 Vaccine. The median duration of follow-up for safety after the second injection during the blinded phase was 4 months. The median duration of follow up for safety after the second injection including both the blinded phase and the open-label phase was 6 months. In Study 1, the median age of the population was 52 years (range 18-95); 75.2% of participants were 18 years through 64 years of age and 24.8% were 65 years of age and older. Overall, 52.6% of the participants were male, 47.4% were female, 20.5% were Hispanic or Latino, 79.2% were White, 10.2% were African American, 4.6% were Asian, 0.8% were American Indian or Alaska Native, 0.2% were Native Hawaiian or Pacific Islander, 2.0% were other races, and 2.1% were Multiracial. Demographic characteristics were similar between participants who received Moderna COVID-19 Vaccine and those who received placebo. Unsolicited Adverse Events Participants were monitored for unsolicited adverse events for 28 days following each dose. Serious adverse events and medically attended adverse events will be recorded for the entire study duration (2 years). Among the 30,346 participants who had received at least 1 dose of vaccine (N=15,184) or placebo (N=15,162), unsolicited adverse events that occurred within 28 days following any vaccination were reported by 31.3% of participants (n=4,752) who received Moderna COVID-19 Vaccine and 28.6% of participants (n=4,338) who received placebo. During the 28-day follow-up period following any dose, lymphadenopathy-related events were reported by 1.7% of vaccine recipients and 0.8% of placebo recipients. These events included lymphadenopathy, lymphadenitis, lymph node pain, vaccination-site lymphadenopathy, injection-site lymphadenopathy, and axillary mass. This imbalance is consistent with the imbalance observed for solicited axillary swelling/tenderness at the injected arm. During the 7-day follow-up period of any vaccination, hypersensitivity events of injection site 10 rash or injection site urticaria, likely related to vaccination, were reported by 6 participants in the Moderna COVID-19 Vaccine group and none in the placebo group. Delayed injection site reactions that began >7 days after vaccination were reported in 1.4% of vaccine recipients and 0.7% of placebo recipients. Delayed injection site reactions included pain, erythema, and swelling and are likely related to vaccination. In the blinded portion of the study, there were 8 reports of facial paralysis (including Bell’s palsy) in the Moderna COVID-19 Vaccine group, and 3 in the placebo group. In the 28-day follow-up period there were two cases of facial paralysis in the Moderna COVID-19 Vaccine group, which occurred on 8 and 22 days, respectively, after vaccination, and one in the placebo group, which occurred 17 days after vaccination. Currently available information on facial paralysis is insufficient to determine a causal relationship with the vaccine. In the blinded portion of the study, there were 50 reports of herpes zoster in the Moderna COVID-19 Vaccine group, and 23 in the placebo group. In the 28-day period after any vaccination, there were 22 cases of herpes zoster in the Moderna COVID-19 Vaccine group, and 15 in the placebo group. Currently available information on herpes zoster infection is insufficient to determine a causal relationship with the vaccine. There were no other notable patterns or numerical imbalances between treatment groups for specific categories of adverse events (including other neurologic, neuro-inflammatory, and thrombotic events) that would suggest a causal relationship to Moderna COVID-19 Vaccine. Serious Adverse Events During the blinded phase of the study, serious adverse events were reported by 1.8% (n=268) of participants who received Moderna COVID-19 Vaccine and 1.9% (n=292) of participants who received placebo. There were three serious adverse events of angioedema/facial swelling in the vaccine group in recipients with a history of injection of dermatological fillers. The onset of swelling was reported 1-2 days after the second dose and was likely related to vaccination. There were no other notable patterns or imbalances between treatment groups for specific categories of serious adverse events (including neurologic, neuro-inflammatory, and thrombotic events) that would suggest a causal relationship to Moderna COVID-19 Vaccine. Participants 12 Years Through 17 Years of Age The safety of Moderna COVID-19 Vaccine was evaluated in an ongoing Phase 3 clinical trial with multiple parts. The randomized, placebo-controlled, observer-blind clinical trial was conducted in the United States involving 3,726 participants 12 years through 17 years of age who received at least one dose of Moderna COVID-19 Vaccine (100 mcg mRNA; n=2,486) or placebo (n=1,240) (Study 3, NCT04649151). Participants started to enter an open-label, observational phase after May 10, 2021. After October 1, 2021, cases of potential myocarditis and/or pericarditis that were identified by the investigator or Applicant were adjudicated by an 11 independent Cardiac Event Adjudication Committee (CEAC) to determine if they met the CDC definition of confirmed or probable myocarditis and/or pericarditis. A safety analysis was conducted in participants who received Moderna COVID-19 Vaccine (n=2,486) with a cut-off date of January 31, 2022. In these analyses, the median duration of follow-up including both the blinded and open-label phases was 312 days after Dose 2 and 95.7% of study participants had at least 6 months of follow-up after Dose 2. Overall, 51.4% were male, 48.6% were female, 11.6% were Hispanic or Latino, 83.8% were White, 3.4% were African American, 6.0% were Asian, 0.5% were American Indian or Alaska Native, <0.1% were Native Hawaiian or Pacific Islander, 1.0% were other races, and 4.5% were Multiracial. Demographic characteristics were similar among participants who received Moderna COVID-19 Vaccine and those who received placebo. Unsolicited Adverse Events Participants were monitored for unsolicited adverse events for 28 days following each dose. Serious adverse events and medically attended adverse events were recorded for the entire study duration. Among the 3,726 participants who had received at least 1 dose of vaccine (n=2,486) or placebo (n=1,240), unsolicited adverse events that occurred within 28 days following any vaccination were reported by 23.4% of participants (n=582) who received Moderna COVID-19 Vaccine and 19.1% of participants (n=237) who received placebo. USER: What are the most common causal side effects of this vaccine? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	50	11	1,126	null	473
Do not use any knowledge other than the provided document. After answering the question, quote in parentheses the section of the document that you referred to for your answer. Use capital letters for this quotation.	Give me a list of all of the EV chargers found in this document.	Electic Vehicle Charging Solutions for Home and Travel PORTABLE PORTABLE EV CHARGER PPC16A35 • European standard plug SCHUKO • Length of cable: 5 meter (16.5 feet) EV CHARGER TYPE-2 to Schuko Adapter cable 5m lenght POWERED FROM 230V SCHUKO SOCKET - NO LIMITS The 16A portable charger is powered by a standard 230V mains socket (Schuko). Becasue of it, you do not need any special installation to charge the car - it’s simple. In addition, the portable charger is characterized by compact dimensions, which guarantees ease of transport and the possibility of using it anywhere. The charger will easily fit into any trunk. • Rated input voltage: 85-265V AC • Rated output voltage: 85-265V AC • Rated current: default -16A • Rated power: Up to 3700W (3,7kW) • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • Cable wrap shell design • With Leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protection 16A TYPE 2 3,7kW INSURANCE! 200 000 eur.PLUG & PLAY - EASY OPERATIONS Plug & Play functionality is one of the many advantages of the charger - vehicle charging starts automatically after connecting the charger to the car. To finish charging, simply disconnect the charging plug from the car. 2IN1 PORTABLE EV QUICK CHARGER SCHUKO TO TYPE 2 ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a Schuko socket on one side and a Type 2 plug on the other. With it, any electric car with a Schuko plug can be charged using a charger with a Type 2 socket. This is especially useful when we use a Schuko cable in an electric car and we want to charge it at a private or public Type 2 charging station. Cable length is 30cm. CEE to Schuko Adapter INCLUDED INSURANCE! 200 000 eur. TYPE 2 11kW PPC32AT 16A cable 5m lenght PORTABLE EV QUICK CHARGER • European standard plug (CEE red) • 3 Phases (trójfazowy) • Length of cable: 5 meter (16.5 feet) • Rated input voltage: 85-400V AC • Rated output voltage: 85-400V AC • Rated current: default - 8A, 10A, 13A, 16A • Rated power: up to 11KW quick charging • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • With LED display to show temperature, charging time, and real current • With leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protectionPORTABLE EV QUICK CHARGER • European standard plug (CEE red) • 3 phases (trójfazowy) • Length of cable: 5 meter (16.5 feet) • Rated input voltage: 85-400V AC • Rated output voltage: 85-400V AC • Rated current: 8A, 10A, 13A, 16A, 20A, 24A, 32A • Rated power: Up to 22KW quick charging • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • With LED display to show temperature, charging time, and real current • With leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protection PLUG & PLAY - EASY OPERATIONS Plug & Play functionality is one of the many advantages of the charger - vehicle charging starts automatically after connecting the charger to the car. To finish charging, simply disconnect the charging plug from the car. 2IN1 PORTABLE EV QUICK CHARGER SCHUKO TO TYPE 2 ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a Schuko socket on one side and a Type 2 plug on the other. With it, any electric car with a Schuko plug can be charged using a charger with a Type 2 socket. This is especially useful when we use a Schuko cable in an electric car and we want to charge it at a private or public Type 2 charging station. Cable length is 30 cm. CEE to Schuko Adapter INCLUDED INSURANCE! 200 000 eur. TYPE 2 22kW PPC32AT22 32A cable 5m lenghtUNIVERSAL MOBILE Adapter PC050EV INCLUDED CHARGING STATION Traveler Set Charger connectors: Type 2 Charging mode: Mode 2 Charging current: 32 A Charging capacity: 16 kW Nominal voltage: 400 V, 230 V Cable length: 7.00 m IP rating: IP66 Colour: Black Width: 300 mm Height: 66 mm Depth: 86 mm Weight: 7.5 kg Type A: PG connector, UK connector, CEE connector (5-pin, 32 A), CEE connector (3-pin, 32 A), CEE connector (5-pin, 16 A), CEE connector (3-pin, 16 A) Type B: Type 2 No. of phases: 3-phase Nominal current: 16 A, 32 A Sustainability / eco-friendliness: Plastic free packaging Product type Mobile electric car charging station One charger for all possible outlet. All adapters for every conceivable 32A TYPE 2 16kW INSURANCE! European outlet. 200 000 eur.TYPE 2 TYPE 2 22kW 11kW 32A 16A INSURANCE! 200 000 eur. ELECTRIC VEHICLE CHARGING CABLE CHARGING CABLE TYPE 2-TYPE 2 • Phase: 3 phase • Rated current: 32A or 16A • Rated voltage: 480V • Max power: 22kW or 11kW • Cable spec 22kW: 5x6mm2 + 2x0,5 mm2 • Outer diameter 22kW: 16,5mm (+/- 0,4mm) • Cable spec 11kW: 5x2,5 mm2 + 2x0,5 mm2 • Outer diameter 11kW: 13,5mm (+/- 0,4mm) • Length: 5m, optional 4m • Protection rank: IP54 (when plugged) • Plug insertion force: >45N <80N • Operating temperature: -35OC to 50OC CHARGING WITH „NO-LIMITS” We can safely take the PLATINET Type 2 cable for charging electric cars on a trip throughout Europe. Becasue of the universal Type 2 plugs, they are compatible with all stations that support this type of charging. It allows you to charge electric cars with a power of up to 11kW or 22kW. It is terminated with Type 2 connectors, which are operated at charging stations all over Europe. Its low weight makes it easy to use, and the cable itself will not take up much space in the trunk of our vehicle. PEVC22KW5B PEVC11KW5B cable 5m (4m optional) lenghtELECTRIC VEHICLE PEVC22KW5B-B CHARGING CABLE lenght cable 5m (4m optional) CHARGING WITH „NO-LIMITS” We can safely take the PLATINET Type 2 cable for charging electric cars on a trip throughout Europe. Becasue of the universal Type 2 plugs, they are compatible with all stations that support this type of charging. It allows you to charge electric cars with a power of up to 11kW or 22kW. It is terminated with Type 2 connectors, which are operated at charging stations all over Europe. Its low weight makes it easy to use, and the cable itself will not take up much space in the trunk of our vehicle. CHARGING CABLE TYPE 2-TYPE 2 • Phase: 3 phase • Rated current: 32A or 16A • Rated voltage: 480V • Max power: 22kW or 11kW • Cable spec 22kW: 5x6mm2 + 2x0,5 mm2 • Outer diameter 22kW: 16,5mm (+/- 0,4mm) • Cable spec 11kW: 5x2,5 mm2 + 2x0,5 mm2 • Outer diameter 11kW: 13,5mm (+/- 0,4mm) • Length: 5m, optional 4m • Protection rank: IP54 (when plugged) • Plug insertion force: >45N <80N TYPE 2 32A 22kW PEVC11KW5B-B TYPE 2 16A 11kW INSURANCE! • Operating temperature: -35OC to 50OC 200 000 eur.EV TYPE 2 PEVA30 TO SCHUKO ADAPTER lenght 30cm PLATINET SCHUKO TO CEE ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a CEE socket on one side and a Schuko plug on the other. Cable length is 30cm. TYPE 2 I	[Task Information] ================== Do not use any knowledge other than the provided document. After answering the question, quote in parentheses the section of the document that you referred to for your answer. Use capital letters for this quotation. ================ [Question] ================== Give me a list of all of the EV chargers found in this document. ================ [Passage] ================== Electic Vehicle Charging Solutions for Home and Travel PORTABLE PORTABLE EV CHARGER PPC16A35 • European standard plug SCHUKO • Length of cable: 5 meter (16.5 feet) EV CHARGER TYPE-2 to Schuko Adapter cable 5m lenght POWERED FROM 230V SCHUKO SOCKET - NO LIMITS The 16A portable charger is powered by a standard 230V mains socket (Schuko). Becasue of it, you do not need any special installation to charge the car - it’s simple. In addition, the portable charger is characterized by compact dimensions, which guarantees ease of transport and the possibility of using it anywhere. The charger will easily fit into any trunk. • Rated input voltage: 85-265V AC • Rated output voltage: 85-265V AC • Rated current: default -16A • Rated power: Up to 3700W (3,7kW) • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • Cable wrap shell design • With Leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protection 16A TYPE 2 3,7kW INSURANCE! 200 000 eur.PLUG & PLAY - EASY OPERATIONS Plug & Play functionality is one of the many advantages of the charger - vehicle charging starts automatically after connecting the charger to the car. To finish charging, simply disconnect the charging plug from the car. 2IN1 PORTABLE EV QUICK CHARGER SCHUKO TO TYPE 2 ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a Schuko socket on one side and a Type 2 plug on the other. With it, any electric car with a Schuko plug can be charged using a charger with a Type 2 socket. This is especially useful when we use a Schuko cable in an electric car and we want to charge it at a private or public Type 2 charging station. Cable length is 30cm. CEE to Schuko Adapter INCLUDED INSURANCE! 200 000 eur. TYPE 2 11kW PPC32AT 16A cable 5m lenght PORTABLE EV QUICK CHARGER • European standard plug (CEE red) • 3 Phases (trójfazowy) • Length of cable: 5 meter (16.5 feet) • Rated input voltage: 85-400V AC • Rated output voltage: 85-400V AC • Rated current: default - 8A, 10A, 13A, 16A • Rated power: up to 11KW quick charging • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • With LED display to show temperature, charging time, and real current • With leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protectionPORTABLE EV QUICK CHARGER • European standard plug (CEE red) • 3 phases (trójfazowy) • Length of cable: 5 meter (16.5 feet) • Rated input voltage: 85-400V AC • Rated output voltage: 85-400V AC • Rated current: 8A, 10A, 13A, 16A, 20A, 24A, 32A • Rated power: Up to 22KW quick charging • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • With LED display to show temperature, charging time, and real current • With leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protection PLUG & PLAY - EASY OPERATIONS Plug & Play functionality is one of the many advantages of the charger - vehicle charging starts automatically after connecting the charger to the car. To finish charging, simply disconnect the charging plug from the car. 2IN1 PORTABLE EV QUICK CHARGER SCHUKO TO TYPE 2 ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a Schuko socket on one side and a Type 2 plug on the other. With it, any electric car with a Schuko plug can be charged using a charger with a Type 2 socket. This is especially useful when we use a Schuko cable in an electric car and we want to charge it at a private or public Type 2 charging station. Cable length is 30 cm. CEE to Schuko Adapter INCLUDED INSURANCE! 200 000 eur. TYPE 2 22kW PPC32AT22 32A cable 5m lenghtUNIVERSAL MOBILE Adapter PC050EV INCLUDED CHARGING STATION Traveler Set Charger connectors: Type 2 Charging mode: Mode 2 Charging current: 32 A Charging capacity: 16 kW Nominal voltage: 400 V, 230 V Cable length: 7.00 m IP rating: IP66 Colour: Black Width: 300 mm Height: 66 mm Depth: 86 mm Weight: 7.5 kg Type A: PG connector, UK connector, CEE connector (5-pin, 32 A), CEE connector (3-pin, 32 A), CEE connector (5-pin, 16 A), CEE connector (3-pin, 16 A) Type B: Type 2 No. of phases: 3-phase Nominal current: 16 A, 32 A Sustainability / eco-friendliness: Plastic free packaging Product type Mobile electric car charging station One charger for all possible outlet. All adapters for every conceivable 32A TYPE 2 16kW INSURANCE! European outlet. 200 000 eur.TYPE 2 TYPE 2 22kW 11kW 32A 16A INSURANCE! 200 000 eur. ELECTRIC VEHICLE CHARGING CABLE CHARGING CABLE TYPE 2-TYPE 2 • Phase: 3 phase • Rated current: 32A or 16A • Rated voltage: 480V • Max power: 22kW or 11kW • Cable spec 22kW: 5x6mm2 + 2x0,5 mm2 • Outer diameter 22kW: 16,5mm (+/- 0,4mm) • Cable spec 11kW: 5x2,5 mm2 + 2x0,5 mm2 • Outer diameter 11kW: 13,5mm (+/- 0,4mm) • Length: 5m, optional 4m • Protection rank: IP54 (when plugged) • Plug insertion force: >45N <80N • Operating temperature: -35OC to 50OC CHARGING WITH „NO-LIMITS” We can safely take the PLATINET Type 2 cable for charging electric cars on a trip throughout Europe. Becasue of the universal Type 2 plugs, they are compatible with all stations that support this type of charging. It allows you to charge electric cars with a power of up to 11kW or 22kW. It is terminated with Type 2 connectors, which are operated at charging stations all over Europe. Its low weight makes it easy to use, and the cable itself will not take up much space in the trunk of our vehicle. PEVC22KW5B PEVC11KW5B cable 5m (4m optional) lenghtELECTRIC VEHICLE PEVC22KW5B-B CHARGING CABLE lenght cable 5m (4m optional) CHARGING WITH „NO-LIMITS” We can safely take the PLATINET Type 2 cable for charging electric cars on a trip throughout Europe. Becasue of the universal Type 2 plugs, they are compatible with all stations that support this type of charging. It allows you to charge electric cars with a power of up to 11kW or 22kW. It is terminated with Type 2 connectors, which are operated at charging stations all over Europe. Its low weight makes it easy to use, and the cable itself will not take up much space in the trunk of our vehicle. CHARGING CABLE TYPE 2-TYPE 2 • Phase: 3 phase • Rated current: 32A or 16A • Rated voltage: 480V • Max power: 22kW or 11kW • Cable spec 22kW: 5x6mm2 + 2x0,5 mm2 • Outer diameter 22kW: 16,5mm (+/- 0,4mm) • Cable spec 11kW: 5x2,5 mm2 + 2x0,5 mm2 • Outer diameter 11kW: 13,5mm (+/- 0,4mm) • Length: 5m, optional 4m • Protection rank: IP54 (when plugged) • Plug insertion force: >45N <80N TYPE 2 32A 22kW PEVC11KW5B-B TYPE 2 16A 11kW INSURANCE! • Operating temperature: -35OC to 50OC 200 000 eur.EV TYPE 2 PEVA30 TO SCHUKO ADAPTER lenght 30cm PLATINET SCHUKO TO CEE ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a CEE socket on one side and a Schuko plug on the other. Cable length is 30cm. TYPE 2 I	Do not use any knowledge other than the provided document. After answering the question, quote in parentheses the section of the document that you referred to for your answer. Use capital letters for this quotation. EVIDENCE: Electic Vehicle Charging Solutions for Home and Travel PORTABLE PORTABLE EV CHARGER PPC16A35 • European standard plug SCHUKO • Length of cable: 5 meter (16.5 feet) EV CHARGER TYPE-2 to Schuko Adapter cable 5m lenght POWERED FROM 230V SCHUKO SOCKET - NO LIMITS The 16A portable charger is powered by a standard 230V mains socket (Schuko). Becasue of it, you do not need any special installation to charge the car - it’s simple. In addition, the portable charger is characterized by compact dimensions, which guarantees ease of transport and the possibility of using it anywhere. The charger will easily fit into any trunk. • Rated input voltage: 85-265V AC • Rated output voltage: 85-265V AC • Rated current: default -16A • Rated power: Up to 3700W (3,7kW) • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • Cable wrap shell design • With Leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protection 16A TYPE 2 3,7kW INSURANCE! 200 000 eur.PLUG & PLAY - EASY OPERATIONS Plug & Play functionality is one of the many advantages of the charger - vehicle charging starts automatically after connecting the charger to the car. To finish charging, simply disconnect the charging plug from the car. 2IN1 PORTABLE EV QUICK CHARGER SCHUKO TO TYPE 2 ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a Schuko socket on one side and a Type 2 plug on the other. With it, any electric car with a Schuko plug can be charged using a charger with a Type 2 socket. This is especially useful when we use a Schuko cable in an electric car and we want to charge it at a private or public Type 2 charging station. Cable length is 30cm. CEE to Schuko Adapter INCLUDED INSURANCE! 200 000 eur. TYPE 2 11kW PPC32AT 16A cable 5m lenght PORTABLE EV QUICK CHARGER • European standard plug (CEE red) • 3 Phases (trójfazowy) • Length of cable: 5 meter (16.5 feet) • Rated input voltage: 85-400V AC • Rated output voltage: 85-400V AC • Rated current: default - 8A, 10A, 13A, 16A • Rated power: up to 11KW quick charging • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • With LED display to show temperature, charging time, and real current • With leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protectionPORTABLE EV QUICK CHARGER • European standard plug (CEE red) • 3 phases (trójfazowy) • Length of cable: 5 meter (16.5 feet) • Rated input voltage: 85-400V AC • Rated output voltage: 85-400V AC • Rated current: 8A, 10A, 13A, 16A, 20A, 24A, 32A • Rated power: Up to 22KW quick charging • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • With LED display to show temperature, charging time, and real current • With leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protection PLUG & PLAY - EASY OPERATIONS Plug & Play functionality is one of the many advantages of the charger - vehicle charging starts automatically after connecting the charger to the car. To finish charging, simply disconnect the charging plug from the car. 2IN1 PORTABLE EV QUICK CHARGER SCHUKO TO TYPE 2 ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a Schuko socket on one side and a Type 2 plug on the other. With it, any electric car with a Schuko plug can be charged using a charger with a Type 2 socket. This is especially useful when we use a Schuko cable in an electric car and we want to charge it at a private or public Type 2 charging station. Cable length is 30 cm. CEE to Schuko Adapter INCLUDED INSURANCE! 200 000 eur. TYPE 2 22kW PPC32AT22 32A cable 5m lenghtUNIVERSAL MOBILE Adapter PC050EV INCLUDED CHARGING STATION Traveler Set Charger connectors: Type 2 Charging mode: Mode 2 Charging current: 32 A Charging capacity: 16 kW Nominal voltage: 400 V, 230 V Cable length: 7.00 m IP rating: IP66 Colour: Black Width: 300 mm Height: 66 mm Depth: 86 mm Weight: 7.5 kg Type A: PG connector, UK connector, CEE connector (5-pin, 32 A), CEE connector (3-pin, 32 A), CEE connector (5-pin, 16 A), CEE connector (3-pin, 16 A) Type B: Type 2 No. of phases: 3-phase Nominal current: 16 A, 32 A Sustainability / eco-friendliness: Plastic free packaging Product type Mobile electric car charging station One charger for all possible outlet. All adapters for every conceivable 32A TYPE 2 16kW INSURANCE! European outlet. 200 000 eur.TYPE 2 TYPE 2 22kW 11kW 32A 16A INSURANCE! 200 000 eur. ELECTRIC VEHICLE CHARGING CABLE CHARGING CABLE TYPE 2-TYPE 2 • Phase: 3 phase • Rated current: 32A or 16A • Rated voltage: 480V • Max power: 22kW or 11kW • Cable spec 22kW: 5x6mm2 + 2x0,5 mm2 • Outer diameter 22kW: 16,5mm (+/- 0,4mm) • Cable spec 11kW: 5x2,5 mm2 + 2x0,5 mm2 • Outer diameter 11kW: 13,5mm (+/- 0,4mm) • Length: 5m, optional 4m • Protection rank: IP54 (when plugged) • Plug insertion force: >45N <80N • Operating temperature: -35OC to 50OC CHARGING WITH „NO-LIMITS” We can safely take the PLATINET Type 2 cable for charging electric cars on a trip throughout Europe. Becasue of the universal Type 2 plugs, they are compatible with all stations that support this type of charging. It allows you to charge electric cars with a power of up to 11kW or 22kW. It is terminated with Type 2 connectors, which are operated at charging stations all over Europe. Its low weight makes it easy to use, and the cable itself will not take up much space in the trunk of our vehicle. PEVC22KW5B PEVC11KW5B cable 5m (4m optional) lenghtELECTRIC VEHICLE PEVC22KW5B-B CHARGING CABLE lenght cable 5m (4m optional) CHARGING WITH „NO-LIMITS” We can safely take the PLATINET Type 2 cable for charging electric cars on a trip throughout Europe. Becasue of the universal Type 2 plugs, they are compatible with all stations that support this type of charging. It allows you to charge electric cars with a power of up to 11kW or 22kW. It is terminated with Type 2 connectors, which are operated at charging stations all over Europe. Its low weight makes it easy to use, and the cable itself will not take up much space in the trunk of our vehicle. CHARGING CABLE TYPE 2-TYPE 2 • Phase: 3 phase • Rated current: 32A or 16A • Rated voltage: 480V • Max power: 22kW or 11kW • Cable spec 22kW: 5x6mm2 + 2x0,5 mm2 • Outer diameter 22kW: 16,5mm (+/- 0,4mm) • Cable spec 11kW: 5x2,5 mm2 + 2x0,5 mm2 • Outer diameter 11kW: 13,5mm (+/- 0,4mm) • Length: 5m, optional 4m • Protection rank: IP54 (when plugged) • Plug insertion force: >45N <80N TYPE 2 32A 22kW PEVC11KW5B-B TYPE 2 16A 11kW INSURANCE! • Operating temperature: -35OC to 50OC 200 000 eur.EV TYPE 2 PEVA30 TO SCHUKO ADAPTER lenght 30cm PLATINET SCHUKO TO CEE ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a CEE socket on one side and a Schuko plug on the other. Cable length is 30cm. TYPE 2 I USER: Give me a list of all of the EV chargers found in this document. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	35	14	1,294	null	149
You must only respond using information from the provided PDF. You must not use any external information. You must present and provide citations only if they are relevant.	What doctrine or doctrines does Kagan use to argue against the Court's decision to overrule Chevron?	JUSTICE KAGAN, with whom JUSTICE SOTOMAYOR and JUSTICE JACKSON join,* dissenting. For 40 years, Chevron U. S. A. Inc. v. Natural Resources Defense Council, Inc., 467 U. S. 837 (1984), has served as a cornerstone of administrative law, allocating responsibility for statutory construction between courts and agencies. Under Chevron, a court uses all its normal interpretive tools to determine whether Congress has spoken to an issue. If the court finds Congress has done so, that is the end of the matter; the agency’s views make no difference. But if the court finds, at the end of its interpretive work, that Congress has left an ambiguity or gap, then a choice must be made. Who should give content to a statute when Congress’s instructions have run out? Should it be a court? Or should it be the agency Congress has charged with administering the statute? The answer Chevron gives is that it should usually be the agency, within the bounds of reasonableness. That rule has formed the backdrop against which Congress, courts, and agencies—as well as regulated parties and the public—all have operated for decades. It has been applied in thousands of judicial decisions. It has become part of the warp and woof of modern government, supporting regulatory efforts of all kinds—to name a few, keeping air and water clean, food and drugs safe, and financial markets honest. And the rule is right. This Court has long understood Chevron deference to reflect what Congress would want, and so to be rooted in a presumption of legislative intent. Congress knows that it does not—in fact cannot—write perfectly complete regulatory statutes. It knows that those statutes will inevitably contain ambiguities that some other actor will have to resolve, and gaps that some other actor will have to fill. And it would usually prefer that actor to be the responsible agency, not a court. Some interpretive issues arising in the regulatory context involve scientific or technical subject matter. Agencies have expertise in those areas; courts do not. Some demand a detailed understanding of complex and interdependent regulatory programs. Agencies know those programs inside-out; again, courts do not. And some present policy choices, including trade-offs between competing goods. Agencies report to a President, who in turn answers to the public for his policy calls; courts have no such accountability and no proper basis for making policy. And of course Congress has conferred on that expert, experienced, and politically accountable agency the authority to administer—to make rules about and otherwise implement—the statute giving rise to the ambiguity or Put all that together and deference to the agency is the almost obvious choice, based on an implicit congressional delegation of interpretive authority. We defer, the Court has explained, “because of a presumption that Congress” would have “desired the agency (rather than the courts)” to exercise “whatever degree of discretion” the statute allows. Smiley v. Citibank (South Dakota), N. A., 517 U. S. 735, 740–741 (1996). Today, the Court flips the script: It is now “the courts (rather than the agency)” that will wield power when Congress has left an area of interpretive discretion. A rule of judicial humility gives way to a rule of judicial hubris. In recent years, this Court has too often taken for itself decision-making authority Congress assigned to agencies. The Court has substituted its own judgment on workplace health for that of the Occupational Safety and Health Administration; its own judgment on climate change for that of the Environmental Protection Agency; and its own judgment on student loans for that of the Department of Education. See, e.g., National Federation of Independent Business v. OSHA, 595 U. S. 109 (2022); West Virginia v. EPA, 597 U. S. 697 (2022); Biden v. Nebraska, 600 U. S. 477 (2023). But evidently that was, for this Court, all too piecemeal. In one fell swoop, the majority today gives itself exclusive power over every open issue—no matter how expertise-driven or policy-laden—involving the meaning of regulatory law. As if it did not have enough on its plate, the majority turns itself into the country’s administrative czar. It defends that move as one (suddenly) required by the (nearly 80-year-old) Administrative Procedure Act. But the Act makes no such demand. Today’s decision is not one Congress directed. It is entirely the majority’s choice. And the majority cannot destroy one doctrine of judicial humility without making a laughing-stock of a second. (If opinions had titles, a good candidate for today’s would be Hubris Squared.) Stare decisis is, among other things, a way to remind judges that wisdom often lies in what prior judges have done. It is a brake on the urge to convert “every new judge’s opinion” into a new legal rule or regime. Dobbs v. Jackson Women’s Health Organization, 597 U. S. 215, 388 (2022) (joint opinion of Breyer, SOTOMAYOR, and KAGAN, JJ., dissenting) (quoting 1 W. Blackstone, Commentaries on the Laws of England 69 (7th ed. 1775)). Chevron is entrenched precedent, entitled to the protection of stare decisis, as even the majority acknowledges. In fact, Chevron is entitled to the supercharged version of that doctrine because Congress could always overrule the decision, and because so many governmental and private actors have relied on it for so long. Because that is so, the majority needs a “particularly special justification” for its action. Kisor v. Wilkie, 588 U. S. 558, 588 (2019) (opinion of the Court). But the majority has nothing that would qualify. It barely tries to advance the usual factors this Court invokes for overruling precedent. Its justification comes down, in the end, to this: Courts must have more say over regulation—over the provision of health care, the protection of the environment, the safety of consumer products, the efficacy of transportation systems, and so on. A longstanding precedent at the crux of administrative governance thus falls victim to a bald assertion of judicial authority. The majority disdains restraint, and grasps for power.	You must only respond using information from the provided PDF. You must not use any external information. You must present and provide citations only if they are relevant. What doctrine or doctrines does Kagan use to argue against the Court's decision to overrule Chevron? JUSTICE KAGAN, with whom JUSTICE SOTOMAYOR and JUSTICE JACKSON join,* dissenting. For 40 years, Chevron U. S. A. Inc. v. Natural Resources Defense Council, Inc., 467 U. S. 837 (1984), has served as a cornerstone of administrative law, allocating responsibility for statutory construction between courts and agencies. Under Chevron, a court uses all its normal interpretive tools to determine whether Congress has spoken to an issue. If the court finds Congress has done so, that is the end of the matter; the agency’s views make no difference. But if the court finds, at the end of its interpretive work, that Congress has left an ambiguity or gap, then a choice must be made. Who should give content to a statute when Congress’s instructions have run out? Should it be a court? Or should it be the agency Congress has charged with administering the statute? The answer Chevron gives is that it should usually be the agency, within the bounds of reasonableness. That rule has formed the backdrop against which Congress, courts, and agencies—as well as regulated parties and the public—all have operated for decades. It has been applied in thousands of judicial decisions. It has become part of the warp and woof of modern government, supporting regulatory efforts of all kinds—to name a few, keeping air and water clean, food and drugs safe, and financial markets honest. And the rule is right. This Court has long understood Chevron deference to reflect what Congress would want, and so to be rooted in a presumption of legislative intent. Congress knows that it does not—in fact cannot—write perfectly complete regulatory statutes. It knows that those statutes will inevitably contain ambiguities that some other actor will have to resolve, and gaps that some other actor will have to fill. And it would usually prefer that actor to be the responsible agency, not a court. Some interpretive issues arising in the regulatory context involve scientific or technical subject matter. Agencies have expertise in those areas; courts do not. Some demand a detailed understanding of complex and interdependent regulatory programs. Agencies know those programs inside-out; again, courts do not. And some present policy choices, including trade-offs between competing goods. Agencies report to a President, who in turn answers to the public for his policy calls; courts have no such accountability and no proper basis for making policy. And of course Congress has conferred on that expert, experienced, and politically accountable agency the authority to administer—to make rules about and otherwise implement—the statute giving rise to the ambiguity or Put all that together and deference to the agency is the almost obvious choice, based on an implicit congressional delegation of interpretive authority. We defer, the Court has explained, “because of a presumption that Congress” would have “desired the agency (rather than the courts)” to exercise “whatever degree of discretion” the statute allows. Smiley v. Citibank (South Dakota), N. A., 517 U. S. 735, 740–741 (1996). Today, the Court flips the script: It is now “the courts (rather than the agency)” that will wield power when Congress has left an area of interpretive discretion. A rule of judicial humility gives way to a rule of judicial hubris. In recent years, this Court has too often taken for itself decision-making authority Congress assigned to agencies. The Court has substituted its own judgment on workplace health for that of the Occupational Safety and Health Administration; its own judgment on climate change for that of the Environmental Protection Agency; and its own judgment on student loans for that of the Department of Education. See, e.g., National Federation of Independent Business v. OSHA, 595 U. S. 109 (2022); West Virginia v. EPA, 597 U. S. 697 (2022); Biden v. Nebraska, 600 U. S. 477 (2023). But evidently that was, for this Court, all too piecemeal. In one fell swoop, the majority today gives itself exclusive power over every open issue—no matter how expertise-driven or policy-laden—involving the meaning of regulatory law. As if it did not have enough on its plate, the majority turns itself into the country’s administrative czar. It defends that move as one (suddenly) required by the (nearly 80-year-old) Administrative Procedure Act. But the Act makes no such demand. Today’s decision is not one Congress directed. It is entirely the majority’s choice. And the majority cannot destroy one doctrine of judicial humility without making a laughing-stock of a second. (If opinions had titles, a good candidate for today’s would be Hubris Squared.) Stare decisis is, among other things, a way to remind judges that wisdom often lies in what prior judges have done. It is a brake on the urge to convert “every new judge’s opinion” into a new legal rule or regime. Dobbs v. Jackson Women’s Health Organization, 597 U. S. 215, 388 (2022) (joint opinion of Breyer, SOTOMAYOR, and KAGAN, JJ., dissenting) (quoting 1 W. Blackstone, Commentaries on the Laws of England 69 (7th ed. 1775)). Chevron is entrenched precedent, entitled to the protection of stare decisis, as even the majority acknowledges. In fact, Chevron is entitled to the supercharged version of that doctrine because Congress could always overrule the decision, and because so many governmental and private actors have relied on it for so long. Because that is so, the majority needs a “particularly special justification” for its action. Kisor v. Wilkie, 588 U. S. 558, 588 (2019) (opinion of the Court). But the majority has nothing that would qualify. It barely tries to advance the usual factors this Court invokes for overruling precedent. Its justification comes down, in the end, to this: Courts must have more say over regulation—over the provision of health care, the protection of the environment, the safety of consumer products, the efficacy of transportation systems, and so on. A longstanding precedent at the crux of administrative governance thus falls victim to a bald assertion of judicial authority. The majority disdains restraint, and grasps for power.	You must only respond using information from the provided PDF. You must not use any external information. You must present and provide citations only if they are relevant. EVIDENCE: JUSTICE KAGAN, with whom JUSTICE SOTOMAYOR and JUSTICE JACKSON join,* dissenting. For 40 years, Chevron U. S. A. Inc. v. Natural Resources Defense Council, Inc., 467 U. S. 837 (1984), has served as a cornerstone of administrative law, allocating responsibility for statutory construction between courts and agencies. Under Chevron, a court uses all its normal interpretive tools to determine whether Congress has spoken to an issue. If the court finds Congress has done so, that is the end of the matter; the agency’s views make no difference. But if the court finds, at the end of its interpretive work, that Congress has left an ambiguity or gap, then a choice must be made. Who should give content to a statute when Congress’s instructions have run out? Should it be a court? Or should it be the agency Congress has charged with administering the statute? The answer Chevron gives is that it should usually be the agency, within the bounds of reasonableness. That rule has formed the backdrop against which Congress, courts, and agencies—as well as regulated parties and the public—all have operated for decades. It has been applied in thousands of judicial decisions. It has become part of the warp and woof of modern government, supporting regulatory efforts of all kinds—to name a few, keeping air and water clean, food and drugs safe, and financial markets honest. And the rule is right. This Court has long understood Chevron deference to reflect what Congress would want, and so to be rooted in a presumption of legislative intent. Congress knows that it does not—in fact cannot—write perfectly complete regulatory statutes. It knows that those statutes will inevitably contain ambiguities that some other actor will have to resolve, and gaps that some other actor will have to fill. And it would usually prefer that actor to be the responsible agency, not a court. Some interpretive issues arising in the regulatory context involve scientific or technical subject matter. Agencies have expertise in those areas; courts do not. Some demand a detailed understanding of complex and interdependent regulatory programs. Agencies know those programs inside-out; again, courts do not. And some present policy choices, including trade-offs between competing goods. Agencies report to a President, who in turn answers to the public for his policy calls; courts have no such accountability and no proper basis for making policy. And of course Congress has conferred on that expert, experienced, and politically accountable agency the authority to administer—to make rules about and otherwise implement—the statute giving rise to the ambiguity or Put all that together and deference to the agency is the almost obvious choice, based on an implicit congressional delegation of interpretive authority. We defer, the Court has explained, “because of a presumption that Congress” would have “desired the agency (rather than the courts)” to exercise “whatever degree of discretion” the statute allows. Smiley v. Citibank (South Dakota), N. A., 517 U. S. 735, 740–741 (1996). Today, the Court flips the script: It is now “the courts (rather than the agency)” that will wield power when Congress has left an area of interpretive discretion. A rule of judicial humility gives way to a rule of judicial hubris. In recent years, this Court has too often taken for itself decision-making authority Congress assigned to agencies. The Court has substituted its own judgment on workplace health for that of the Occupational Safety and Health Administration; its own judgment on climate change for that of the Environmental Protection Agency; and its own judgment on student loans for that of the Department of Education. See, e.g., National Federation of Independent Business v. OSHA, 595 U. S. 109 (2022); West Virginia v. EPA, 597 U. S. 697 (2022); Biden v. Nebraska, 600 U. S. 477 (2023). But evidently that was, for this Court, all too piecemeal. In one fell swoop, the majority today gives itself exclusive power over every open issue—no matter how expertise-driven or policy-laden—involving the meaning of regulatory law. As if it did not have enough on its plate, the majority turns itself into the country’s administrative czar. It defends that move as one (suddenly) required by the (nearly 80-year-old) Administrative Procedure Act. But the Act makes no such demand. Today’s decision is not one Congress directed. It is entirely the majority’s choice. And the majority cannot destroy one doctrine of judicial humility without making a laughing-stock of a second. (If opinions had titles, a good candidate for today’s would be Hubris Squared.) Stare decisis is, among other things, a way to remind judges that wisdom often lies in what prior judges have done. It is a brake on the urge to convert “every new judge’s opinion” into a new legal rule or regime. Dobbs v. Jackson Women’s Health Organization, 597 U. S. 215, 388 (2022) (joint opinion of Breyer, SOTOMAYOR, and KAGAN, JJ., dissenting) (quoting 1 W. Blackstone, Commentaries on the Laws of England 69 (7th ed. 1775)). Chevron is entrenched precedent, entitled to the protection of stare decisis, as even the majority acknowledges. In fact, Chevron is entitled to the supercharged version of that doctrine because Congress could always overrule the decision, and because so many governmental and private actors have relied on it for so long. Because that is so, the majority needs a “particularly special justification” for its action. Kisor v. Wilkie, 588 U. S. 558, 588 (2019) (opinion of the Court). But the majority has nothing that would qualify. It barely tries to advance the usual factors this Court invokes for overruling precedent. Its justification comes down, in the end, to this: Courts must have more say over regulation—over the provision of health care, the protection of the environment, the safety of consumer products, the efficacy of transportation systems, and so on. A longstanding precedent at the crux of administrative governance thus falls victim to a bald assertion of judicial authority. The majority disdains restraint, and grasps for power. USER: What doctrine or doctrines does Kagan use to argue against the Court's decision to overrule Chevron? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	28	16	983	null	824
All your responses are based exclusively in the user-provided text. You do not use any outside information or prior knowledge in your responses.	Explain the differences between gamma ray and infrared telescopes.	How Telescopes Are Like Eyes Telescopes and eyes are both tools for collecting and detecting light. In fact, telescopes can be thought of as bigger, more powerful eyes. Eyes have an opening called the pupil where the light enters; a lens to focus the light; and a retina in the back to detect the light. Telescopes also have an opening to let in light; a lens or mirror to focus the light; and a detector to receive and process the light. In the eye, chemical reactions in the retina convert light into electrical signals, w h i c h are processed by the brain. In telescopes, several different kinds of light detectors are used. Some telescopes contain electronic devices that convert light into electrical signals that can be analyzed and stored by a computer. In other telescopes, the light is focused onto photographic film, where the information is recorded as a photograph. In simple backyard telescopes, the light is focused onto the eye of the person looking through the telescope. In this case, the telescope’s light detector is a human eye. When you look through a telescope, all of the light that enters eventually reaches the back of your eye. Hundreds of times more light enters a small telescope than would n o rmally enter your eye because the telescope’s opening (also known as its “apert u r e ” ) is much bigger than your pupil. The telescope’s lens or mirror focuses all of this light so that it fits through your pupil. This is why telescopes let you see objects that do not give off enough light to see by unaided eye alone. Telescopes have several advantages over eyes, including larger light-collecting areas; collecting light for longer periods of time; and the ability to detect wavelengths of light invisible to humans. Larger Light-Collecting Areas When you move from a bright area into darkness, the pupil in your eye can expand from less than 1/1 6 inch to more than o inch in diameter — becoming sixteen times greater in area —in order to take in more light. Telescopes offer a way to expand the light-collecting area even further, in effect increasing the size of your pupil by hundreds or thousands of times. A simple backyard telescope with a 4-inch-diameter lens can capture 250 times more light than an eye with a o -inch-wide pupil, and the Hubble Space Telescope’s 94.5-inch mirror captures 143,000 times as much light as a o -inch pupil. Telescopes that capture radio waves look nothing like optical telescopes, but the surface area of the collector still determines how powerful the telescope is. Radio telescopes collect light in “dishes” that resemble satellite TV antennas. The wider the dish, the more powerful the telescope, because a wider dish can capture more light. The radio telescope at the Arecibo Observatory in Puerto Rico has a dish 1,000 feet wide Collecting Light for Longer Periods of Time The light detectors in telescopes can gather light from a single source over a long period of time. In some cases, light collected over several hours is used to create a single image. This is something the human eye cannot do. The cells in your retina collect light for just a fraction of a second. Then they repeat the process, essentially taking a new picture about twenty times a second. This enables your eye to keep track of moving objects. If your eye did not constantly update its information about where things are, moving objects would become a blur. When collecting light from faint objects such as distant galaxies, however, a twentieth of a second is not enough time for your eye to see anything at all, even if you are looking through a large telescope. Astronomers solve this problem by attaching special detectors to telescopes. This lets them point a telescope at a single object for minutes or even hours and combine all the light the camera receives into a single image. The resulting image reveals much more than a person could see with their eyes, even looking through the same telescope. In the past, telescope detectors used photographic film. Though some still use film, most research telescopes now use electronic cameras that store digital images on a computer. The electronic light detectors used in telescopes are called charged-coupled devices, or CCDs. CCD chips are made of thousands of tiny sensors that convert light into an electrical signal. The amount of electricity that passes through a given spot on the chip reveals how much light struck that point. Computers process the electrical information to make a digital image. The same technology is used in photocopiers, fax machines, video cameras, and bar code readers, all of which convert light signals into electrical signals. The Ability to Detect Wavelengths of Light Invisible to Humans Many telescopes are built to detect wavelengths of light your eyes cannot. Light from space comes in many wavelengths, most of which are invisible to the human eye—including gamma rays, X rays, ultraviolet and infrared light, microwaves, and radio waves. Whether visible or invisible, all light contains information about its source. So astronomers use special telescopes to detect wavelengths of light not visible to humans. The hotter an object is, the shorter the wavelengths of light it gives off. Because stars are so hot, much of the light they emit is in wavelengths too short for your eyes to see. Pictures of the Sun taken in ultraviolet or X-ray light, for instance, show hot, glowing jets of gas arching out of the Sun. These shapes are always there, but they cannot be seen in visible wavelengths. Telescopes sensitive to different wavelengths of light are useful in observing different astronomical phenomena. Gamma Ray Telescopes Gamma rays have the shortest wavelength and contain the most energy of any form of light. They are believed to come from highly energetic processes such as collisions between two black holes, collisions between two neutron stars, or the collapse of hyperstars—giant stars even bigger than the ones that cause supernovas. The design of a gamma-ray telescope is unique in that the telescope itself is one big detector without any lenses or mirrors. The wavelengths of gamma rays are so small that they pass easily through conventional lenses or mirrors. X-ray Telescopes X-ray telescopes are used to observe extremely hot sources, such as the gases around black holes. X-ray telescopes cannot focus X-ray light the same way that ordinary telescopes do, because X-rays go right through most mirrors. Some X ray telescopes have special mirrors shaped like long, narrow tubes. As X rays enter the tube, they graze the mirror just enough to reflect gently toward a detector instead of passing through the mirror. Ultraviolet Telescopes Ultraviolet (UV) light has shorter wavelengths than visible light. These waves come from very hot stars. Ultraviolet telescopes can also be used to observe the hot gases surrounding the Sun. UV telescopes appear very similar in design to visible light telescopes except they are equipped with specially designed detectors sensitive to UV light. Visible Light Telescopes Optical telescopes capture the same kind of light your eyes can see. They reveal how distant objects would look if we were closer to them. Most of the cosmic images we see in magazines and newspapers come from visible light telescopes. Visible light is also a good source of information about average-temperature stars like the Sun. Infrared Telescopes Infrared light has fairly long wavelengths that pass through clouds of dust better than light with shorter wavelengths. Infrared telescopes are used to observe objects surrounded by dust, such as young stars being born inside nebulae. Because all warm objects give off infrared light, infrared telescopes are chilled so that they won’t detect their own glow. The lifespan of an infrared telescope is limited by how long the telescope can be kept cool. Microwave Telescopes Microwaves are used to observe the afterglow of the Big Bang, the ancient explosion that created the Universe. Microwave radiation also reveals the presence of many small molecules, such as carbon monoxide. The design of microwave telescopes is most similar to that of radio telescopes: large metallic “dishes” that collect and focus the longer wavelengths of microwave light. Radio Telescopes Radio waves have long wavelengths, from a meter on up to over a kilometer. Extremely large telescope dishes are required to capture these long wavelengths. Radio telescopes can reveal details of distant galaxies and nebulae. Radio telescopes helped astronomers discover “pulsars,” which are collapsed stars that rotate rapidly, emitting pulses of radio waves like the rotating lights on a police car or a lighthouse.	Question: Explain the differences between gamma ray and infrared telescopes. System Instructions: All your responses are based exclusively in the user-provided text. You do not use any outside information or prior knowledge in your responses. Text: The Ability to Detect Wavelengths of Light Invisible to Humans Many telescopes are built to detect wavelengths of light your eyes cannot. Light from space comes in many wavelengths, most of which are invisible to the human eye—including gamma rays, X rays, ultraviolet and infrared light, microwaves, and radio waves. Whether visible or invisible, all light contains information about its source. So astronomers use special telescopes to detect wavelengths of light not visible to humans. The hotter an object is, the shorter the wavelengths of light it gives off. Because stars are so hot, much of the light they emit is in wavelengths too short for your eyes to see. Pictures of the Sun taken in ultraviolet or X-ray light, for instance, show hot, glowing jets of gas arching out of the Sun. These shapes are always there, but they cannot be seen in visible wavelengths. Telescopes sensitive to different wavelengths of light are useful in observing different astronomical phenomena. Gamma Ray Telescopes Gamma rays have the shortest wavelength and contain the most energy of any form of light. They are believed to come from highly energetic processes such as collisions between two black holes, collisions between two neutron stars, or the collapse of hyperstars—giant stars even bigger than the ones that cause supernovas. The design of a gamma-ray telescope is unique in that the telescope itself is one big detector without any lenses or mirrors. The wavelengths of gamma rays are so small that they pass easily through conventional lenses or mirrors. X-ray Telescopes X-ray telescopes are used to observe extremely hot sources, such as the gases around black holes. X-ray telescopes cannot focus X-ray light the same way that ordinary telescopes do, because X-rays go right through most mirrors. Some X ray telescopes have special mirrors shaped like long, narrow tubes. As X rays enter the tube, they graze the mirror just enough to reflect gently toward a detector instead of passing through the mirror. Ultraviolet Telescopes Ultraviolet (UV) light has shorter wavelengths than visible light. These waves come from very hot stars. Ultraviolet telescopes can also be used to observe the hot gases surrounding the Sun. UV telescopes appear very similar in design to visible light telescopes except they are equipped with specially designed detectors sensitive to UV light. Visible Light Telescopes Optical telescopes capture the same kind of light your eyes can see. They reveal how distant objects would look if we were closer to them. Most of the cosmic images we see in magazines and newspapers come from visible light telescopes. Visible light is also a good source of information about average-temperature stars like the Sun. Infrared Telescopes Infrared light has fairly long wavelengths that pass through clouds of dust better than light with shorter wavelengths. Infrared telescopes are used to observe objects surrounded by dust, such as young stars being born inside nebulae. Because all warm objects give off infrared light, infrared telescopes are chilled so that they won’t detect their own glow. The lifespan of an infrared telescope is limited by how long the telescope can be kept cool. Microwave Telescopes Microwaves are used to observe the afterglow of the Big Bang, the ancient explosion that created the Universe. Microwave radiation also reveals the presence of many small molecules, such as carbon monoxide. The design of microwave telescopes is most similar to that of radio telescopes: large metallic “dishes” that collect and focus the longer wavelengths of microwave light. Radio Telescopes Radio waves have long wavelengths, from a meter on up to over a kilometer. Extremely large telescope dishes are required to capture these long wavelengths. Radio telescopes can reveal details of distant galaxies and nebulae. Radio telescopes helped astronomers discover “pulsars,” which are collapsed stars that rotate rapidly, emitting pulses of radio waves like the rotating lights on a police car or a lighthouse.	All your responses are based exclusively in the user-provided text. You do not use any outside information or prior knowledge in your responses. EVIDENCE: How Telescopes Are Like Eyes Telescopes and eyes are both tools for collecting and detecting light. In fact, telescopes can be thought of as bigger, more powerful eyes. Eyes have an opening called the pupil where the light enters; a lens to focus the light; and a retina in the back to detect the light. Telescopes also have an opening to let in light; a lens or mirror to focus the light; and a detector to receive and process the light. In the eye, chemical reactions in the retina convert light into electrical signals, w h i c h are processed by the brain. In telescopes, several different kinds of light detectors are used. Some telescopes contain electronic devices that convert light into electrical signals that can be analyzed and stored by a computer. In other telescopes, the light is focused onto photographic film, where the information is recorded as a photograph. In simple backyard telescopes, the light is focused onto the eye of the person looking through the telescope. In this case, the telescope’s light detector is a human eye. When you look through a telescope, all of the light that enters eventually reaches the back of your eye. Hundreds of times more light enters a small telescope than would n o rmally enter your eye because the telescope’s opening (also known as its “apert u r e ” ) is much bigger than your pupil. The telescope’s lens or mirror focuses all of this light so that it fits through your pupil. This is why telescopes let you see objects that do not give off enough light to see by unaided eye alone. Telescopes have several advantages over eyes, including larger light-collecting areas; collecting light for longer periods of time; and the ability to detect wavelengths of light invisible to humans. Larger Light-Collecting Areas When you move from a bright area into darkness, the pupil in your eye can expand from less than 1/1 6 inch to more than o inch in diameter — becoming sixteen times greater in area —in order to take in more light. Telescopes offer a way to expand the light-collecting area even further, in effect increasing the size of your pupil by hundreds or thousands of times. A simple backyard telescope with a 4-inch-diameter lens can capture 250 times more light than an eye with a o -inch-wide pupil, and the Hubble Space Telescope’s 94.5-inch mirror captures 143,000 times as much light as a o -inch pupil. Telescopes that capture radio waves look nothing like optical telescopes, but the surface area of the collector still determines how powerful the telescope is. Radio telescopes collect light in “dishes” that resemble satellite TV antennas. The wider the dish, the more powerful the telescope, because a wider dish can capture more light. The radio telescope at the Arecibo Observatory in Puerto Rico has a dish 1,000 feet wide Collecting Light for Longer Periods of Time The light detectors in telescopes can gather light from a single source over a long period of time. In some cases, light collected over several hours is used to create a single image. This is something the human eye cannot do. The cells in your retina collect light for just a fraction of a second. Then they repeat the process, essentially taking a new picture about twenty times a second. This enables your eye to keep track of moving objects. If your eye did not constantly update its information about where things are, moving objects would become a blur. When collecting light from faint objects such as distant galaxies, however, a twentieth of a second is not enough time for your eye to see anything at all, even if you are looking through a large telescope. Astronomers solve this problem by attaching special detectors to telescopes. This lets them point a telescope at a single object for minutes or even hours and combine all the light the camera receives into a single image. The resulting image reveals much more than a person could see with their eyes, even looking through the same telescope. In the past, telescope detectors used photographic film. Though some still use film, most research telescopes now use electronic cameras that store digital images on a computer. The electronic light detectors used in telescopes are called charged-coupled devices, or CCDs. CCD chips are made of thousands of tiny sensors that convert light into an electrical signal. The amount of electricity that passes through a given spot on the chip reveals how much light struck that point. Computers process the electrical information to make a digital image. The same technology is used in photocopiers, fax machines, video cameras, and bar code readers, all of which convert light signals into electrical signals. The Ability to Detect Wavelengths of Light Invisible to Humans Many telescopes are built to detect wavelengths of light your eyes cannot. Light from space comes in many wavelengths, most of which are invisible to the human eye—including gamma rays, X rays, ultraviolet and infrared light, microwaves, and radio waves. Whether visible or invisible, all light contains information about its source. So astronomers use special telescopes to detect wavelengths of light not visible to humans. The hotter an object is, the shorter the wavelengths of light it gives off. Because stars are so hot, much of the light they emit is in wavelengths too short for your eyes to see. Pictures of the Sun taken in ultraviolet or X-ray light, for instance, show hot, glowing jets of gas arching out of the Sun. These shapes are always there, but they cannot be seen in visible wavelengths. Telescopes sensitive to different wavelengths of light are useful in observing different astronomical phenomena. Gamma Ray Telescopes Gamma rays have the shortest wavelength and contain the most energy of any form of light. They are believed to come from highly energetic processes such as collisions between two black holes, collisions between two neutron stars, or the collapse of hyperstars—giant stars even bigger than the ones that cause supernovas. The design of a gamma-ray telescope is unique in that the telescope itself is one big detector without any lenses or mirrors. The wavelengths of gamma rays are so small that they pass easily through conventional lenses or mirrors. X-ray Telescopes X-ray telescopes are used to observe extremely hot sources, such as the gases around black holes. X-ray telescopes cannot focus X-ray light the same way that ordinary telescopes do, because X-rays go right through most mirrors. Some X ray telescopes have special mirrors shaped like long, narrow tubes. As X rays enter the tube, they graze the mirror just enough to reflect gently toward a detector instead of passing through the mirror. Ultraviolet Telescopes Ultraviolet (UV) light has shorter wavelengths than visible light. These waves come from very hot stars. Ultraviolet telescopes can also be used to observe the hot gases surrounding the Sun. UV telescopes appear very similar in design to visible light telescopes except they are equipped with specially designed detectors sensitive to UV light. Visible Light Telescopes Optical telescopes capture the same kind of light your eyes can see. They reveal how distant objects would look if we were closer to them. Most of the cosmic images we see in magazines and newspapers come from visible light telescopes. Visible light is also a good source of information about average-temperature stars like the Sun. Infrared Telescopes Infrared light has fairly long wavelengths that pass through clouds of dust better than light with shorter wavelengths. Infrared telescopes are used to observe objects surrounded by dust, such as young stars being born inside nebulae. Because all warm objects give off infrared light, infrared telescopes are chilled so that they won’t detect their own glow. The lifespan of an infrared telescope is limited by how long the telescope can be kept cool. Microwave Telescopes Microwaves are used to observe the afterglow of the Big Bang, the ancient explosion that created the Universe. Microwave radiation also reveals the presence of many small molecules, such as carbon monoxide. The design of microwave telescopes is most similar to that of radio telescopes: large metallic “dishes” that collect and focus the longer wavelengths of microwave light. Radio Telescopes Radio waves have long wavelengths, from a meter on up to over a kilometer. Extremely large telescope dishes are required to capture these long wavelengths. Radio telescopes can reveal details of distant galaxies and nebulae. Radio telescopes helped astronomers discover “pulsars,” which are collapsed stars that rotate rapidly, emitting pulses of radio waves like the rotating lights on a police car or a lighthouse. USER: Explain the differences between gamma ray and infrared telescopes. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	23	9	1,434	null	70
Respond using only information from the provided content. Adhere to a 300-word limit. Avoid responding in table format or JSON	According to the article, if you are unable to obtain a normal credit card, what are your alternatives?	Ten steps to rebuild your credit There are many ways to rebuild credit, and the most effective options vary from person to person. Use this list of options as a starting point to make your own personalized plan to rebuild your credit. 1. Get current with payments Before you do anything else to rebuild credit, make sure every account you have is current (not behind on payments). Accounts that are more than 30 days past due can do serious damage to your credit, and the later they get, the worse the damage will be. Plus, outstanding balances can mean late fees and interest fees get piled on top of your existing debt. The longer you're behind, the more expensive it'll be to catch up. If you're struggling to get current on your credit cards, make sure to contact your issuers. In most cases, a credit card issuer will work with you to establish a payment plan. After all, it's in the issuer's best interest for you to repay that debt. 2. Pay down high balances One of the key factors used in credit scoring is called your credit utilization ratio. This is the ratio of how much credit card debt you have (amounts owed) versus your total available credit. For example, a credit card with a balance of $500 and a credit limit of $1,000 has a utilization ratio of of 50% ($500 / $1,000 = 0.5 x 10). High utilization (being close to your credit limits) is a warning sign to creditors that you may have taken on too much debt and could be living beyond your means. As a result, high utilization can hurt your credit score. One way to rebuild credit is to pay down those balances. The general rule of thumb is to keep your utilization below 30%. Try not to owe more than one-third of your credit limit; keeping your limit below 10% is ideal. Building a budget that prioritizes debt repayment is often the best method for paying down high balances. See below for more information on budgets, or our guide to paying off debt for our top tips. If you're already living on a tight budget, a debt consolidation loan may be a good way to pay down credit cards and boost your credit score. Opening a debt consolidation loan can bring down your score in the short term, but can benefit your score in the long term. If changing your budget isn't an option, it's worth investigating whether a debt consolidation loan is right for you. 3. Pay on time, every time Every time you make a credit card payment and the issuer reports your payment to the credit bureaus, you are contributing to your payment history. Your payment history is the most important part of your credit score. No plan to rebuild credit will work if you aren't making payments on time. Make at least your minimum required payment by the due date every single month. (Ideally, pay off your entire balance every month to avoid credit card interest fees.) 4. Activate automatic payments If you're having trouble remembering due dates, you can let the credit card company take care of it for you. Most banks and issuers will allow you to set up automatic payments. You can choose the amount you want to pay -- make sure it's at least your minimum payment -- as well as when you want the payments to process. If you don't have automatic payments set to cover your entire monthly bill, be sure to follow up with additional payments to pay your full balance. 5. Keep balances low As mentioned, your utilization rate has a lot of influence on your credit score. Once you've paid down your outstanding balances, make sure to keep them low. You'll struggle to rebuild credit if you keep running up your credit card balances after paying them down. People with excellent credit tend to have utilization rates below 10%. 6. Open a secured credit card The only surefire way to rebuild credit is to have a recent positive payment history. Of course, if your credit is heavily damaged, you may have trouble qualifying for a credit card with which to build that payment history. This is where a secured credit card can help. Secured credit cards can be pretty easy to get, even if your credit is damaged. That's because secured cards rely on a cash security deposit to minimize risk to the issuer. If you pay off your balance in full, you'll get the security deposit back when you close your account. Some issuers will even automatically upgrade you to an unsecured account and return your deposit. 7. Become an authorized user on someone else's card Another way to rebuild credit is to be added as an authorized user on another person's card (such as a trusted family member). When you become an authorized user on someone else's credit card, you receive your own credit card with your name. But the credit account is still the responsibility of the primary account holder. The card company typically reports the credit card account to the credit bureaus for both the primary account holder and the authorized user. As long as the account is in good standing, being added as an authorized user can help raise your credit score. Being an authorized user isn't without risks, however. For example, if the cardholder or the authorized user runs up a high balance, both users could see credit score damage. Only tie your credit score to individuals you trust. 8. Build a budget -- and stick to it Any plan to rebuild credit score damage is sure to fail if you don't address the root of the problem. In many cases, the root cause boils down to the lack of a budget -- and yes, that means a realistic budget, not an idealized one. If your budget doesn't reflect your actual lifestyle, spending, and debts, it'll be useless. A good budget can help you repay debts and keep from overextending yourself in the future. RELATED: Best Budgeting Apps 9. Keep an eye on your credit reports and scores As you work to rebuild credit, be sure to check up on your credit reports and scores regularly. Many credit card issuers offer free monthly credit scores, especially on credit-building products. You can also get free copies of your credit reports from each of the three bureaus once a year through AnnualCreditReport.com. If you find any errors on your reports, be sure to dispute them quickly with the credit bureaus. 10. Give it time Like it or not, sometimes time is the only way to rebuild credit. Those delinquent payments and defaulted accounts aren't going anywhere fast. It can take years of building a positive payment history to recover from big mistakes -- especially when those mistakes can sit on your reports for up to seven years. If you're doing everything right to rebuild your credit, but you're not seeing much movement in your credit scores: be patient. Time -- and keeping on top of your payments -- heals most credit wounds. How long will it take to rebuild my credit? Every credit profile is unique. As a result, the best strategy for rebuilding credit will depend on your credit history and the reasons for your credit problems. In other words, the answer to the question of "How long does it take to rebuild credit?" is: It depends. A low credit score caused by high credit card balances can be the quickest thing to fix (assuming you have the funds to pay them off). Paying down high balances can help you rebuild credit in 30 days or less. On the other hand, if you need to rebuild credit due to late payments or a defaulted account, you're probably going to need longer. It will take at least six to 12 months to rebuild credit scores to an acceptable level -- and several years for the negative items to disappear altogether. In fact, negative items can linger on your credit reports for up to 10 years in certain cases (primarily bankruptcy), with most negative items having a shelf life of seven years. On the bright side, negative items impact your credit scores less as they age, particularly when you've been building a positive payment history in the meantime. How can I raise my credit score by 100 points? If you have very high credit utilization -- meaning you're close to your credit limits -- paying down your balances could provide a large credit score boost. Credit scores damaged by credit report errors can also jump quite a bit when those errors are removed. Outside of these situations, however, you'll typically need to rebuild credit over many months to see a gain of 100 points or more. There is no guaranteed way to raise your credit score by a specific amount -- and 100 points is a lot to expect. For example, a 100-point jump from 570 to 670 moves you from bad credit into fair credit. What type of credit cards work for rebuilding credit? The best credit cards to rebuild credit have minimal costs and report your payments to the credit bureaus each month. This means cards with affordable annual fees -- or, even better, credit cards with no annual fees -- and the option to make automatic payments. Wondering where to start? A number of credit cards for fair or average credit won't charge a fee. If you can't qualify for an unsecured card without an annual fee, consider a secured credit card instead. Secured cards differ from traditional cards in one key way: the deposit. Secured credit cards require an upfront cash deposit to open and maintain. This makes them safer for the issuer. Even if you have significant credit damage, you can likely find an issuer willing to offer you a secured credit card. Banks where you already have a good reputation and your local credit union are often the best places to find a secured card. Look for one that might allow you to graduate easily to an unsecured card (and avoid annual fees, if possible).	query: According to the article, if you are unable to obtain a normal credit card, what are your alternatives? ---------- task instruction: Respond using only information from the provided content. Adhere to a 300-word limit. Avoid responding in table format or JSON ---------- passage: Ten steps to rebuild your credit There are many ways to rebuild credit, and the most effective options vary from person to person. Use this list of options as a starting point to make your own personalized plan to rebuild your credit. 1. Get current with payments Before you do anything else to rebuild credit, make sure every account you have is current (not behind on payments). Accounts that are more than 30 days past due can do serious damage to your credit, and the later they get, the worse the damage will be. Plus, outstanding balances can mean late fees and interest fees get piled on top of your existing debt. The longer you're behind, the more expensive it'll be to catch up. If you're struggling to get current on your credit cards, make sure to contact your issuers. In most cases, a credit card issuer will work with you to establish a payment plan. After all, it's in the issuer's best interest for you to repay that debt. 2. Pay down high balances One of the key factors used in credit scoring is called your credit utilization ratio. This is the ratio of how much credit card debt you have (amounts owed) versus your total available credit. For example, a credit card with a balance of $500 and a credit limit of $1,000 has a utilization ratio of of 50% ($500 / $1,000 = 0.5 x 10). High utilization (being close to your credit limits) is a warning sign to creditors that you may have taken on too much debt and could be living beyond your means. As a result, high utilization can hurt your credit score. One way to rebuild credit is to pay down those balances. The general rule of thumb is to keep your utilization below 30%. Try not to owe more than one-third of your credit limit; keeping your limit below 10% is ideal. Building a budget that prioritizes debt repayment is often the best method for paying down high balances. See below for more information on budgets, or our guide to paying off debt for our top tips. If you're already living on a tight budget, a debt consolidation loan may be a good way to pay down credit cards and boost your credit score. Opening a debt consolidation loan can bring down your score in the short term, but can benefit your score in the long term. If changing your budget isn't an option, it's worth investigating whether a debt consolidation loan is right for you. 3. Pay on time, every time Every time you make a credit card payment and the issuer reports your payment to the credit bureaus, you are contributing to your payment history. Your payment history is the most important part of your credit score. No plan to rebuild credit will work if you aren't making payments on time. Make at least your minimum required payment by the due date every single month. (Ideally, pay off your entire balance every month to avoid credit card interest fees.) 4. Activate automatic payments If you're having trouble remembering due dates, you can let the credit card company take care of it for you. Most banks and issuers will allow you to set up automatic payments. You can choose the amount you want to pay -- make sure it's at least your minimum payment -- as well as when you want the payments to process. If you don't have automatic payments set to cover your entire monthly bill, be sure to follow up with additional payments to pay your full balance. 5. Keep balances low As mentioned, your utilization rate has a lot of influence on your credit score. Once you've paid down your outstanding balances, make sure to keep them low. You'll struggle to rebuild credit if you keep running up your credit card balances after paying them down. People with excellent credit tend to have utilization rates below 10%. 6. Open a secured credit card The only surefire way to rebuild credit is to have a recent positive payment history. Of course, if your credit is heavily damaged, you may have trouble qualifying for a credit card with which to build that payment history. This is where a secured credit card can help. Secured credit cards can be pretty easy to get, even if your credit is damaged. That's because secured cards rely on a cash security deposit to minimize risk to the issuer. If you pay off your balance in full, you'll get the security deposit back when you close your account. Some issuers will even automatically upgrade you to an unsecured account and return your deposit. 7. Become an authorized user on someone else's card Another way to rebuild credit is to be added as an authorized user on another person's card (such as a trusted family member). When you become an authorized user on someone else's credit card, you receive your own credit card with your name. But the credit account is still the responsibility of the primary account holder. The card company typically reports the credit card account to the credit bureaus for both the primary account holder and the authorized user. As long as the account is in good standing, being added as an authorized user can help raise your credit score. Being an authorized user isn't without risks, however. For example, if the cardholder or the authorized user runs up a high balance, both users could see credit score damage. Only tie your credit score to individuals you trust. 8. Build a budget -- and stick to it Any plan to rebuild credit score damage is sure to fail if you don't address the root of the problem. In many cases, the root cause boils down to the lack of a budget -- and yes, that means a realistic budget, not an idealized one. If your budget doesn't reflect your actual lifestyle, spending, and debts, it'll be useless. A good budget can help you repay debts and keep from overextending yourself in the future. RELATED: Best Budgeting Apps 9. Keep an eye on your credit reports and scores As you work to rebuild credit, be sure to check up on your credit reports and scores regularly. Many credit card issuers offer free monthly credit scores, especially on credit-building products. You can also get free copies of your credit reports from each of the three bureaus once a year through AnnualCreditReport.com. If you find any errors on your reports, be sure to dispute them quickly with the credit bureaus. 10. Give it time Like it or not, sometimes time is the only way to rebuild credit. Those delinquent payments and defaulted accounts aren't going anywhere fast. It can take years of building a positive payment history to recover from big mistakes -- especially when those mistakes can sit on your reports for up to seven years. If you're doing everything right to rebuild your credit, but you're not seeing much movement in your credit scores: be patient. Time -- and keeping on top of your payments -- heals most credit wounds. How long will it take to rebuild my credit? Every credit profile is unique. As a result, the best strategy for rebuilding credit will depend on your credit history and the reasons for your credit problems. In other words, the answer to the question of "How long does it take to rebuild credit?" is: It depends. A low credit score caused by high credit card balances can be the quickest thing to fix (assuming you have the funds to pay them off). Paying down high balances can help you rebuild credit in 30 days or less. On the other hand, if you need to rebuild credit due to late payments or a defaulted account, you're probably going to need longer. It will take at least six to 12 months to rebuild credit scores to an acceptable level -- and several years for the negative items to disappear altogether. In fact, negative items can linger on your credit reports for up to 10 years in certain cases (primarily bankruptcy), with most negative items having a shelf life of seven years. On the bright side, negative items impact your credit scores less as they age, particularly when you've been building a positive payment history in the meantime. How can I raise my credit score by 100 points? If you have very high credit utilization -- meaning you're close to your credit limits -- paying down your balances could provide a large credit score boost. Credit scores damaged by credit report errors can also jump quite a bit when those errors are removed. Outside of these situations, however, you'll typically need to rebuild credit over many months to see a gain of 100 points or more. There is no guaranteed way to raise your credit score by a specific amount -- and 100 points is a lot to expect. For example, a 100-point jump from 570 to 670 moves you from bad credit into fair credit. What type of credit cards work for rebuilding credit? The best credit cards to rebuild credit have minimal costs and report your payments to the credit bureaus each month. This means cards with affordable annual fees -- or, even better, credit cards with no annual fees -- and the option to make automatic payments. Wondering where to start? A number of credit cards for fair or average credit won't charge a fee. If you can't qualify for an unsecured card without an annual fee, consider a secured credit card instead. Secured cards differ from traditional cards in one key way: the deposit. Secured credit cards require an upfront cash deposit to open and maintain. This makes them safer for the issuer. Even if you have significant credit damage, you can likely find an issuer willing to offer you a secured credit card. Banks where you already have a good reputation and your local credit union are often the best places to find a secured card. Look for one that might allow you to graduate easily to an unsecured card (and avoid annual fees, if possible).	Respond using only information from the provided content. Adhere to a 300-word limit. Avoid responding in table format or JSON EVIDENCE: Ten steps to rebuild your credit There are many ways to rebuild credit, and the most effective options vary from person to person. Use this list of options as a starting point to make your own personalized plan to rebuild your credit. 1. Get current with payments Before you do anything else to rebuild credit, make sure every account you have is current (not behind on payments). Accounts that are more than 30 days past due can do serious damage to your credit, and the later they get, the worse the damage will be. Plus, outstanding balances can mean late fees and interest fees get piled on top of your existing debt. The longer you're behind, the more expensive it'll be to catch up. If you're struggling to get current on your credit cards, make sure to contact your issuers. In most cases, a credit card issuer will work with you to establish a payment plan. After all, it's in the issuer's best interest for you to repay that debt. 2. Pay down high balances One of the key factors used in credit scoring is called your credit utilization ratio. This is the ratio of how much credit card debt you have (amounts owed) versus your total available credit. For example, a credit card with a balance of $500 and a credit limit of $1,000 has a utilization ratio of of 50% ($500 / $1,000 = 0.5 x 10). High utilization (being close to your credit limits) is a warning sign to creditors that you may have taken on too much debt and could be living beyond your means. As a result, high utilization can hurt your credit score. One way to rebuild credit is to pay down those balances. The general rule of thumb is to keep your utilization below 30%. Try not to owe more than one-third of your credit limit; keeping your limit below 10% is ideal. Building a budget that prioritizes debt repayment is often the best method for paying down high balances. See below for more information on budgets, or our guide to paying off debt for our top tips. If you're already living on a tight budget, a debt consolidation loan may be a good way to pay down credit cards and boost your credit score. Opening a debt consolidation loan can bring down your score in the short term, but can benefit your score in the long term. If changing your budget isn't an option, it's worth investigating whether a debt consolidation loan is right for you. 3. Pay on time, every time Every time you make a credit card payment and the issuer reports your payment to the credit bureaus, you are contributing to your payment history. Your payment history is the most important part of your credit score. No plan to rebuild credit will work if you aren't making payments on time. Make at least your minimum required payment by the due date every single month. (Ideally, pay off your entire balance every month to avoid credit card interest fees.) 4. Activate automatic payments If you're having trouble remembering due dates, you can let the credit card company take care of it for you. Most banks and issuers will allow you to set up automatic payments. You can choose the amount you want to pay -- make sure it's at least your minimum payment -- as well as when you want the payments to process. If you don't have automatic payments set to cover your entire monthly bill, be sure to follow up with additional payments to pay your full balance. 5. Keep balances low As mentioned, your utilization rate has a lot of influence on your credit score. Once you've paid down your outstanding balances, make sure to keep them low. You'll struggle to rebuild credit if you keep running up your credit card balances after paying them down. People with excellent credit tend to have utilization rates below 10%. 6. Open a secured credit card The only surefire way to rebuild credit is to have a recent positive payment history. Of course, if your credit is heavily damaged, you may have trouble qualifying for a credit card with which to build that payment history. This is where a secured credit card can help. Secured credit cards can be pretty easy to get, even if your credit is damaged. That's because secured cards rely on a cash security deposit to minimize risk to the issuer. If you pay off your balance in full, you'll get the security deposit back when you close your account. Some issuers will even automatically upgrade you to an unsecured account and return your deposit. 7. Become an authorized user on someone else's card Another way to rebuild credit is to be added as an authorized user on another person's card (such as a trusted family member). When you become an authorized user on someone else's credit card, you receive your own credit card with your name. But the credit account is still the responsibility of the primary account holder. The card company typically reports the credit card account to the credit bureaus for both the primary account holder and the authorized user. As long as the account is in good standing, being added as an authorized user can help raise your credit score. Being an authorized user isn't without risks, however. For example, if the cardholder or the authorized user runs up a high balance, both users could see credit score damage. Only tie your credit score to individuals you trust. 8. Build a budget -- and stick to it Any plan to rebuild credit score damage is sure to fail if you don't address the root of the problem. In many cases, the root cause boils down to the lack of a budget -- and yes, that means a realistic budget, not an idealized one. If your budget doesn't reflect your actual lifestyle, spending, and debts, it'll be useless. A good budget can help you repay debts and keep from overextending yourself in the future. RELATED: Best Budgeting Apps 9. Keep an eye on your credit reports and scores As you work to rebuild credit, be sure to check up on your credit reports and scores regularly. Many credit card issuers offer free monthly credit scores, especially on credit-building products. You can also get free copies of your credit reports from each of the three bureaus once a year through AnnualCreditReport.com. If you find any errors on your reports, be sure to dispute them quickly with the credit bureaus. 10. Give it time Like it or not, sometimes time is the only way to rebuild credit. Those delinquent payments and defaulted accounts aren't going anywhere fast. It can take years of building a positive payment history to recover from big mistakes -- especially when those mistakes can sit on your reports for up to seven years. If you're doing everything right to rebuild your credit, but you're not seeing much movement in your credit scores: be patient. Time -- and keeping on top of your payments -- heals most credit wounds. How long will it take to rebuild my credit? Every credit profile is unique. As a result, the best strategy for rebuilding credit will depend on your credit history and the reasons for your credit problems. In other words, the answer to the question of "How long does it take to rebuild credit?" is: It depends. A low credit score caused by high credit card balances can be the quickest thing to fix (assuming you have the funds to pay them off). Paying down high balances can help you rebuild credit in 30 days or less. On the other hand, if you need to rebuild credit due to late payments or a defaulted account, you're probably going to need longer. It will take at least six to 12 months to rebuild credit scores to an acceptable level -- and several years for the negative items to disappear altogether. In fact, negative items can linger on your credit reports for up to 10 years in certain cases (primarily bankruptcy), with most negative items having a shelf life of seven years. On the bright side, negative items impact your credit scores less as they age, particularly when you've been building a positive payment history in the meantime. How can I raise my credit score by 100 points? If you have very high credit utilization -- meaning you're close to your credit limits -- paying down your balances could provide a large credit score boost. Credit scores damaged by credit report errors can also jump quite a bit when those errors are removed. Outside of these situations, however, you'll typically need to rebuild credit over many months to see a gain of 100 points or more. There is no guaranteed way to raise your credit score by a specific amount -- and 100 points is a lot to expect. For example, a 100-point jump from 570 to 670 moves you from bad credit into fair credit. What type of credit cards work for rebuilding credit? The best credit cards to rebuild credit have minimal costs and report your payments to the credit bureaus each month. This means cards with affordable annual fees -- or, even better, credit cards with no annual fees -- and the option to make automatic payments. Wondering where to start? A number of credit cards for fair or average credit won't charge a fee. If you can't qualify for an unsecured card without an annual fee, consider a secured credit card instead. Secured cards differ from traditional cards in one key way: the deposit. Secured credit cards require an upfront cash deposit to open and maintain. This makes them safer for the issuer. Even if you have significant credit damage, you can likely find an issuer willing to offer you a secured credit card. Banks where you already have a good reputation and your local credit union are often the best places to find a secured card. Look for one that might allow you to graduate easily to an unsecured card (and avoid annual fees, if possible). USER: According to the article, if you are unable to obtain a normal credit card, what are your alternatives? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	20	18	1,695	null	255
Only use the information contained within the provided text to answer the question. Do not use outside sources. Write a full sentence and use a bullet point. Ensure the entire sentence is in italics.	According only to the article provided, what are the main difference between corporate bonds and preferred stocks?	Overview of Corporate Bonds The stock market crash of the late 2000s taught many investors a painful lesson about the importance of diversifying their investments. They remain committed to low- to moderate-risk investment vehicles that provide a compromise between security and return on investment. Corporate bonds are one such vehicle. They can provide predictable interest payments for income-seeking investors at manageable risk levels. They occupy a middle ground between low-interest, low-risk government bonds and stocks, which may offer higher returns but are much riskier overall. But corporate bonds are not perfect. Individual corporate bonds have significant drawbacks you should carefully consider before investing. What Is a Corporate Bond? Both private and public companies sell corporate bonds to raise money for business operations. In exchange, they pay you interest on the amount you purchased. Like other assets that pay interest, companies most often use corporate bonds to fund capital projects. This term encompasses just about any investment a company can make, such as: • Construction of a new warehouse or manufacturing facility • Purchasing or leasing new property • Purchasing or leasing new equipment • Buying inventory They typically come in units that carry a face value of $1,000. Also known as “par value,” it’s the amount the company, known as the bond issuer, must pay the holder on the bond’s maturity date. Some bonds require investors to buy more than one unit, so they may have a minimum purchase amount, such as $3,000 or $5,000. Corporate Bonds Structure A corporate bond makes regular interest payments to its investors. It’s popular among income-seeking investors, from financial institutions looking to offset higher-risk investments to retirement investors trying to earn interest income over a set period. Maturity Period & Call Date Like a U.S. Treasury bond, a corporate bond has a specific maturity date. That’s the day you get the original amount of your investment back. Maturity terms on corporate bonds — the period between their issue date and maturity date — range from as short as one year to as long as 30 years. Corporate bonds with less than one year maturity periods are known as “corporate paper” or “short-term financing.” The most common investors in these bonds are likely to be larger financial entities, including banks, mutual funds, and hedge funds rather than individual investors. Many corporate bonds also have call dates. Call dates are the first date the issuing company can legally buy the bond back from investors if it no longer needs the money. Prospectus Before it issues a new bond to the general public, the company must release a prospectus that outlines the intended use of the money. This requirement applies even to private companies not listed on any stock exchange. The prospectus describes the bond’s term, including its final maturity date and call date. It also outlines the bond’s initial interest rate and describes how and when the bond pays interest quarterly, semiannually, annually, or in a lump sum when the issuer buys the bond back. Finally, the prospectus outlines the bondholder’s right of repayment if the issuing company defaults or declares bankruptcy. It includes the order in which investors receive repayment based on their investor type, which depends on whether the bond is secured or unsecured. Secured vs. Unsecured Corporate Bonds Corporate bonds can be secured or unsecured. Secured bonds are guaranteed by some form of collateral, such as inventory, real property, or monetary assets. When a corporate bond issuer declares bankruptcy, secured bondholders have a legal right to seize the collateral. Unsecured bonds, also known as debentures, are only guaranteed by the company’s promise to repay. Unsecured bondholders have no right to seize property. In the event of bankruptcy, they may be forced to forfeit future interest payments as well as a significant fraction of their principal payments. Some bond types are always unsecured, such as convertible notes (which you can convert into shares of company stock). Others, such as fixed-rate and variable-rate bonds, may be either. You can find the bond’s secured status in the prospectus. Because unsecured bonds are considered riskier for investors, they have higher interest rates than secured bonds. However, convertible bonds tend to come with lower interest rates because you can convert them into equity. Corporate Bonds vs. Preferred Stocks Corporate bonds share some features with preferred stock, such as regular payments to investors. These similarities are enough to create confusion for inexperienced investors. But there are some important differences between the two as well: • Debt vs. Equity. A corporate bond is a debt instrument that provides no ownership stake in its issuer. In contrast, a preferred stock is an equity vehicle that does confer ownership in the underlying company. • Liquidity. You can trade both corporate bonds and preferred stock on secondary markets. But preferred stock often trades on stock exchanges, increasing the potential market size and making it easier for investors to buy and sell them. • Repayment Order. In bankruptcy, preferred stockholders are entitled to repayment before common stockholders but after corporate bondholders. • Exchange for Common Stock. You can exchange convertible corporate bonds for the issuers’ common shares under certain circumstances. Otherwise, it’s difficult or impossible for bondholders to exchange their holdings for stock. In contrast, you can always exchange preferred stocks for common stocks at an agreed-upon ratio. Types of Corporate Bonds Corporate bonds come in several different forms. A given bond can fall into more than one of these categories. Fixed-Rate Bonds This type of bond carries a fixed interest rate for its entire life. The rate is determined by its issuer’s credit rating on the bond’s issue date. Companies with higher credit ratings pay lower interest rates on their bonds, while companies with lower credit ratings pay higher interest rates. Fixed-rate bonds typically make semiannual interest payments. They’re currently the most common type of corporate bond. Variable-Rate Bonds Variable-rate bonds’ interest rates change in response to fluctuations in long-term benchmark rates, with most bonds changing once per year. Their yield is generally determined by the company’s credit rating on the date of each interest payment. Floating-Rate Bonds Floating-rate bonds’ interest rates fluctuate with market benchmarks like Libor or the Federal Reserve’s federal funds rate and the company’s credit rating on the date of each readjustment. Unlike variable-rate bonds’ annual readjustments, changes in floating-rate bond rates usually occur after each quarterly interest payment. Zero-Coupon Bonds Zero-coupon bonds don’t pay interest. Instead, they trade at deep discounts to par value (face value). At maturity, the investor can redeem their zero-coupon bond for par value, realizing a profit over what they originally paid. Callable Bonds Issuers of callable bonds have the right to buy them back after an initial lockup period ends but before maturity. The first date the issuer can buy back the bond is known as the call date. The buyback is always voluntary. For example, a company that issues a callable bond with a final maturity date of Jan. 31, 2030, and a call date of Jan. 31, 2024, can buy it back after the earlier of the two dates, but it doesn’t have to. If a bond is called, its issuer typically pays par value and any unpaid accrued interest. Callable bonds can have fixed, variable, or floating rates. A company may call bonds for various reasons. But most often, it’s because prevailing interest rates have fallen and the issuer’s credit allows it to secure lower rates on new debt issues. Since called bonds are usually replaced with lower-yield bonds, an investor whose bond is called may have to settle for lower yields on future bond purchases that offer comparable levels of risk. They also miss out on future interest payments on the called bond. Both factors reduce their overall yield. Putable Bond Putable bonds, also called put bonds or retractable bonds, are the reverse of callable bonds. After a set date, holders of putable bonds are entitled to ask the issuer for repayment of their principal plus all accumulated interest. It often occurs when a bondholder dies. Heirs of deceased bondholders may have a “survivor’s option” that entitles them to sell inherited bonds back to their issuers. Bondholders may also exercise the put in inflationary environments. As prevailing interest rates rise, bonds with lower interest rates become less attractive, and their market value falls. It makes sense for bondholders to exercise the put sooner rather than later and use the proceeds to invest in bonds paying higher rates. Because they give bondholders the right to early repayment, put bonds are less risky, more attractive investments. They typically have lower interest rates as a result. Convertible You can convert a convertible bond into a set amount of its issuer’s common stock. It allows a company’s creditor to secure an actual equity stake in it. Like callable and putable bonds, convertible bonds come with restrictions on how and when you can convert to stock. They’re also more susceptible to issuers’ stock price fluctuations than other types of bonds. Corporate Bond Ratings Every corporate bond is rated by at least one of the major U.S. rating agencies — Fitch, Standard & Poor’s, or Moody’s. Each agency has its own letter-grade scale, but the most important distinction is between the two broad risk categories: investment grade and noninvestment grade. Noninvestment-grade bonds are popularly known as “junk,” as in “junk bonds.” In more polite circles, they’re known as “high-yield bonds.” On S&P’s scale, which is the most commonly used measurement in the United States, all bonds rated below BBB- are considered noninvestment grade. A bond’s yield is inversely proportional to its issuer’s credit rating. The higher the rating, the lower the yield. Lower-rated bonds come with a higher risk of default. However, they also have high interest rates — far higher than investors could get in a savings account or CD. That’s worth the risk to some people. Corporate bondholders do enjoy greater security than stockholders. Whereas a publicly traded company may suspend dividends on common or preferred stock at any time, any company that issues a corporate bond has a legal obligation to issue regular interest payments. The only ways out of it are to default on its bonds or declare bankruptcy.	{query} ======= According only to the article provided, what are the main difference between corporate bonds and preferred stocks? {task} ======= Only use the information contained within the provided text to answer the question. Do not use outside sources. Write a full sentence and use a bullet point. Ensure the entire sentence is in italics. {text} ======= Overview of Corporate Bonds The stock market crash of the late 2000s taught many investors a painful lesson about the importance of diversifying their investments. They remain committed to low- to moderate-risk investment vehicles that provide a compromise between security and return on investment. Corporate bonds are one such vehicle. They can provide predictable interest payments for income-seeking investors at manageable risk levels. They occupy a middle ground between low-interest, low-risk government bonds and stocks, which may offer higher returns but are much riskier overall. But corporate bonds are not perfect. Individual corporate bonds have significant drawbacks you should carefully consider before investing. What Is a Corporate Bond? Both private and public companies sell corporate bonds to raise money for business operations. In exchange, they pay you interest on the amount you purchased. Like other assets that pay interest, companies most often use corporate bonds to fund capital projects. This term encompasses just about any investment a company can make, such as: • Construction of a new warehouse or manufacturing facility • Purchasing or leasing new property • Purchasing or leasing new equipment • Buying inventory They typically come in units that carry a face value of $1,000. Also known as “par value,” it’s the amount the company, known as the bond issuer, must pay the holder on the bond’s maturity date. Some bonds require investors to buy more than one unit, so they may have a minimum purchase amount, such as $3,000 or $5,000. Corporate Bonds Structure A corporate bond makes regular interest payments to its investors. It’s popular among income-seeking investors, from financial institutions looking to offset higher-risk investments to retirement investors trying to earn interest income over a set period. Maturity Period & Call Date Like a U.S. Treasury bond, a corporate bond has a specific maturity date. That’s the day you get the original amount of your investment back. Maturity terms on corporate bonds — the period between their issue date and maturity date — range from as short as one year to as long as 30 years. Corporate bonds with less than one year maturity periods are known as “corporate paper” or “short-term financing.” The most common investors in these bonds are likely to be larger financial entities, including banks, mutual funds, and hedge funds rather than individual investors. Many corporate bonds also have call dates. Call dates are the first date the issuing company can legally buy the bond back from investors if it no longer needs the money. Prospectus Before it issues a new bond to the general public, the company must release a prospectus that outlines the intended use of the money. This requirement applies even to private companies not listed on any stock exchange. The prospectus describes the bond’s term, including its final maturity date and call date. It also outlines the bond’s initial interest rate and describes how and when the bond pays interest quarterly, semiannually, annually, or in a lump sum when the issuer buys the bond back. Finally, the prospectus outlines the bondholder’s right of repayment if the issuing company defaults or declares bankruptcy. It includes the order in which investors receive repayment based on their investor type, which depends on whether the bond is secured or unsecured. Secured vs. Unsecured Corporate Bonds Corporate bonds can be secured or unsecured. Secured bonds are guaranteed by some form of collateral, such as inventory, real property, or monetary assets. When a corporate bond issuer declares bankruptcy, secured bondholders have a legal right to seize the collateral. Unsecured bonds, also known as debentures, are only guaranteed by the company’s promise to repay. Unsecured bondholders have no right to seize property. In the event of bankruptcy, they may be forced to forfeit future interest payments as well as a significant fraction of their principal payments. Some bond types are always unsecured, such as convertible notes (which you can convert into shares of company stock). Others, such as fixed-rate and variable-rate bonds, may be either. You can find the bond’s secured status in the prospectus. Because unsecured bonds are considered riskier for investors, they have higher interest rates than secured bonds. However, convertible bonds tend to come with lower interest rates because you can convert them into equity. Corporate Bonds vs. Preferred Stocks Corporate bonds share some features with preferred stock, such as regular payments to investors. These similarities are enough to create confusion for inexperienced investors. But there are some important differences between the two as well: • Debt vs. Equity. A corporate bond is a debt instrument that provides no ownership stake in its issuer. In contrast, a preferred stock is an equity vehicle that does confer ownership in the underlying company. • Liquidity. You can trade both corporate bonds and preferred stock on secondary markets. But preferred stock often trades on stock exchanges, increasing the potential market size and making it easier for investors to buy and sell them. • Repayment Order. In bankruptcy, preferred stockholders are entitled to repayment before common stockholders but after corporate bondholders. • Exchange for Common Stock. You can exchange convertible corporate bonds for the issuers’ common shares under certain circumstances. Otherwise, it’s difficult or impossible for bondholders to exchange their holdings for stock. In contrast, you can always exchange preferred stocks for common stocks at an agreed-upon ratio. Types of Corporate Bonds Corporate bonds come in several different forms. A given bond can fall into more than one of these categories. Fixed-Rate Bonds This type of bond carries a fixed interest rate for its entire life. The rate is determined by its issuer’s credit rating on the bond’s issue date. Companies with higher credit ratings pay lower interest rates on their bonds, while companies with lower credit ratings pay higher interest rates. Fixed-rate bonds typically make semiannual interest payments. They’re currently the most common type of corporate bond. Variable-Rate Bonds Variable-rate bonds’ interest rates change in response to fluctuations in long-term benchmark rates, with most bonds changing once per year. Their yield is generally determined by the company’s credit rating on the date of each interest payment. Floating-Rate Bonds Floating-rate bonds’ interest rates fluctuate with market benchmarks like Libor or the Federal Reserve’s federal funds rate and the company’s credit rating on the date of each readjustment. Unlike variable-rate bonds’ annual readjustments, changes in floating-rate bond rates usually occur after each quarterly interest payment. Zero-Coupon Bonds Zero-coupon bonds don’t pay interest. Instead, they trade at deep discounts to par value (face value). At maturity, the investor can redeem their zero-coupon bond for par value, realizing a profit over what they originally paid. Callable Bonds Issuers of callable bonds have the right to buy them back after an initial lockup period ends but before maturity. The first date the issuer can buy back the bond is known as the call date. The buyback is always voluntary. For example, a company that issues a callable bond with a final maturity date of Jan. 31, 2030, and a call date of Jan. 31, 2024, can buy it back after the earlier of the two dates, but it doesn’t have to. If a bond is called, its issuer typically pays par value and any unpaid accrued interest. Callable bonds can have fixed, variable, or floating rates. A company may call bonds for various reasons. But most often, it’s because prevailing interest rates have fallen and the issuer’s credit allows it to secure lower rates on new debt issues. Since called bonds are usually replaced with lower-yield bonds, an investor whose bond is called may have to settle for lower yields on future bond purchases that offer comparable levels of risk. They also miss out on future interest payments on the called bond. Both factors reduce their overall yield. Putable Bond Putable bonds, also called put bonds or retractable bonds, are the reverse of callable bonds. After a set date, holders of putable bonds are entitled to ask the issuer for repayment of their principal plus all accumulated interest. It often occurs when a bondholder dies. Heirs of deceased bondholders may have a “survivor’s option” that entitles them to sell inherited bonds back to their issuers. Bondholders may also exercise the put in inflationary environments. As prevailing interest rates rise, bonds with lower interest rates become less attractive, and their market value falls. It makes sense for bondholders to exercise the put sooner rather than later and use the proceeds to invest in bonds paying higher rates. Because they give bondholders the right to early repayment, put bonds are less risky, more attractive investments. They typically have lower interest rates as a result. Convertible You can convert a convertible bond into a set amount of its issuer’s common stock. It allows a company’s creditor to secure an actual equity stake in it. Like callable and putable bonds, convertible bonds come with restrictions on how and when you can convert to stock. They’re also more susceptible to issuers’ stock price fluctuations than other types of bonds. Corporate Bond Ratings Every corporate bond is rated by at least one of the major U.S. rating agencies — Fitch, Standard & Poor’s, or Moody’s. Each agency has its own letter-grade scale, but the most important distinction is between the two broad risk categories: investment grade and noninvestment grade. Noninvestment-grade bonds are popularly known as “junk,” as in “junk bonds.” In more polite circles, they’re known as “high-yield bonds.” On S&P’s scale, which is the most commonly used measurement in the United States, all bonds rated below BBB- are considered noninvestment grade. A bond’s yield is inversely proportional to its issuer’s credit rating. The higher the rating, the lower the yield. Lower-rated bonds come with a higher risk of default. However, they also have high interest rates — far higher than investors could get in a savings account or CD. That’s worth the risk to some people. Corporate bondholders do enjoy greater security than stockholders. Whereas a publicly traded company may suspend dividends on common or preferred stock at any time, any company that issues a corporate bond has a legal obligation to issue regular interest payments. The only ways out of it are to default on its bonds or declare bankruptcy.	Only use the information contained within the provided text to answer the question. Do not use outside sources. Write a full sentence and use a bullet point. Ensure the entire sentence is in italics. EVIDENCE: Overview of Corporate Bonds The stock market crash of the late 2000s taught many investors a painful lesson about the importance of diversifying their investments. They remain committed to low- to moderate-risk investment vehicles that provide a compromise between security and return on investment. Corporate bonds are one such vehicle. They can provide predictable interest payments for income-seeking investors at manageable risk levels. They occupy a middle ground between low-interest, low-risk government bonds and stocks, which may offer higher returns but are much riskier overall. But corporate bonds are not perfect. Individual corporate bonds have significant drawbacks you should carefully consider before investing. What Is a Corporate Bond? Both private and public companies sell corporate bonds to raise money for business operations. In exchange, they pay you interest on the amount you purchased. Like other assets that pay interest, companies most often use corporate bonds to fund capital projects. This term encompasses just about any investment a company can make, such as: • Construction of a new warehouse or manufacturing facility • Purchasing or leasing new property • Purchasing or leasing new equipment • Buying inventory They typically come in units that carry a face value of $1,000. Also known as “par value,” it’s the amount the company, known as the bond issuer, must pay the holder on the bond’s maturity date. Some bonds require investors to buy more than one unit, so they may have a minimum purchase amount, such as $3,000 or $5,000. Corporate Bonds Structure A corporate bond makes regular interest payments to its investors. It’s popular among income-seeking investors, from financial institutions looking to offset higher-risk investments to retirement investors trying to earn interest income over a set period. Maturity Period & Call Date Like a U.S. Treasury bond, a corporate bond has a specific maturity date. That’s the day you get the original amount of your investment back. Maturity terms on corporate bonds — the period between their issue date and maturity date — range from as short as one year to as long as 30 years. Corporate bonds with less than one year maturity periods are known as “corporate paper” or “short-term financing.” The most common investors in these bonds are likely to be larger financial entities, including banks, mutual funds, and hedge funds rather than individual investors. Many corporate bonds also have call dates. Call dates are the first date the issuing company can legally buy the bond back from investors if it no longer needs the money. Prospectus Before it issues a new bond to the general public, the company must release a prospectus that outlines the intended use of the money. This requirement applies even to private companies not listed on any stock exchange. The prospectus describes the bond’s term, including its final maturity date and call date. It also outlines the bond’s initial interest rate and describes how and when the bond pays interest quarterly, semiannually, annually, or in a lump sum when the issuer buys the bond back. Finally, the prospectus outlines the bondholder’s right of repayment if the issuing company defaults or declares bankruptcy. It includes the order in which investors receive repayment based on their investor type, which depends on whether the bond is secured or unsecured. Secured vs. Unsecured Corporate Bonds Corporate bonds can be secured or unsecured. Secured bonds are guaranteed by some form of collateral, such as inventory, real property, or monetary assets. When a corporate bond issuer declares bankruptcy, secured bondholders have a legal right to seize the collateral. Unsecured bonds, also known as debentures, are only guaranteed by the company’s promise to repay. Unsecured bondholders have no right to seize property. In the event of bankruptcy, they may be forced to forfeit future interest payments as well as a significant fraction of their principal payments. Some bond types are always unsecured, such as convertible notes (which you can convert into shares of company stock). Others, such as fixed-rate and variable-rate bonds, may be either. You can find the bond’s secured status in the prospectus. Because unsecured bonds are considered riskier for investors, they have higher interest rates than secured bonds. However, convertible bonds tend to come with lower interest rates because you can convert them into equity. Corporate Bonds vs. Preferred Stocks Corporate bonds share some features with preferred stock, such as regular payments to investors. These similarities are enough to create confusion for inexperienced investors. But there are some important differences between the two as well: • Debt vs. Equity. A corporate bond is a debt instrument that provides no ownership stake in its issuer. In contrast, a preferred stock is an equity vehicle that does confer ownership in the underlying company. • Liquidity. You can trade both corporate bonds and preferred stock on secondary markets. But preferred stock often trades on stock exchanges, increasing the potential market size and making it easier for investors to buy and sell them. • Repayment Order. In bankruptcy, preferred stockholders are entitled to repayment before common stockholders but after corporate bondholders. • Exchange for Common Stock. You can exchange convertible corporate bonds for the issuers’ common shares under certain circumstances. Otherwise, it’s difficult or impossible for bondholders to exchange their holdings for stock. In contrast, you can always exchange preferred stocks for common stocks at an agreed-upon ratio. Types of Corporate Bonds Corporate bonds come in several different forms. A given bond can fall into more than one of these categories. Fixed-Rate Bonds This type of bond carries a fixed interest rate for its entire life. The rate is determined by its issuer’s credit rating on the bond’s issue date. Companies with higher credit ratings pay lower interest rates on their bonds, while companies with lower credit ratings pay higher interest rates. Fixed-rate bonds typically make semiannual interest payments. They’re currently the most common type of corporate bond. Variable-Rate Bonds Variable-rate bonds’ interest rates change in response to fluctuations in long-term benchmark rates, with most bonds changing once per year. Their yield is generally determined by the company’s credit rating on the date of each interest payment. Floating-Rate Bonds Floating-rate bonds’ interest rates fluctuate with market benchmarks like Libor or the Federal Reserve’s federal funds rate and the company’s credit rating on the date of each readjustment. Unlike variable-rate bonds’ annual readjustments, changes in floating-rate bond rates usually occur after each quarterly interest payment. Zero-Coupon Bonds Zero-coupon bonds don’t pay interest. Instead, they trade at deep discounts to par value (face value). At maturity, the investor can redeem their zero-coupon bond for par value, realizing a profit over what they originally paid. Callable Bonds Issuers of callable bonds have the right to buy them back after an initial lockup period ends but before maturity. The first date the issuer can buy back the bond is known as the call date. The buyback is always voluntary. For example, a company that issues a callable bond with a final maturity date of Jan. 31, 2030, and a call date of Jan. 31, 2024, can buy it back after the earlier of the two dates, but it doesn’t have to. If a bond is called, its issuer typically pays par value and any unpaid accrued interest. Callable bonds can have fixed, variable, or floating rates. A company may call bonds for various reasons. But most often, it’s because prevailing interest rates have fallen and the issuer’s credit allows it to secure lower rates on new debt issues. Since called bonds are usually replaced with lower-yield bonds, an investor whose bond is called may have to settle for lower yields on future bond purchases that offer comparable levels of risk. They also miss out on future interest payments on the called bond. Both factors reduce their overall yield. Putable Bond Putable bonds, also called put bonds or retractable bonds, are the reverse of callable bonds. After a set date, holders of putable bonds are entitled to ask the issuer for repayment of their principal plus all accumulated interest. It often occurs when a bondholder dies. Heirs of deceased bondholders may have a “survivor’s option” that entitles them to sell inherited bonds back to their issuers. Bondholders may also exercise the put in inflationary environments. As prevailing interest rates rise, bonds with lower interest rates become less attractive, and their market value falls. It makes sense for bondholders to exercise the put sooner rather than later and use the proceeds to invest in bonds paying higher rates. Because they give bondholders the right to early repayment, put bonds are less risky, more attractive investments. They typically have lower interest rates as a result. Convertible You can convert a convertible bond into a set amount of its issuer’s common stock. It allows a company’s creditor to secure an actual equity stake in it. Like callable and putable bonds, convertible bonds come with restrictions on how and when you can convert to stock. They’re also more susceptible to issuers’ stock price fluctuations than other types of bonds. Corporate Bond Ratings Every corporate bond is rated by at least one of the major U.S. rating agencies — Fitch, Standard & Poor’s, or Moody’s. Each agency has its own letter-grade scale, but the most important distinction is between the two broad risk categories: investment grade and noninvestment grade. Noninvestment-grade bonds are popularly known as “junk,” as in “junk bonds.” In more polite circles, they’re known as “high-yield bonds.” On S&P’s scale, which is the most commonly used measurement in the United States, all bonds rated below BBB- are considered noninvestment grade. A bond’s yield is inversely proportional to its issuer’s credit rating. The higher the rating, the lower the yield. Lower-rated bonds come with a higher risk of default. However, they also have high interest rates — far higher than investors could get in a savings account or CD. That’s worth the risk to some people. Corporate bondholders do enjoy greater security than stockholders. Whereas a publicly traded company may suspend dividends on common or preferred stock at any time, any company that issues a corporate bond has a legal obligation to issue regular interest payments. The only ways out of it are to default on its bonds or declare bankruptcy. USER: According only to the article provided, what are the main difference between corporate bonds and preferred stocks? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	34	17	1,698	null	37
Only respond using information from the context.	What factors are negatively affecting the housing market?	U.S. Economic, Housing and Mortgage Market Outlook Recent developments U.S. economy: U.S. economic growth moderated to start the year. According to the U.S. Bureau of Economic Analysis (BEA) “advance” estimate of Real Gross Domestic Product (GDP), the seasonally adjusted annual rate (SAAR) of growth in GDP in Q1 2024 was 1.6%, slowing from a 3.4% rate in Q4 2023. The deceleration in GDP growth was led by slower growth in consumption expenditures, net exports, and government consumption expenditures. Consumer spending was weaker due to a decline in spending on durable goods, primarily autos, and flatlining nondurable goods, primarily due to less spending on gasoline. Spending on services accelerated in the first quarter, led by higher spending on health care, financial services and insurance. Trade weighed on GDP growth with more modest exports and an increase in imports. Compared to most advanced economies, the U.S. economy continues to perform relatively well. The positive tailwinds to overall growth from government spending are waning. The contribution to GDP growth from government consumption expenditures and gross investment remains positive but was less than a third of what it was in Q4 2023. The latest report paints a picture of an economy that continues to perform well, but that is moderating as it settles into a growth pattern more consistent with long-run trends. Consistent with economic growth trends, the labor market moderated in April 2024 with nonfarm payroll employment increasing by 175,000, down from an increase of 315,000 in March, according to the Bureau of Labor Statistics (BLS). The unemployment rate inched up from 3.8% in March to 3.9% in April. However, the unemployment rate has remained below 4% for the twenty-seventh consecutive month. Average hourly earnings for all employees on private nonfarm payrolls rose 0.2% month-over-month, and compared to a year ago, average hourly earnings increased 3.9%. Overall, the jobs report indicates a resilient but cooling labor market. The core Personal Consumption Expenditures (PCE) price index, the Federal Reserve’s preferred inflation gauge that strips out volatile food and energy prices, rose 0.3% month-over-month in March.1 While this increase in the core PCE was in line with expectations, the progress on inflation has slowed and has implications for future Federal Reserve monetary policy. The index increased 2.8% from a year ago and remains above the Federal Reserve target of 2.0%. The Consumer Price Index (CPI) increased by 0.4% in April, exceeding consensus expectations and triggering a negative market reaction. In another sign of persistent inflationary pressures, the employment cost index came in above expectations with a 1.2% quarter-over-quarter increase in Q1 2024 and a 4.2% increase in compensation costs over the year. The persistence of inflation has led market participants to conclude that the likelihood of multiple Federal Reserve rate cuts in 2024 is diminished and the next rate cut is also likely further away. In summary, U.S. economic growth moderated at the beginning of 2024, reflecting the impact of higher interest rates and declining consumer savings. The labor market also showed signs of cooling with softer-than expected job growth in April. U.S. housing and mortgage market: After benefitting from stable mortgage rates in the first couple of months of the year, the housing market witnessed a slowdown in March due to the rebound in rates. Total (existing + new) home sales for March fell by 2.7% from February and were down 2.1% from a year ago. This decline was led by existing home sales, which continued to reel under the impact of rising rates. Existing home sales were at an annual rate of 4.19 million in March, 4.3% below February sales and 3.7% lower than March 2023.2 However, new home sales for March grew 8.8% from February to an annualized rate of 693,000, accounting for about 14% of total home sales.3 As the supply of existing homes for sale remains low and home prices continue to rise, more buyers are choosing to purchase new homes than in previous years. According to the National Association of Homebuilders’ Housing Market Index, homebuilder confidence remained steady in March with the index coming in at 51. This is above the threshold of 50, indicating positive building conditions.4 However, the housing construction sector experienced some moderation. According to the U.S. Census Bureau, new residential construction fell in March with total starts decreasing 14.7%, the largest monthly decline since May 2022. The decline was led by multifamily starts which fell around 21% month-overmonth and single-family housing starts fell 12% month-over-month in March. The FHFA Purchase-Only Home Price Index for February increased by 1.2% month-over-month compared to a decrease of 0.1% in January. Year-over-year house price growth remained strong at 7.0% for February. The depleted inventory of homes available for sale, along with still high demand, continued to put upward pressure on house prices. Mortgage rates ticked up in April averaging 6.99% for the month, as measured by Freddie Mac’s Primary Mortgage Market Survey®, and ended the month at 7.17%. According to the Mortgage Bankers Association (MBA) Weekly Application Survey, mortgage activity declined over the month as rates exceeded 7% for the first time this year. Overall mortgage activity was down 1.8% month-over-month and 10.4% year-over-year at the end of April. Refinance activity for April was down 3.3% compared to March, and purchase applications were down 2.7% month-over-month.Tight inventory coupled with higher rates resulted in a stagnant start to the year in terms of homeownership. The homeownership rate in Q1 2024 ticked down to 65.6% from 65.7% in Q4 2023 and 66% in Q1 2023.5 The historical average homeownership rate over the period from Q1 1964 to Q1 2024 is 65.2%. Total housing stock was at 146.4 million units as of Q1 2024, an increase of around 1.6 million units compared to the same time last year. This reflected an increase of approximately 1.4 million in total occupied housing units and 0.2 million vacant units. A large share of the increase in occupied units came from renters compared to homeowners. Renter-occupied units increased approximately 1 million over the last year while owner-occupied units were up around 0.6 million. The homeowner vacancy rate in Q1 2024 was down to 0.8% from 0.9% in Q4 2023. The rental vacancy rate was unchanged over the quarter at 6.6%. Vacancy rates remain on balance very low. To bring the vacancy rate, both rental and homeowner, back in line with historical averages, the U.S. would need to add an additional 1.5 million vacant for-sale and for-rent homes (Exhibit 1).6 Without such units, the pressure on housing markets will persist. Additionally, the vacant housing undersupply metric is almost certainly a dramatic underestimate of the total housing shortage for the U.S. This is because this metric does not account for latent housing demand and vacant housing that is not for sale or for rent. Overall, tight inventory and “higher for longer” rates are still key barriers to home sale volumes. Mortgage rates above 7% continue to price out many prospective homebuyers and sellers have less incentive to sell. Outlook While the U.S. economy has shown resilience so far, we expect higher interest rates to weigh on future growth, with the economy settling into a lower rate of growth in 2024 and 2025. However, we do not expect a recession in our baseline scenario. In our baseline, slower growth and a weaker labor market help to rein in inflation while the economy throttles back but avoids stalling. Our baseline scenario has one Federal Reserve rate cut towards the end of the year. As a result, we expect mortgage rates to remain elevated through most of 2024. These high interest rates will prompt prospective buyers to readjust their housing expectations, but we anticipate housing demand to remain high due to favorable demographics, particularly in the starter home segment. Despite the strong housing demand, our housing market outlook is tempered by lack of inventory for sale. Under our baseline scenario, we anticipate improvement in home sales compared to 2023, albeit by a slim margin, as the rate lock-in effect will delay existing homes from entering the market. Our outlook on the mortgage origination market is also clouded by the expectation of low sale volumes. With our projection of mortgage interest rates remaining higher for longer, we anticipate modest growth in mortgage origination volumes, supported by high home prices. However, the combination of higher interest rates and limited inventory could limit purchase originations. Additionally, we expect refinance origination volumes to decline as homeowners have already secured low rates, posing potential challenge in the refinance market. While our outlook is positive, there are emerging risks, particularly from inflation. Over the last year, almost half of the overall gains in inflation came from housing inflation, and in an environment where home prices are growing, inflationary pressures might persist for longer. Under a high inflation scenario, interest rates will remain high, negatively impacting consumer spending behavior and credit performance, which can further slowdown economic growth.	Only respond using information from the context. What factors are negatively affecting the housing market? U.S. Economic, Housing and Mortgage Market Outlook Recent developments U.S. economy: U.S. economic growth moderated to start the year. According to the U.S. Bureau of Economic Analysis (BEA) “advance” estimate of Real Gross Domestic Product (GDP), the seasonally adjusted annual rate (SAAR) of growth in GDP in Q1 2024 was 1.6%, slowing from a 3.4% rate in Q4 2023. The deceleration in GDP growth was led by slower growth in consumption expenditures, net exports, and government consumption expenditures. Consumer spending was weaker due to a decline in spending on durable goods, primarily autos, and flatlining nondurable goods, primarily due to less spending on gasoline. Spending on services accelerated in the first quarter, led by higher spending on health care, financial services and insurance. Trade weighed on GDP growth with more modest exports and an increase in imports. Compared to most advanced economies, the U.S. economy continues to perform relatively well. The positive tailwinds to overall growth from government spending are waning. The contribution to GDP growth from government consumption expenditures and gross investment remains positive but was less than a third of what it was in Q4 2023. The latest report paints a picture of an economy that continues to perform well, but that is moderating as it settles into a growth pattern more consistent with long-run trends. Consistent with economic growth trends, the labor market moderated in April 2024 with nonfarm payroll employment increasing by 175,000, down from an increase of 315,000 in March, according to the Bureau of Labor Statistics (BLS). The unemployment rate inched up from 3.8% in March to 3.9% in April. However, the unemployment rate has remained below 4% for the twenty-seventh consecutive month. Average hourly earnings for all employees on private nonfarm payrolls rose 0.2% month-over-month, and compared to a year ago, average hourly earnings increased 3.9%. Overall, the jobs report indicates a resilient but cooling labor market. The core Personal Consumption Expenditures (PCE) price index, the Federal Reserve’s preferred inflation gauge that strips out volatile food and energy prices, rose 0.3% month-over-month in March.1 While this increase in the core PCE was in line with expectations, the progress on inflation has slowed and has implications for future Federal Reserve monetary policy. The index increased 2.8% from a year ago and remains above the Federal Reserve target of 2.0%. The Consumer Price Index (CPI) increased by 0.4% in April, exceeding consensus expectations and triggering a negative market reaction. In another sign of persistent inflationary pressures, the employment cost index came in above expectations with a 1.2% quarter-over-quarter increase in Q1 2024 and a 4.2% increase in compensation costs over the year. The persistence of inflation has led market participants to conclude that the likelihood of multiple Federal Reserve rate cuts in 2024 is diminished and the next rate cut is also likely further away. In summary, U.S. economic growth moderated at the beginning of 2024, reflecting the impact of higher interest rates and declining consumer savings. The labor market also showed signs of cooling with softer-than expected job growth in April. U.S. housing and mortgage market: After benefitting from stable mortgage rates in the first couple of months of the year, the housing market witnessed a slowdown in March due to the rebound in rates. Total (existing + new) home sales for March fell by 2.7% from February and were down 2.1% from a year ago. This decline was led by existing home sales, which continued to reel under the impact of rising rates. Existing home sales were at an annual rate of 4.19 million in March, 4.3% below February sales and 3.7% lower than March 2023.2 However, new home sales for March grew 8.8% from February to an annualized rate of 693,000, accounting for about 14% of total home sales.3 As the supply of existing homes for sale remains low and home prices continue to rise, more buyers are choosing to purchase new homes than in previous years. According to the National Association of Homebuilders’ Housing Market Index, homebuilder confidence remained steady in March with the index coming in at 51. This is above the threshold of 50, indicating positive building conditions.4 However, the housing construction sector experienced some moderation. According to the U.S. Census Bureau, new residential construction fell in March with total starts decreasing 14.7%, the largest monthly decline since May 2022. The decline was led by multifamily starts which fell around 21% month-overmonth and single-family housing starts fell 12% month-over-month in March. The FHFA Purchase-Only Home Price Index for February increased by 1.2% month-over-month compared to a decrease of 0.1% in January. Year-over-year house price growth remained strong at 7.0% for February. The depleted inventory of homes available for sale, along with still high demand, continued to put upward pressure on house prices. Mortgage rates ticked up in April averaging 6.99% for the month, as measured by Freddie Mac’s Primary Mortgage Market Survey®, and ended the month at 7.17%. According to the Mortgage Bankers Association (MBA) Weekly Application Survey, mortgage activity declined over the month as rates exceeded 7% for the first time this year. Overall mortgage activity was down 1.8% month-over-month and 10.4% year-over-year at the end of April. Refinance activity for April was down 3.3% compared to March, and purchase applications were down 2.7% month-over-month.Tight inventory coupled with higher rates resulted in a stagnant start to the year in terms of homeownership. The homeownership rate in Q1 2024 ticked down to 65.6% from 65.7% in Q4 2023 and 66% in Q1 2023.5 The historical average homeownership rate over the period from Q1 1964 to Q1 2024 is 65.2%. Total housing stock was at 146.4 million units as of Q1 2024, an increase of around 1.6 million units compared to the same time last year. This reflected an increase of approximately 1.4 million in total occupied housing units and 0.2 million vacant units. A large share of the increase in occupied units came from renters compared to homeowners. Renter-occupied units increased approximately 1 million over the last year while owner-occupied units were up around 0.6 million. The homeowner vacancy rate in Q1 2024 was down to 0.8% from 0.9% in Q4 2023. The rental vacancy rate was unchanged over the quarter at 6.6%. Vacancy rates remain on balance very low. To bring the vacancy rate, both rental and homeowner, back in line with historical averages, the U.S. would need to add an additional 1.5 million vacant for-sale and for-rent homes (Exhibit 1).6 Without such units, the pressure on housing markets will persist. Additionally, the vacant housing undersupply metric is almost certainly a dramatic underestimate of the total housing shortage for the U.S. This is because this metric does not account for latent housing demand and vacant housing that is not for sale or for rent. Overall, tight inventory and “higher for longer” rates are still key barriers to home sale volumes. Mortgage rates above 7% continue to price out many prospective homebuyers and sellers have less incentive to sell. Outlook While the U.S. economy has shown resilience so far, we expect higher interest rates to weigh on future growth, with the economy settling into a lower rate of growth in 2024 and 2025. However, we do not expect a recession in our baseline scenario. In our baseline, slower growth and a weaker labor market help to rein in inflation while the economy throttles back but avoids stalling. Our baseline scenario has one Federal Reserve rate cut towards the end of the year. As a result, we expect mortgage rates to remain elevated through most of 2024. These high interest rates will prompt prospective buyers to readjust their housing expectations, but we anticipate housing demand to remain high due to favorable demographics, particularly in the starter home segment. Despite the strong housing demand, our housing market outlook is tempered by lack of inventory for sale. Under our baseline scenario, we anticipate improvement in home sales compared to 2023, albeit by a slim margin, as the rate lock-in effect will delay existing homes from entering the market. Our outlook on the mortgage origination market is also clouded by the expectation of low sale volumes. With our projection of mortgage interest rates remaining higher for longer, we anticipate modest growth in mortgage origination volumes, supported by high home prices. However, the combination of higher interest rates and limited inventory could limit purchase originations. Additionally, we expect refinance origination volumes to decline as homeowners have already secured low rates, posing potential challenge in the refinance market. While our outlook is positive, there are emerging risks, particularly from inflation. Over the last year, almost half of the overall gains in inflation came from housing inflation, and in an environment where home prices are growing, inflationary pressures might persist for longer. Under a high inflation scenario, interest rates will remain high, negatively impacting consumer spending behavior and credit performance, which can further slowdown economic growth.	Only respond using information from the context. EVIDENCE: U.S. Economic, Housing and Mortgage Market Outlook Recent developments U.S. economy: U.S. economic growth moderated to start the year. According to the U.S. Bureau of Economic Analysis (BEA) “advance” estimate of Real Gross Domestic Product (GDP), the seasonally adjusted annual rate (SAAR) of growth in GDP in Q1 2024 was 1.6%, slowing from a 3.4% rate in Q4 2023. The deceleration in GDP growth was led by slower growth in consumption expenditures, net exports, and government consumption expenditures. Consumer spending was weaker due to a decline in spending on durable goods, primarily autos, and flatlining nondurable goods, primarily due to less spending on gasoline. Spending on services accelerated in the first quarter, led by higher spending on health care, financial services and insurance. Trade weighed on GDP growth with more modest exports and an increase in imports. Compared to most advanced economies, the U.S. economy continues to perform relatively well. The positive tailwinds to overall growth from government spending are waning. The contribution to GDP growth from government consumption expenditures and gross investment remains positive but was less than a third of what it was in Q4 2023. The latest report paints a picture of an economy that continues to perform well, but that is moderating as it settles into a growth pattern more consistent with long-run trends. Consistent with economic growth trends, the labor market moderated in April 2024 with nonfarm payroll employment increasing by 175,000, down from an increase of 315,000 in March, according to the Bureau of Labor Statistics (BLS). The unemployment rate inched up from 3.8% in March to 3.9% in April. However, the unemployment rate has remained below 4% for the twenty-seventh consecutive month. Average hourly earnings for all employees on private nonfarm payrolls rose 0.2% month-over-month, and compared to a year ago, average hourly earnings increased 3.9%. Overall, the jobs report indicates a resilient but cooling labor market. The core Personal Consumption Expenditures (PCE) price index, the Federal Reserve’s preferred inflation gauge that strips out volatile food and energy prices, rose 0.3% month-over-month in March.1 While this increase in the core PCE was in line with expectations, the progress on inflation has slowed and has implications for future Federal Reserve monetary policy. The index increased 2.8% from a year ago and remains above the Federal Reserve target of 2.0%. The Consumer Price Index (CPI) increased by 0.4% in April, exceeding consensus expectations and triggering a negative market reaction. In another sign of persistent inflationary pressures, the employment cost index came in above expectations with a 1.2% quarter-over-quarter increase in Q1 2024 and a 4.2% increase in compensation costs over the year. The persistence of inflation has led market participants to conclude that the likelihood of multiple Federal Reserve rate cuts in 2024 is diminished and the next rate cut is also likely further away. In summary, U.S. economic growth moderated at the beginning of 2024, reflecting the impact of higher interest rates and declining consumer savings. The labor market also showed signs of cooling with softer-than expected job growth in April. U.S. housing and mortgage market: After benefitting from stable mortgage rates in the first couple of months of the year, the housing market witnessed a slowdown in March due to the rebound in rates. Total (existing + new) home sales for March fell by 2.7% from February and were down 2.1% from a year ago. This decline was led by existing home sales, which continued to reel under the impact of rising rates. Existing home sales were at an annual rate of 4.19 million in March, 4.3% below February sales and 3.7% lower than March 2023.2 However, new home sales for March grew 8.8% from February to an annualized rate of 693,000, accounting for about 14% of total home sales.3 As the supply of existing homes for sale remains low and home prices continue to rise, more buyers are choosing to purchase new homes than in previous years. According to the National Association of Homebuilders’ Housing Market Index, homebuilder confidence remained steady in March with the index coming in at 51. This is above the threshold of 50, indicating positive building conditions.4 However, the housing construction sector experienced some moderation. According to the U.S. Census Bureau, new residential construction fell in March with total starts decreasing 14.7%, the largest monthly decline since May 2022. The decline was led by multifamily starts which fell around 21% month-overmonth and single-family housing starts fell 12% month-over-month in March. The FHFA Purchase-Only Home Price Index for February increased by 1.2% month-over-month compared to a decrease of 0.1% in January. Year-over-year house price growth remained strong at 7.0% for February. The depleted inventory of homes available for sale, along with still high demand, continued to put upward pressure on house prices. Mortgage rates ticked up in April averaging 6.99% for the month, as measured by Freddie Mac’s Primary Mortgage Market Survey®, and ended the month at 7.17%. According to the Mortgage Bankers Association (MBA) Weekly Application Survey, mortgage activity declined over the month as rates exceeded 7% for the first time this year. Overall mortgage activity was down 1.8% month-over-month and 10.4% year-over-year at the end of April. Refinance activity for April was down 3.3% compared to March, and purchase applications were down 2.7% month-over-month.Tight inventory coupled with higher rates resulted in a stagnant start to the year in terms of homeownership. The homeownership rate in Q1 2024 ticked down to 65.6% from 65.7% in Q4 2023 and 66% in Q1 2023.5 The historical average homeownership rate over the period from Q1 1964 to Q1 2024 is 65.2%. Total housing stock was at 146.4 million units as of Q1 2024, an increase of around 1.6 million units compared to the same time last year. This reflected an increase of approximately 1.4 million in total occupied housing units and 0.2 million vacant units. A large share of the increase in occupied units came from renters compared to homeowners. Renter-occupied units increased approximately 1 million over the last year while owner-occupied units were up around 0.6 million. The homeowner vacancy rate in Q1 2024 was down to 0.8% from 0.9% in Q4 2023. The rental vacancy rate was unchanged over the quarter at 6.6%. Vacancy rates remain on balance very low. To bring the vacancy rate, both rental and homeowner, back in line with historical averages, the U.S. would need to add an additional 1.5 million vacant for-sale and for-rent homes (Exhibit 1).6 Without such units, the pressure on housing markets will persist. Additionally, the vacant housing undersupply metric is almost certainly a dramatic underestimate of the total housing shortage for the U.S. This is because this metric does not account for latent housing demand and vacant housing that is not for sale or for rent. Overall, tight inventory and “higher for longer” rates are still key barriers to home sale volumes. Mortgage rates above 7% continue to price out many prospective homebuyers and sellers have less incentive to sell. Outlook While the U.S. economy has shown resilience so far, we expect higher interest rates to weigh on future growth, with the economy settling into a lower rate of growth in 2024 and 2025. However, we do not expect a recession in our baseline scenario. In our baseline, slower growth and a weaker labor market help to rein in inflation while the economy throttles back but avoids stalling. Our baseline scenario has one Federal Reserve rate cut towards the end of the year. As a result, we expect mortgage rates to remain elevated through most of 2024. These high interest rates will prompt prospective buyers to readjust their housing expectations, but we anticipate housing demand to remain high due to favorable demographics, particularly in the starter home segment. Despite the strong housing demand, our housing market outlook is tempered by lack of inventory for sale. Under our baseline scenario, we anticipate improvement in home sales compared to 2023, albeit by a slim margin, as the rate lock-in effect will delay existing homes from entering the market. Our outlook on the mortgage origination market is also clouded by the expectation of low sale volumes. With our projection of mortgage interest rates remaining higher for longer, we anticipate modest growth in mortgage origination volumes, supported by high home prices. However, the combination of higher interest rates and limited inventory could limit purchase originations. Additionally, we expect refinance origination volumes to decline as homeowners have already secured low rates, posing potential challenge in the refinance market. While our outlook is positive, there are emerging risks, particularly from inflation. Over the last year, almost half of the overall gains in inflation came from housing inflation, and in an environment where home prices are growing, inflationary pressures might persist for longer. Under a high inflation scenario, interest rates will remain high, negatively impacting consumer spending behavior and credit performance, which can further slowdown economic growth. USER: What factors are negatively affecting the housing market? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	7	8	1,480	null	428
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 are the essential steps and key points from the customer discovery process outlined in "Talking to Humans"?	TALKING TO HUMANS Success starts with understanding your customers GIFF CONSTABLE with Frank Rimalovski illustrations by Tom Fishburne and foreword by Steve Blank Copyright ©2014 Gif Constable First edition, v1.71 All rights reserved. Book design: Gif Constable Illustrations by Tom Fishburne Cover design assistance: Jono Mallanyk Lean Startup is trademarked by Eric Ries Customer Discovery is a phrase coined by Steve Blank ISBN: 978-0-9908009-0-3 Special thanks to the NYU Entrepreneurial Institute for their collaboration and support in the creation of Talking to Humans Acclaim for Talking to Humans “If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have.” Steve Blank, entrepreneur, educator and author of Four Steps to the Epiphany and The Startup Owner’s Manual “If entrepreneurship 101 is talking to customers, this is the syllabus. Talking to Humans is a thoughtful guide to the customer informed product development that lies at the foundation of successful start-ups.” Phin Barnes, Partner, First Round Capital “Getting started on your Customer Discovery journey is the most important step to becoming a successful entrepreneur and reading Talking To Humans is the smartest frst step to fnding and solving real problems for paying customers.” Andre Marquis, Executive Director, Lester Center for Entrepreneurship University of California Berkeley “A lot of entrepreneurs pay lip service to talking to customers but you have to know how. Talking to Humans ofers concrete examples on how to how to recruit candidates, how to conduct interviews, and how to prioritize learning from customers more through listening versus talking.” Ash Maurya, Founder Spark59 and Author of Running Lean “Tis is a great how-to guide for entrepreneurs that provides practical guidance and examples on one of the most important and ofen under practiced requirements of building a great startup—getting out of the ofce, talking directly with customers and partners, and beginning the critical process of building a community.” David Aronoff, General Partner, Flybridge Capital “Gif has been one of the thought leaders in the lean startup movement from the very beginning. Entrepreneurs in all industries will fnd Talking to Humans practical, insightful, and incredibly useful.” Patrick Vlaskovits, New York Times bestselling author of The Lean Entpreneur “Current and future customers are the best source of feedback and insight for your new product ideas. Talking to them is intimidating and seemingly time-consuming. In this focused, practical, down-to-earth book Gif Constable demystifes the art (not science) of customer discovery helping entrepreneurs and product veterans alike learn how to build a continuous conversation with their market and ensure the best chances of success for their ideas. Want to know what your audience is thinking? Read this book!” Jeff Gothelf, author of LeanUX “When getting ‘out of the building,’ too many people crash and burn right out of the gate and wonder what happened. Talking to Humans is a quick and efective guide for how Lean Startup interviews should be done: who to talk to, how to talk your way in the door, and how to gain the most insight and learning. Don’t crash and burn – read Talking to Humans!” Dean Chang, Associate Vice President for Innovation & Entrepreneurship University of Maryland “A must read for anyone who is considering creating a startup, developing a new product or starting a new division. Read this book frst – a great guide to the evolving art of customer discovery. Don’t waste your time building products that your customer may or may not want. Before you write the frst line of code, pitch your idea to investors or build the frst prototype, do your self a favor, read this book and follow the advice! I guarantee you will make better decisions, build a better product and have a more successful company.” John Burke, Partner, True Ventures “Primary market research has been around for a long time because it has stood the test of time and proved that it is fundamental to building a successful venture; it underlies all that we do at MIT in entrepreneurship. Te question is how we more broadly deployed appropriate skills to entrepreneurs so they can be guided to do this in an efcient and efective manner while maintaining rigor. With all the sloganeering out there on the topic, this book stands out in that it delivers real value to the practitioner in this regard.” Bill Aulet, Managing Director, Martin Trust Center for MIT Entrepreneurship “Talking to strangers can be scary, but it’s vital to launching any new product. Trough storytelling, Gif Constable makes customer development concepts accessible. Tis book will show you how to articulate assumptions, get useful information and turn it into meaningful insights. Ten it delivers practical advice you can use immediately to test your ideas. Fear holds people back. Tis book will give you the confdence to jump.” Andres Glusman, Chief Strategy Offcer, Meetup.com Table of Contents 8 Foreword 11 Introduction 14 The Story 28 Lessons Learned 30 How To 31 Getting Started with Customer Discovery 32 Who Do You Want to Learn From? 36 What Do You Want to Learn? 44 How Do You Find Your Interview Subjects? 52 How to Ensure an Effective Session? 58 How Do You Make Sense of What You Learn? 65 Conclusion 66 Appendix 67 Cold Approach Examples 69 Business Assumptions Exercise 72 Teaching Exercise #1: Mock Interviews 74 Teaching Exercise #2: Mock Approach 76 Screwing Up Customer Discovery 80 Glossary 82 Other Learning Resources 83 Behind the Book 8 Talking to Humans Foreword “Get out of the building!” Tat’s been the key lesson in building startups since I frst started teaching customer development and the Lean Launchpad curriculum in 2002. Since then, a lot has happened. Te concepts I frst outlined in my book Te Four Steps to the Epiphany have grown into an international movement: Te Lean Startup. Te class I developed - Te Lean Launchpad - is now taught at Stanford, UC Berkeley, Columbia University, UCSF, and most recently New York University (NYU). More than 200 college and university faculty have taken my Lean Launchpad Educators Seminar, and have gone on to teach the curriculum at hundreds of universities around the globe. Te National Science Foundation, and now the National Institute of Health, use it to commercialize scientifc research as part of their Innovation Corps (I-Corps) program. My How to Build a Startup class on Udacity has been viewed by over 225,000 students worldwide. During the past few years, we’ve seen dozens of large companies including General Electric, Qualcomm and Intuit begin to adopt the lean startup methodology. Te Lean Startup turns the decades-old formula of writing a business plan, pitching it to investors, assembling a team, and launching and selling a product on its head. While terms like “pivot” and “minimum viable product” have become widely used, they are not understood by many. Te same can be said of “getting out of the building”. Many entrepreneurs “get out” and get in front of customers, but take a simplistic view and ask their customers what they want, or if they would buy their startup’s (half-baked) product. Te “getting out” part is easy. It is the application of the customer Foreword & Introduction 9 development methodology and the testing of their hypotheses with users, customers and partners that is both critical and ofen difcult for entrepreneurs to grasp in the search for a scalable and repeatable business model. Since the Four Steps, many other books have been written on customer development including Te Startup Owner’s Manual, Business Model Generation, Te Lean Startup, and others. Each of these texts has advanced our understanding of the customer development methodology in one way or another, teaching aspiring students and entrepreneurs the what, when and why we should get out of the building, but have only skimmed the surface on “how” to get out of the building. For both my own classes as well as I-Corps, I always made Gif Constable’s blog post “12 Tips for Early Customer Development Interviews” required reading. It answered the “how” question as well. Now Gif has turned those 12 tips into an entire book of great advice. In a comprehensive, yet concise and accessible manner, Talking to Humans teaches you how to get out of the building. It guides students and entrepreneurs through the critical elements: how to fnd interview candidates, structure and conduct efective interviews and synthesize your learning. Gif provides ample anecdotes as well as useful strategies, tactics and best practices to help you hit the ground running in your customer discovery interviews. If you are a student, aspiring entrepreneur or product manager trying to bring the value of getting out of the building to an existing company, Talking to Humans is a must read. It is chock full of lessons learned and actionable advice that will enable you to make the most of your time out of the building. Talking to Humans is the perfect complement to the existing 10 Talking to Humans body of work on customer development. If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have. Steve Blank September 3, 2014 Foreword & Introduction 11 Introduction 12 Talking to Humans Te art of being a great entrepreneur is fnding the right balance between vision and reality. You are probably opening this book because you want to put something new in the world. Tat’s an incredibly powerful and meaningful endeavor. It’s also scary and extremely risky. How can you get ahead of that risk and beat the odds? Every new business idea is built upon a stack of assumptions. We agree with Steve Blank’s insight that it is better to challenge your risky assumptions right at the start. You can’t challenge anything sitting in a conference room. You have to get into the market, or, as Blank likes to say, “Get out of the building!” Tere are two efective ways to do this: 1. talk directly to your customers and partners, and observe their behavior; 2. run experiments in which you put people through an experience and track what happens. Tis book focuses on the frst. Te qualitative part of customer discovery is surprisingly hard for most people, partly because talking to strangers can feel intimidating, and partially because our instincts on how to do it are ofen wrong. Here’s what customer discovery is not: It is not asking people to design your product for you. It is not about abdicating your vision. It is also not about pitching. A natural tendency is to try to sell other people on your idea, but your job in customer discovery is to learn. You are a detective. You are looking for clues that help confrm or deny your assumptions. Whether you are a tiny startup or an intrapreneurial team within a big company, your goal is not to compile statistically signifcant answers. Instead you want to look for patterns that will help you make better decisions. Tose decisions should lead to action, and smart action is what you need for success. Foreword & Introduction 13 Tis book was written as a focused primer on qualitative research to help you get started. You should view it as a complement to the other excellent resources out there on customer development and lean innovation. It is not a rulebook, but hopefully you will fnd the principles included here useful. Te book comes in two parts. It begins with a fctional story of two entrepreneurs doing customer research for the frst time. Te second part is a mix of theory and tactics to guide you through the core steps of customer discovery. While the fctional story highlights a consumer-facing business, I should note that there are plenty of tips in this book for teams who sell to the enterprise. Some last words to kick things of: entrepreneurs have a tendency to over-obsess about their product to the neglect of other business risks. Tey also tend to stay inside their heads for far too long. I urge you to be brave, get out of the building, and go talk to real human beings. Gif Constable August 2014 Some Thanks Are Due Many thanks to Frank Rimalovski for encouraging me to write this, and his students and team at NYU for providing early feedback, Steve Blank for the foreword and his inspiration and leadership on the topic of entrepreneurship, Tom Fishburne for his great illustrations, Josh Seiden and Jef Gothelf for their insights, my colleagues at Neo for continuing to push forward the craf of customer development, the many speakers and members of New York’s Lean Lessons Learned meetup who have shared their stories with me, and Eric Ries for inspiring me and so many others. The Story PART ONE The Story 15 Breakthrough Koshi and Roberta had so much adrenaline pumping through their systems that neither could sleep that night. Afer a year of challenging lab work, they had fnally cracked it. Tey were now sure they could manufacture artifcial down feathers cost-efectively. Teir insomnia was ironic, since their very dream was to transform the quality of people’s sleep through the invention of a better pillow. Tey knew they had a technical advantage. Teir artifcial down had heightened levels of insulation, a better resilience/resistance quotient, and was kinder to both animals and the environment. Now the question was, did they have a business? The Advisor Tey called a meeting with their entrepreneurial advisor the next day. Samantha had built four companies, successfully exiting two of them. She was now an angel investor and believed frmly in giving back by working with frst-time entrepreneurs. “We fnally cracked it!” Roberta blurted out. “What she means,” Koshi said, “is that we’re convinced we can manufacture NewDown in a cost-efective and repeatable manner. Now we think we can make a real business.” “So you want to know if the time has come to jump in feet frst?” asked Samantha. Te two scientists nodded. “If you want to be successful bringing something to market, you need to understand the market. Do you feel like you know when and why people buy pillows today?” “Not really,” Roberta said. “We’ve spent our time in the lab focused on the product side.” “I suspected so. Founders commonly obsess about product at the 16 Talking to Humans expense of the understanding the customer or the business model. You need to work on it all, and you have to challenge your thinking. Behind your startup is a belief system about how your business will work. Some of your assumptions will be right, but the ones that are wrong could crater your business. I want you to get ahead of the risky hypotheses that might cause failure.” Samantha had the founders list out the riskiest hypotheses. 1. We believe that people care about sleep quality when making a pillow purchase decision. 2. We believe that we can sell online directly to customers. 3. We believe that our customers will be young urban professionals. 4. We believe that our very frst customers will be new graduates who need to outft their apartments. 5. We believe that we can sell our pillows at a high enough price to cover our costs. 6. We believe that we can raise enough capital to cover investments in manufacturing. “Let’s put aside the fundraising risk right now,” Samantha said. “It’s what everyone jumps to, but you need to strengthen your story frst. Many of your risks are tied to your customer. I like attacking a problem from multiple directions and recommend three approaches. First, I want you to walk a day in your customer’s shoes and actually go out and buy a pillow. Second, I want you to observe people in the process of buying a pillow. And third, I want you to talk directly to them.” “Talk to people?” said Koshi. “I’m a scientist, not a salesperson. If I simply asked someone if my pillow was better, they would have no idea. If I asked them if they would buy my pillow, I couldn’t trust The Story 17 the answer. So what is the point?” “Your job right now isn’t to sell, but rather to learn. You are right, though: getting the customer to speculate is rarely useful,” Samantha said. “You need to understand your market. How does your customer buy? When do they buy? Why do they buy? Where do they buy? As a scientist, you are fully capable of doing research, gathering data, and seeing if your data supports your hypotheses. I promise you, if you are polite and creative, people will be more receptive to you than you might think.” “Buying. Observing. Talking. Do we really need to do all three? Can we really aford to spend the time?” “Can you aford not to? Each of the three approaches is imperfect, but together you should see patterns. By walking in your customer’s shoes you will gain empathy and personal understanding, but you don’t want to rely solely on your own experience. By watching people shop, you can witness honest behavior, but you won’t be able to get into their heads to know their motivations. By talking to people, you gather intel on both behavior and motivation, but you have to be careful not to take what you hear too literally. Each method has strengths and weaknesses, but taken together you will learn a ton. You will have a lot more confdence that you are either on the right track, or that you have to make changes to your plans. It is far better to discover bad assumptions now, before you have invested a lot! Now, how do you think you should proceed?” “We want our customers to buy online from us, so I guess we should also buy our own pillow online,” said Roberta. “And we can observe people shopping by going to a home goods store.” “Tat sounds good,” said Samantha. “You will want to talk to some of those people in the store as well. I see one catch: you will be 18 Talking to Humans targeting the moment of purchase but not the type of customer you are hoping for. One of your risk assumptions was specifcally about young urban professionals and new graduates, so what can you also do to target and connect with them?” “What about going to a cofee shop near the downtown ofce buildings as people are going to work?” Koshi said. “Can’t we just hit up some of the people we used to know in college who are now in the working world?” Roberta said. “Why don’t you try both, and see which approach works better,” said Samantha. “Roberta, I would also ask your friends if they will refer you to their friends. It’s best to talk to people who aren’t too close to you. You don’t want a someone’s afection for you to steer what they have to say. “Let’s start by thinking through the questions you want to ask. It always makes sense to prioritize what you want to learn. You should write down an interview plan, even if you don’t completely stick to it. Break the ice, and then get them to tell you a story about buying a pillow!” Te scientists sketched out a plan: Intro: hello, I’m a PhD candidate at Hillside University and I’m researching sleep quality. I’m asking people about the last time they bought a pillow. Would you mind if I asked a few questions? When was the last time you bought a pillow? Why did you go looking for a pillow? How did you start shopping for a pillow? Why did you choose the one you bought? After you bought, how did you feel about the pillow you purchased? The Story 19 Are you going to be in the market for a pillow anytime soon? “Tat’s a great start,” Samantha said. “Keep good notes as you go, and remember to regularly regroup to review your fndings and look for patterns. Be mindful of which method you used as you discuss your observations.” Walking in the Customer’s Shoes Koshi and Roberta got together the next day afer both purchasing a pillow online. “I found it all a bit frustrating,” said Roberta. “It was hard to learn why you would choose down feathers, cotton, or foam. Te manufacturer websites felt like they were from the 1990s. Tere were some reviews available on Amazon and Bed Bath & Beyond, which helped. In my interpretation, about 65% of reviews talked about sleep quality, which seems like a good sign for our frst risk. A lot of the reviews had to do with personal preference for frm versus sof pillows. I think we can ofer both kinds eventually, but we likely need to choose one at the beginning and that could impact some of our assumptions around market size. ” “I started out by searching Google,” said Koshi. “Amazon and BB&B dominated the results, as we expected, but there were a few specialty providers like BestPillow that ranked high. BestPillow lets you navigate their website by sleep issue, such as snoring or neck pain, which I found interesting. While I see some makers pushing hypoallergenic oferings, I didn’t see anyone who could meet our claims of being environmentally friendly. I agree that all the manufacturer websites felt ancient. I think there’s an opportunity to be smart about search engine optimization and really stand out if we can get the messaging right. I guess our next step is to visit the retail 20 Talking to Humans stores.” Observing the Customer Roberta ended up going to a Bed Bath & Beyond while Koshi went to a local department store. She watched three diferent people come in and pick through several diferent pillows, puzzling over the packaging material. One of them asked a store employee for help, and two pulled out their mobile phones to look online. She then watched a woman go right to a particular shelf, grab a pillow and head back to the aisle. Roberta’s plan was to balance observation and interaction, so she decided to jump in. “Pardon me,” she said “I am trying to fgure out which pillow to purchase and noticed that you went right to that one. Might I ask why you chose that pillow?” “Oh, I replaced some ratty old pillows in my house a few weeks ago,” the woman said, “and I liked this one so much that I thought I would replace my whole set.” “Do you mind if I ask how you decided to buy that pillow in the frst place? My name is Roberta, by the way.” “Nice to meet you, Roberta. I’m Susan. Well, I guess I started by researching online and...” A day later, the founders met to compare notes. “Te BB&B had good foot trafc,” Roberta said, “and I was able to watch ffeen people, and speak to ten. Of the ten, one knew what she wanted going into the store, three were basing their purchase just on packaging and store price, and six did Google searches on their phones, right there in the store. Tey were looking up reviews and pricing. You mentioned search engine optimization earlier — I think it could be even stronger with a fabulous mobile experience.” She looked down at her notes. “I also found that seven out of ten were trying to choose a pillow specifcally for better sleep, although their sleep problems were diverse. Finally, when I asked The Story 21 them why they were buying a pillow, the folks over 40 seemed to be in replacement mode, while the folks under 40 seemed to be reacting to a life change. Two people were moving to a bigger house from an apartment. Another person was moving in with their girlfriend, and another said that she got a new job and could now aford nicer things.” “I went to the home goods section of a high-end department store,” said Koshi. “I saw eighteen people, and fve of them knew what they wanted already. Te rest spent time puzzling over the packaging and, like your group, going online with their mobile phone. I spoke to nine shoppers. I said that I was a scientist trying to invent a new pillow. People thought that was pretty cool. Two of them admitted that they were buying the highest price pillow because they assumed that it had to be the best. Two got the cheapest because it was the cheapest. Te others had specifc preferences for down, cotton or foam based on the frmness they were looking for in a pillow. Te frmness preference seemed to be tied to a belief that they would sleep more soundly. On price, I was relieved to see that the prices of the better pillows were in line with what we were hoping to charge.” Roberta pulled out a pad. “So we saw thirty-three people and spoke to nineteen. Our sample set is still small, but Samantha told us to look for patterns and not worry about statistical signifcance right now. If we break our observations into a few metrics, what have we learned?” • 24% of shoppers knew what they wanted when they walked in • 52% looked up information on their phone in the store • 45% of shoppers purchased a mid-priced or high-priced pillow • 68% of the people we spoke to indicated that better sleep was a major driver of their choice 22 Talking to Humans • 37% of the people we spoke to were reacting to a life change • 37% of the people we spoke to were in replacement mode “I think the use of mobile phones is something we need to pay attention to and work into our strategy,” Koshi said. “I guess for our next step, we should follow Samantha’s suggestions to target urban professionals.” Regrouping A week and many interviews later, the team sat down with Samantha. “How did things go?” she asked. “I went to a downtown cofee shop at peak hour,” Koshi said. “At frst, everyone was in such a hurry to get to work that I didn’t get much response, but then I made a little sign I held up outside that promised ‘cofee for science,’ which started to get laughs and a lot of curiosity. I ended up talking to about ffeen people who matched our target of young urban professionals. I got to talk to them for about fve to twenty minutes each. It was actually very enjoyable. “One clear pattern was that people right out of school tended to have no clue. Tey either had never bought a pillow themselves, or if they had, it had been the cheapest thing they could get. A few admitted that they were probably going to buy new bedding. I know it is speculation, but I asked them to guess how they might go about looking for a pillow, based on how they shop for other things. Te common responses were searching on Google or Amazon, or walking into a Bed Bath & Beyond. “Te few folks in their later twenties or thirties whom I spoke to had usually bought at least one pillow — some from Amazon and some from retailers. Te ones who liked a frm pillow avoided The Story 23 down feathers. Te ones who wanted to upgrade to fancier duvets and high thread-count sheets all seemed to go with duck and goose feathers. Tey didn’t know any brands and instead relied on product packaging. Amazon buyers did actually read the reviews. All these folks were only planning on buying new pillows when they were moving to a bigger apartment because they were getting married or something.” “Yes, that aligns with what we learned when we spoke to people in the retail stores and what I saw with my other interviews,” said Roberta. “Pillow buying seems to be tied to life events like moving and marriage and such. I interviewed a diferent group. A whole bunch of our old classmates responded to my email or my Facebook post. I even had some folks pass me on to their friends, and so I got to talk to some people who didn’t go to school with us. “Like you, I saw a lag efect afer someone graduated from college. When new graduates told me that they had not spent any money on their linens yet, I inquired further and found out that their initial spending money was predominately going towards clothes. I spoke to twelve people between 22 and 25, and roughly 60% had actually bought a pillow in the last few years. I saw similar trends as you, although most went right to Google, Amazon or a few specialty online retailers. It seemed like a very online crowd. Te price sensitive ones stayed away from down. Tey didn’t have much to go on for brand, but the reviews helped. Te women defnitely cared more about quality and put more efort into their hunt.” “Te good news is that everyone thought inventing a new pillow was an awesome idea!” said Koshi. Samantha chuckled. “Of everything I’ve heard you say, that last bit is probably the least useful. It’s easy to say something is cool. It’s another thing to actually buy. Te good news is, you are a lot more educated about your market than you were last time we met. 24 Talking to Humans I see from your notes that you have either spoken to or observed 72 people. We should be able to see some patterns from that. Let’s revisit our critical assumptions.” Challenging Assumptions Te team looked at their initial list. 1. We believe that people care about sleep quality when making a purchase decision. “68% of the retail shoppers indicated that this was a major factor,” said Roberta. “Of our young urban professionals, we were able to ask this of only a portion of our interviewees. Only 56% indicated that it was a factor, but if we factor out the new graduates, it was more like 70%. We’ve also read a lot of online reviews and have seen this come up repeatedly. We feel reasonably confdent that this is a common decision point in choosing a pillow,” said Koshi. “I’m glad you are approaching this with rigor and actually calculating metrics from your observations,” said Samantha. “Tat will prevent you from letting innate biases override your actual results. However, one word of advice. At this stage, don’t take any of your statistics too literally and don’t let any single number dominate your strategic thinking. Just as we’re not looking for statistical signifcance at this point, we also don’t want to start treating our results as if they are indisputable facts. How about the next assumption?” 2. We believe that we can sell online directly to customers. “We have seen some promising signs. 77% of our urban professionals start researching purchases with a search engine. Te question is whether they would discover, visit, or convert with our The Story 25 online store. We did see a ton of mobile usage in the retail stores and think there might be a chance to steal those customers if we have good enough search engine optimization. Overall, our conclusion is that we need more data here.” 3. We believe that our customers will be young urban professionals. “I need to run some numbers on size of market and the number of purchases we might expect from this group, but we still feel like this is a good group for us. We clearly saw purchase behavior. Tey want, and can aford, quality things, and prefer to buy things online.” 4. We believe that our very frst customers will be new graduates who need to outft their apartments. “Tis is where we were totally wrong. Buying behavior, or at least the willingness to buy something that isn’t the cheapest option, did not seem to be very prevalent among new grads. Only 25% of the newly minted grads we spoke with had purchased a pillow on their own. Instead, the evidence points us towards people in their mid-tolate twenties or early thirties. “We also saw a correlation between purchasing and life changes. While this was only 37% with our retail shoppers, it was 70% of our urban professionals. From an early adopter perspective, I wonder if we can do well targeting people who are getting married or moving to a larger apartment or house?” 5. We believe we can sell our pillows at a high enough price to cover our costs. “45% of our retail shoppers bought at least a mid-priced pillow. We admit that we visited reasonably high-end stores, but that was still a nice statistic to see. Te good news is that our initial target price is comparable with the high-end of the current market. We 26 Talking to Humans won’t be proftable at the beginning, but if we can scale and improve our manufacturing process then we can move into the black. Of course, they have to want to buy our pillow.” Samantha nodded. “To test that, you will need to actually try selling a few, which ties back to your second risk. But I’m glad you have spent time learning rather than rushing to sell. Overall, it sounds like you have gotten some solid intel. I’m also glad you caught the issue with college grads before you spent a lot of money and energy trying to target them. Have your eforts uncovered new risks or worries?” “I’m both excited and worried by how confused customers are,” Koshi said. “Every brand promises a better night’s sleep. I’m also worried about signals we picked up that the market might be divided into those who want a frm pillow versus a sof pillow. We think that’s erroneous thinking. Our pillow lands in the middle, and our studies show better results. I don’t know if people will believe our data. We really need to get the messaging right.” “As for me,” Roberta said, “I’m most worried about the size of our initial market, how quickly we could grow, and if we can survive to proftability.” “I’m not surprised,” said Samantha. “I have some suggestions. One of you should continue doing these interviews, but try adding a new spin. You are both worried about diferentiation and if people will understand or appreciate the proof from your scientifc studies. Let’s test some messaging. Given what you have said about mobile usage, maybe create an infographic that tries to make your case. Show it to people on a phone. Ask them to explain it to you. First you can see if they understand it, and then if they fnd it meaningful. “Expanding from qualitative research, I also think one of you should create a fnancial model that lets you play with how much The Story 27 you charge, how many items you might sell, and what your costs will be. Take into account what you have learned so far and see if your business model adds up. “Finally, I think you’ve learned enough to run some experiments around customer acquisition and sales. It is straightforward to create a basic online store using one of the hosted services. You can test selling a few pillows before you invest in manufacturing capability. Try driving trafc through Google or Facebook ads, and run some A/B tests around ad copy, landing-page messaging and price points. Study your metrics. Ten follow up with your customers and interview them on their buying process and decision.” Roberta’s eyes widened. “Wow. Maybe we can get our frst paying customer!” “Exactly,” said Samantha. “Just remember Steve Blank’s phrase about startups: you are in search of a scalable and repeatable business model. Run these experiments and keep in mind that your mission at this point is to learn before you scale. Don’t stop talking directly to customers. Your questions will likely evolve, but no matter what stage you are in, you’ll usually fnd that your best insights will come from talking to real people and observing real behavior.” 28 Talking to Humans Lessons Learned The Story 29 So what are the key takeaways from Roberta and Koshi’s adventure? 1. Customer discovery is about gaining much deeper insight into your customer, or your partners, or your market 2. Being told your idea is cool is not useful; seeing behavior that validates your customer’s willingness to buy is very useful 3. Prepare an interview guide before you get out of the building 4. To ask the right questions, you need to understand your risks and assumptions 5. Get creative when trying to recruit people — if at frst you don’t succeed, try something new 6. Sometimes observation is as powerful as interviews 7. Take good notes, especially on your key risks, so that you can calculate metrics later. Even better, set your target goals ahead of time! 8. Bring learning back and analyze your patterns as a team 9. Never stop asking hard questions about your business In the next section of this book, we’re going to dive into tactics and talk about all this and more in detail. How To PART TWO How To 31 Getting Started with Customer Discovery Qualitative research, i.e. talking to humans, is something you never want to stop doing, but it can defnitely feel intimidating at frst. Te good news is that if you go about it in a professional and thoughtful way, you will fnd lots of people who are willing to help and give you some of their valuable time. You need to begin with a core set of questions: t Who do you want to learn from? t What do you want to learn? t How will you get to them? t How can you ensure an efective session? t How do you make sense of what you learn? 32 Talking to Humans Who Do You Want to Learn From? How To 33 If your desired customer is a doctor, it stands to reason that it won’t help you much talking to a plumber. If you were aiming for teenagers, would you talk to grandparents? Te frst step in trying to learn from the market is having an opinion about who your market actually is. I recommend thinking about a few categories: t Te typical customer you envision if you get traction with your idea t Your early adopter, i.e. the people who will take a chance on your product before anyone else t Critical partners for distribution, fulfllment, or other parts of your business You might think you are creating a product for “everyone”, but that is not an actionable or useful description in the early stages. You need to get more specifc. Your job is to think through the kinds of people who have the problem you are interested in solving. Sometimes they have a particular job, or a state of mind, live in a particular part of the world, or belong to a certain age group. Standard demographics might be useful, or they might be irrelevant. What are the commonalities across your customer base? Here are some examples: • A hospital management system has to think about the hospital administrator who will buy their software and the actual hospital workers who would use it • An on-call veterinarian service needs to talk to pet owners • An online marketplace for plumbers might consider plumbers on the sell side, and home owners on the buy side 34 Talking to Humans You also want to think about your early adopters. Why do they matter? Most new products ft alongside a “technology adoption curve,” as illustrated below. New founders tend to obsess about their mainstream customer (represented in the chart as the early and late majority). However, by defnition, the mainstream is waiting for proof from early adopters before they try something. If you cannot get early adopters, you cannot move on. Early adopters are usually folks who feel a pain point acutely, or love to try new products and services. In our story of Koshi and Roberta, the scientists hypothesized that their early adopter would be urban professionals in their mid to late twenties. For the three customer examples we just gave, here are examples of early adopters: • Our hospital management system might target hospital chains still stuck with an archaic vendor • Our vet service might target busy 20-somethings in a major city • Our online market for plumbers might target solo practices on the sellside and frst-time home owners on the buy-side How To 35 Tere is no prescription for how narrowly or broadly you should cast your net for customer discovery interviews. However, the more focused you can be, the easier it is to make sense of your evidence. Special Note for B2B Products If you are selling to the enterprise, you should also think about the diferent kinds of participants in your sales process. In a classic enterprise sale, you will ofen have a strategic buyer (who is excited about the change you can bring), an economic buyer (who controls the purse), a technical buyer (who might have approval/blocker rights), and then the actual users of your product. Can you identify your champion? Can you identify who might be a saboteur? For B2B companies, Steve Blank also recommends that you start by talking to mid-level managers rather than the C-suite. It can be easier to get their time, it is ofen easier to get repeat conversations, and, most importantly, it will allow you to get better educated before you go up the chain. 36 Talking to Humans What Do You Want to Learn? How To 37 Go into every customer interview with a prepared list of questions. Tis list, which we refer to as an interview guide, will keep you organized. You will appear more professional, and it will ensure that you get to your most important questions early. How do you know your most important questions? I like to begin by understanding my most important, and most risky, assumptions. Tose tend to be the areas where you need to gather insights most urgently. You can uncover your assumptions in a myriad of ways. You can use Alex Osterwalder’s business model canvas or Ash Maurya’s lean canvas. Personally, I ask these questions (see the Appendix for a worksheet and tips): • My target customer will be? • The problem my customer wants to solve is? • My customer’s need can be solved with? • Why can’t my customer solve this today? • The measurable outcome my customer wants to achieve is? • My primary customer acquisition tactic will be? • My earliest adopter will be? • I will make money (revenue) by? • My primary competition will be? • I will beat my competitors primarily because of? • My biggest risk to fnancial viability is? • My biggest technical or engineering risk is? • What assumptions do we have that, if proven wrong, would cause this business to fail? (Tip: include market size in this list) You should be able to look at this list and spot the assumptions that are both highly important and fairly uncertain. Be honest. You want to focus on the most important issues. 38 Talking to Humans In the case of our pillow entrepreneurs, they chose six initial risks which drove their research approach and frst set of questions. To give another scenario, in the last chapter we shared the example of an on-call veterinarian service. Te founders might identify a set of risks: 1. Pet owners are frustrated having to go to a vet and would rather have someone come to them 2. Customers are willing to pay a big premium to have a vet show up at their door 3. We think busy urbanite pet owners will be our early adopters 4. We think people currently discover their vets either through word of mouth or online searches 5. We can affordably acquire our customers through targeted Google search ads 6. We can recruit enough vets across the country to make this a big enough business 7. With travel baked in, our vets can see enough people in a day to be fnancially viable Not every assumption can be tested efectively through qualitative research, but in this case, our founders can probably get some insights on risks 1, 3, 4, and 6 just by talking to people. Risks 1, 3 and 4 would be focused on pet owners, while #6 would be focused on vets. Get Stories, Not Speculation When you are contemplating your questions, be careful with speculation. Humans are spectacularly bad at predicting their future behavior. It is tempting to say, “Would you like this idea?” or “Would you buy this product?” Unfortunately, you really have to treat those How To 39 answers with a great deal of skepticism. It is more efective to ask your interview subject to share a story about the past. For example, when our fctional scientists Koshi and Roberta created their interview plan, the questions were focused on getting the interviewee to tell a story about their last pillow buying experience. Keeping with our second example of an on-call vet service, the team might have a loose interview plan that looks like the following: • Warm up: concise intro on the purpose of the conversation • Warm up: basic questions about person and pet (name, age, picture) • Who is your current vet? Can you tell me about how you found and chose him/her? • Please describe the last time you had to take your pet to the vet for a checkup • Walk me through the process of scheduling a time to visit the vet. • What was frustrating about that experience? • What did you like about that experience? • Have you ever had an emergency visit to a vet? if yes, can you describe that experience for me? • Have you ever thought about changing vets? why / why not? Ask Open-Ended Questions Your goal is to talk little and get the other person sharing openly. To that end, it is imperative that you structure open-ended questions, or at minimum follow up yes/no questions with an open-ended question that gets them talking. One tip is to try to ask questions that start with words like who, what, why and how. Avoid questions that start with is, are, would, and do you. But remember, if you do get a yes/no answer to a 40 Talking to Humans question, you can always follow up in a way that gets them talking. An interesting open-ended question, which Steve Blank likes to use to conclude his interviews, is: “What should I have asked you that I didn’t?” Testing for Price Two of the hardest questions to answer through qualitative research are: will people pay? and how much will they pay? Speculative answers on this topic are extremely suspect. You can learn a lot, however, by asking questions like: • How much do you currently spend to address this problem? • What budget do you have allocated to this, and who controls it? • How much would you pay to make this problem go away? (this can lead to interesting answers as long as you don’t take answers too literally) My recommendation is to set up a situation where the subject thinks they are actually buying something, even if they know the thing doesn’t exist yet. Kickstarter and other crowdfunding platforms are used by a lot of teams to test pre-order demand. For expensive corporate products, you can also try to get customers to buy in advance or sign a non-binding letter of intent to buy. Te key thing to remember is that people don’t honestly think about willingness to pay unless they feel like it is a real transaction. Getting Feedback on a Prototype Sometimes you will want to get reactions to a product solution. You can learn a lot by putting mockups or prototypes in front of people, but, as with all speculation, you should interpret reactions with a degree of skepticism. If you show your interview subject a proposed solution, you need to separate this step from your questions about their behavior. How To 41 Ask your questions about behavior and challenges frst, so that the discussion about product features does not poison or take over the conversation. People do love talking features! The Magic Wand Question Some people like to ask, “if you could wave a magic wand and have this product do whatever you want, what would it do?” Personally, I avoid questions like this because customers are too constrained by their current reality to design efective solutions. It is the customer’s job to explain their behavior, goals, and challenges. It is the product designer’s job to come up with the best solution. Tere is one variation to the magic wand question that I do like, however, because it focuses on problems and not solutions: “If you could wave a magic wand and solve any problem, what would you want to solve?” I suspect, however, that you will fnd many people struggle with such an open question. Design “Pass/Fail” Tests Customer discovery is made up of a lot of qualitative research, but it helps to take a quantitative mindset. Set goals for key questions and track results. For example, halfway through their initial research, our scientists Koshi and Roberta already knew stats like: • 24% of shoppers knew what they wanted when they walked in • 45% of shoppers purchased a mid-priced or high-priced pillow • 68% of the shoppers we spoke to indicated that better sleep was a major driver of their choice Even better would have been if they had set targets ahead of time. For example, they might have set the following goals: • Because we are a new brand, we are hoping that most shoppers are undecided. We want to see that 40% or fewer shoppers already know what 42 Talking to Humans they want when they walk in • Because our pillow is expensive, we want to see that at least 40% of the shoppers buy mid or high-end models • Because we believe that sleep quality is a major differentiator for our product, we want over 60% of shoppers to indicate that this is a major factor in their decision making process Te numerical target you choose can be an educated guess. You do not need to stress over picking the perfect number. It is more important that you set a goal and really track what is happening. Setting a target forces you carefully think through what you are hoping to see, and makes decisions and judgment calls a bit easier as you review your data. A Guide, Not a Script An interview guide is not a script. You do not need to read from it like an automaton. You should feel free to veer of of it if the conversation brings up something interesting and new. It will likely evolve as you learn from the market and unearth new questions. But always plan, prioritize and prep your questions before any session. Observation Can Be As Powerful As Questions Sometimes the best thing you can do is sit back and watch someone’s behavior. You might watch their purchase process, or examine how they go about solving a particular problem. As you think about what you want to learn, also think through how you might gather data through observation rather than direct interviews. In our story of Koshi and Roberta, the two got some of their most valuable insights by going to linen stores and watching potential customers struggle to buy a pillow. Tey observed behavior and only then jumped in to ask questions. Tis technique cannot always be used. For example, when my How To 43 team was trying to validate a weight loss product idea, it did not feel practical to watch people go about their diet. Instead we did interviews and then put a group of customers through a two-week concierge experiment (see Glossary) where we manually acted out the diet experience. But, where possible, observing uninfuenced behavior can lead to great insights. 44 Talking to Humans How Do You Find Your Interview Subjects? How To 45 Entrepreneurs new to customer development are ofen intimidated at the thought of approaching complete strangers. It might surprise you to hear that people are ofen very willing to help out. Tis is especially true if you are working on a topic that interests them and you approach them nicely and professionally. Tere are three general rules to keep in mind when recruiting candidates to speak with: 1. Try to get one degree of separation away (don’t interview your mom, your uncle, or your best friends) 2. Be creative (and don’t expect people to come to you) 3. Fish where the fsh are (and not where they are not) Get Creative One aspiring entrepreneur wanted to target mothers of young children. She had heard stories about talking to people in a cofee shop, but felt like it was too unfocused. So she tried hanging around school pickup zones, but the moms were too busy and refused to speak to her. Next, she tried the playground, where she fgured moms would be bored watching their kids play. Tis worked reasonably well, but she was only able to get a few minutes of anyone’s time. So instead, she started organizing evening events for moms at a local spa where she bought them pedicures and wine. Te time of day worked because the moms could leave the kids at home with their partner. Te attendees had a great time and were happy to talk while they were getting their nails done. Find the Moment of Pain If you can connect with people at the moment of their theoretical pain, it can be very illuminating. My colleague Alexa Roman was working with an automotive company and they had a concept tied 46 Talking to Humans to the experience of getting gas. So Alexa and team visited a series of gas stations. Tey watched consumers go through the process of buying gas. Ten they approached them and asked questions. By thinking about the moment of pain they wanted to address, they knew exactly where to fnd their consumers and they were able to gather valuable observational research. Make Referrals Happen Use referrals to your advantage. Let’s say you want to talk to doctors. Tey are busy and have strong gatekeepers. I bet you know how to get to at least one doctor, however. Tat doctor will know other doctors. Even if your doctor happens to be a close friend and thus breaks the “more than one degree of separation” guideline, she can still give you advice on when might be a good time to talk to a doctor. She can also connect you with other doctors. You should use referrals as much as possible. Set a goal of walking out of every interview with 2 or 3 new candidates. When you end an interview, ask the person if they know others who face the problem you are trying to solve. If they feel like you have respected their time, they will ofen be willing to introduce you to others. Conferences & Meetups Conferences and meetups can be an amazing recruiting ground, because they bring a group of people with shared interests into one place. You just need to be respectful of people’s time. I have found that it is extremely efective to ask people for their time, but for later, afer the conference or meetup. Get their business card, let them get back to networking, and then have an in-depth conversation when it fts their schedule. Immediately afer the conference while their memories are still fresh, send them a short email that reminds them where you met, and give your ask for a conversation. Tis How To 47 works as efectively for in-demand panel speakers as it does for other attendees. Meetups are usually inexpensive, but conference tickets can be pricey. If you are on a budget, you can “hack” expensive conferences by intercepting people outside of the building, or, if you can get access to the attendee or speaker lists ahead of time, contacting people directly and meeting them near the event. Meetup.com has decent search tools to discover relevant events in your area, and a few good Google search queries can usually get you to a short list of conferences that ft your needs. Enterprise Customers Finding interviewees can be harder when you are focused on an enterprise customer. You need laser-like targeting. In addition to conferences, LinkedIn can be extremely useful. If you have hypotheses on the titles of the people you are seeking, run searches on LinkedIn. You might be able to get to them through a referral over LinkedIn, or you might need to cold call them through their company’s main phone number. You then have to decide on your approach method. You can either ask for advice (where you make it clear that you are not selling anything), or you can go in as if you were selling something specifc. Advice vs Selling Asking for advice should be your default method early in your customer discovery process. You will have better luck gaining access. People like being asked (it makes them feel important). Steve Blank used to call people up and say something like, “My name is Steve and [dropped name] told me you were one of the smartest people in the industry and you had really valuable advice to ofer. I’m not trying to sell you anything, but was hoping to get 20 minutes of your time.” 48 Talking to Humans Another efective spin on “asking for advice” is to create a blog focused on your problem space, and ask people if you can interview them for an article. When do you approach someone as if you were selling a product? Tis method is useful if you are past initial learning and want to test your assumptions around customer acquisition and messaging. Just don’t jump into sales mode too early. Beneftting from Gatekeepers If LinkedIn isn’t helping you and you need to reach high up in an organization, another approach is to call the CEO’s ofce. Your goal is not to talk to the CEO but actually their executive assistant. His job is to be an efective gatekeeper, so if you explain, “I’m looking to talk to the person who handles X”, they will ofen connect you to the right person (especially if you are pleasant and professional — notice the trend on that one?). Te added advantage of this method is if you end up leaving a voice mail for your intended contact, you can say “Jim from [CEO’s name]’s ofce gave me your name”. Dropping the boss’ name tends to improve response rates. Another approach is to send a targeted email into an organization with a very short email that asks for an introduction to the right person to speak to. You can make guesses as to email addresses based on LinkedIn queries. For this tactic to work, you must keep your emails extremely concise. Students and Researchers While people are willing to grant time to polite people who ask for advice, you have an extra advantage if you are a student or academic researcher. In other words, if you are a student or researcher, say so. As an extra incentive, you might also ofer to share the results of your research with your interview subjects. How To 49 You Might Be Surprised Another colleague of mine, Jonathan Irwin, was working with a Fortune 50 company. Te client team wanted to interview a special kind of oil platform engineer, of which there were less than 20 in the world! To access these people required security clearance and safety training. We challenged the team to fnd a way, expecting that they would have to rely on video conferencing or phone calls. However, the team started researching this speciality profession through Google and discovered that there was an onshore training facility just an hour away. Te moral of the story is that it ofen isn’t as hard as you think. No Fish in the Sea When I say fsh where the fsh are, it is really important to remember the fip side to that statement: don’t fsh where the fsh are not. If a method isn’t working, try something new. We were doing a project with a major magazine testing out new product ideas. Our target was busy women, and we knew that the readership correlated closely with shoppers of Te Container Store (a retail store). So we parked out front of a store and intercepted folks as they came in and out. People were willing to speak for a few minutes, but many were in a bit too much of a rush. Ten one of our teammates discovered a sample sale happening around the corner. Tere were probably 200 bored women waiting in line, most of whom were happy to talk to us to pass the time. (Note: fnding bored people stuck in line is a common recruiting hack.) Still, we didn’t feel like we were targeting quite as narrowly as we wanted (busy, working women) or as geographically broadly (we didn’t want to just talk to New Yorkers). So we turned to the magazine’s social media presence. We created a short online survey to help us qualify responses, and the magazine posted a link to their Twitter and Facebook pages with a catchy sentence. We had hundreds of women fll out the survey, and then we picked our top 50 Talking to Humans thirty candidates and scheduled calls. Online Forms & Landing Pages In a similar vein, one efective tactic is to create an online form or landing page and build up a list of people to contact. Below is an example of a landing page. Our team was testing a product idea for better home organization. Tis landing page test actually consisted of a three-step funnel with a call to action, a price choice, and then a request for an email address. We tracked the conversion metrics carefully and used the emails to schedule interviews. Caveat: driving trafc is never a trivial process. If you have budget, Google or Facebook ads can work. Otherwise, you can try to generate some word of mouth on social media or through bloggers. How To 51 Conclusion Hopefully what you are picking up through these examples is that there is no single way to get to people. It takes some creativity and hustle, but it isn’t as hard as you might think. Trust me, people will not think you are rude if you carry yourself well and act professionally. Check Out the Appendix for Examples Te Appendix has more tips and examples for cold email and voice mail approaches. 52 Talking to Humans How to Ensure an Effective Session? How To 53 I recommend the following guidelines for running a productive interview session. Do Your Interviews In Person Te quality of your learning can vary a lot depending on your communication method. Talking in person is by far the best approach. You can read body language and build rapport much easier. Remember that a huge percentage of human communication is non-verbal, so why blind your senses if you don’t have to? Te next best approach is video conferencing, because at least you can still read someone’s facial expressions. Phone calls should be your method of last resort (sometimes there is no choice), and I would entirely avoid using text-based mediums like email or chat. Talk to One Person at a Time I believe in talking to one person at a time. It is useful to have a second person on your side quietly taking notes. I strongly recommend avoiding focus groups for two reasons: 1. you want to avoid group think; 2. you will really struggle to focus on one person’s stories, and drill into areas of interest, when you are juggling multiple people. Adding a Note Taker Bringing a note taker will allow you to stay in the moment without worrying about getting every bit down on paper. You can stay focused on the topics, the body language, and where to take the conversation. If you have to take your own notes, that’s not the end of the world. It can sometimes make for a more intimate conversation. Just remember to write up your notes right afer the session or you will lose a lot of detail and color that you weren’t able to write down. You can also ask the interview subject if you can record them, 54 Talking to Humans and many people are willing. Te risk is that a recorder can inhibit the conversation, but most people forget that they are being recorded once the discussion is fowing. I highly recommend that you play back the audio and write up your notes soon afer the session, both because writing up notes will reinforce what you learned in your own mind, and also because written notes are easier and faster for both you and your teammates to scan. I’ve found that once audio or video is more than a couple weeks old, somehow they never get touched again. Start With a Warm Up & Keep It Human When you kick things of, concisely explain why you are there, and thank them for the time. Launch into things with one or two easy warm up questions. For example, if you are talking to a consumer, you might ask where they are from and what they do for a living. If you are talking to enterprise, you might ask how long they have been with their company. You don’t want to spend a lot of time on this stuf, but it does get the ball rolling. Have a written or printed list of questions, but don’t rigidly read from your list. Be in the moment. Make the interview subject feel like you are really listening to them. Disarm Your Own Biases Human beings have an amazing ability to hear what they want to hear (this is called “confrmation bias”). Go into each session prepared to hear things that you might not want to hear. Some entrepreneurs even take the mindset that they are trying to kill their idea, rather than support it, just to set the bar high and prevent themselves from leading the witness. Get Them to Tell a Story As I mentioned in the chapter “What Do You Want to Learn,” How To 55 humans are terrible at predicting their own behavior. If you ask any speculative questions, be prepared to listen with a healthy dose of skepticism. I far prefer to get people telling stories about how they experienced a problem area in the past. In particular, try to fnd out if they have tried to solve the problem. What triggered their search for a solution? How did they look for a solution? What did they think the solution would do, before they tried it? How did that particular solution work out? And if they are struggling to remember specifcs, help them set the scene of their story: what part of the year or time of day? Were you with anyone? As they are telling their story, follow up with questions about their emotional state. You might get some historical revisionism, but what you hear can be very illuminating. Te researchers at Meetup.com, who borrow from Clayton Christensen’s Jobs To Be Done framework, use an interesting tactic to help their subjects get in story mode. When they are asking someone to take them through a purchase experience, from frst thought through purchase and then actual product usage, they say: “Imagine you are flming the documentary of your life. Pretend you are flming the scene, watching the actor playing you. At this moment, what is their emotion, what are they feeling?” Look for Solution Hacks One of the best indicators that the market needs a new or better solution is that some people are not just accepting their frustration with a particular problem, but they are actively trying to solve it. Maybe they have tried a few diferent solutions. Maybe they have tried hacking together their own solution. Tese stories are a great indicator of market need. Understanding Priority For someone to try a new product, their pain usually needs to be 56 Talking to Humans acute enough that they will change their behavior, take a risk, and even pay for it. If you feel like you are seeing good evidence that someone actually has a problem, it is worth asking where it ranks in their list of things to solve. Is it their #1 pain, or something too low in priority to warrant attention and budget? Listen, Don’t Talk Try to shut up as much as possible. Try to keep your questions short and unbiased (i.e. don’t embed the answer you want to hear into the question). Don’t rush to fll the “space” when the customer pauses, because they might be thinking or have more to say. Make sure you are learning, not selling! Or, at least make sure you are not in “sales” mode until the point when you actually do try to close a sale as part of an experiment. Follow Your Nose and Drill Down Anytime something tweaks your antenna, drill down with follow up questions. Don’t be afraid to ask for clarifcations and the “why” behind the “what.” You can even try drilling into multiple layers of “why” (run an Internet search for “Five Whys” for more info), as long as the interviewee doesn’t start getting annoyed. Parrot Back or Misrepresent to Confrm For important topics, try repeating back what the person said. You can occasionally get one of two interesting results. Tey might correct you because you’ve misinterpreted what they said. Or, by hearing their own thoughts, they’ll actually realize that their true opinion is slightly diferent, and they will give you a second, more sophisticated answer. Another approach is to purposefully misrepresent what they just said when you parrot it back, and then see if they correct you. But How To 57 use this technique sparingly, if at all. Do a Dry Run If you are a beginner at customer discovery, do a dry run with a friend or colleague. See how your questions feel coming out of your mouth. Get a sense of what it is like to listen carefully and occasionally improvise. Getting Feedback on Your Product If you want to get feedback on your product ideas, whether you show simple mockups or a more polished demo, there are a few important tips to keep in mind: As I mentioned before, separate the storytelling part of your session from the feedback part. People love to brainstorm on features and solutions, and this will end up infuencing the stories they might tell. So dig into their stories frst, and gather any feedback second. Second, disarm their politeness training. People are trained not to call your baby ugly. You need to make them feel safe to do this. Ask them up-front to be brutally honest, and explain that it is the very best way for them to help you. If they seem confused, explain that the worst thing that could happen is to build something people didn’t care about. Finally, keep in mind that it is incredibly easy for people to tell you that they like your product. Don’t trust this feedback. Instead, you need to put people through an actual experience and watch their behavior or try to get them to open their wallet. Tere is no right answer on how polished your early mockups need to be. If you are in the fashion space, you need to have a high degree of visual polish as table stakes. If you are creating a solution for engineers, you probably need much less. Just don’t wait for perfection, because initial product versions rarely get everything right. You need to spot your errors sooner rather than later. 58 Talking to Humans How Do You Make Sense of What You Learn? How To 59 Your goal is not to learn for learning’s sake. Your goal is to make better decisions that increase the odds of success. So how do you translate your observations into decisions? Te frst step is to make sense of your patterns. Take Good Notes To fnd your patterns, frst you need to track the data. Tis is easy if you bring a good notetaker to the interview, but otherwise, make sure that you write up your notes as soon afer your conversation as possible. Make them available to the entire team with Google Docs or the equivalent. At the start of every entry, note the following information: • Name of interview subject • Date and time • Name of interviewer • In person or video conference • Photo (if you have one) Ten at the start of your notes, include basic descriptive information of the interview subject. Quantitative Measures If you are setting specifc metric goals for your interviews, you might set up a shared spreadsheet that essentially acts as a running scorecard for how you are doing and how you are tracking to targets. EXAMPLE Let’s imagine that you have invented a new air purifer that triples the growth speed of greenhouse plants. Now you plan to talk to 20 60 Talking to Humans farmers, and you have a few core questions: • Will their business actually beneft from increased growth speed? You are assuming that increased volume will help rather than hurt. You plan to talk to growers of different crops with the goal of fnding crops where 60% or more of farmers want increased volume. • Are farmers spending any money today on growth accelerator solutions? Your qualitative research will drill into what and why, but your metrics goal says that you hope at least 50% of the market is already spending at least some money. • Do they have the facilities to support your purifer? In this case, you need your purifer to be both in a specifc location, but also have access to an electrical outlet. You are hoping that 70% of the farmers have an outlet 20 feet or closer to your spot. Here is the kind of spreadsheet that you and your team might track: As Samantha advised Koshi and Roberta in the fctional story, turning your observations into quantifable metrics is both useful and tricky. Our brains like to infuence our thinking with cognitive biases, especially fltering results for what we want to hear. Calculating actual metrics helps fght against that dynamic. How To 61 At the same time, you have to beware a diferent kind of bias: our desire to turn statistics into facts. Hopefully you are getting enough data points that you can trust the patterns, but do not confuse this with statistical signifcance or take your results too literally. My advice is to calculate metrics, but remain skeptical of them, don’t obsess over any one particular metric, and continue to question what is behind your numbers. Dump and Sort Exercise Bring your team together and arm them with sticky notes and sharpies. Give everyone 10 minutes to jot down as many patterns and observations as they saw during their interviews. Put all the sticky notes on a wall and have someone sort them into groups. As a team, discuss the patterns, and then re-review your assumptions or business canvas and see what might need to change or require greater investigation. Look for Patterns and Apply Judgement Customer development interviews will not give you statistically signifcant data, but they will give you insights based on patterns. Tey can be very tricky to interpret, because what people say is not always what they do. You don’t want to react too strongly to any single person’s comments. You don’t want to take things too literally. But neither do you want to be bogged down trying to talk to thousands of people before you can make a decision. You need to use your judgement to read between the lines, to read body language, to try to understand context and agendas, and to flter out biases based on the types of people in your pool of interviewees. But it is exactly the ability to use human judgement based on human connections that make interviews so much more useful than surveys. Ultimately, you are better of moving fast and making decisions 62 Talking to Humans from credible patterns than dithering about in analysis paralysis. Don’t Abdicate Your Role As Product Designer It is not the job of the customer to design your product. It is yours. As you are gathering information and making decisions, act like a intelligent flter, not an order-taker. Expect False Positives While all entrepreneurs get their fair share of naysayers and skeptics, you have to be wary of the opposite problem in customer development interviews. People will want to be helpful and nice, and your brain will want to hear nice things. As you are weighing what you have learned, just keep this in mind. The Truth Curve I am a big believer in qualitative research. I think a good product team should build a regular cadence of talking to relevant people into their process. However, you don’t want your only source of learning to be talking to people. You don’t really know the absolute truth about your product until it is live and people are truly using it and you are making real money from it. But that does not mean you should jump straight to a live product, because that is a very expensive and slow way to iterate your new business. Get into the market early and begin testing your assumptions right away, starting with conversations and proceeding from there. It will dramatically increase the odds that you will create a product that customers actually want. As you build confdence, test with increasing levels of fdelity. I think of it like peeling an onion in reverse. I created the accompanying chart to demonstrate the levels of believability for diferent kinds of experiments. How To 63 Talking to people is powerful. It tends to give you your biggest leaps of insight, but, as I keep on repeating, what people say is not what they do. You might show people mockups and that might give you another level of learning and feedback, but reactions still need to be taken with skepticism. Concierge and “Wizard of Oz” experiments, where you fake the product through manual labor (see Glossary) will give you stronger evidence, because you put people through an experience and watch their actions. Te next layers of the onion are to test with a truly functional “Minimum Viable Product” (see Glossary) and beyond. Te point I want to make is that all of the steps on the curve can be very useful to help you learn, make smarter decisions, and reduce risk, but you need to use your head, and apply judgement to everything you are learning. 64 Talking to Humans How many people to talk to? Tere is no pat answer to this question. A consumer business should talk to an order of magnitude more people than a business that sells to enterprise. If you are in the consumer space and haven’t spoken to at least 50 to 100 people, you probably have not done enough research. In his I-Corps course, Steve Blank requires his teams, many of which are B2B, to talk to at least 100 people over 7 weeks. I advise that you never stop talking to potential customers, but you will probably evolve what you seek to learn. If you see the same patterns over and over again, you might change things up and examine diferent assumptions and risks. For example, if you feel like you have a frm understanding of your customer’s true need, you might move on to exploring how they learn about and purchase solutions in your product category today. And don’t forget that observing your customers can be as powerful as directly talking to them. Lead with Vision Customer Development and lean startup techniques are some of the most powerful ways to increase your odds of success, but they are not a replacement for vision. You need to start with vision. You need to start with how you want to improve the world and add value to people’s lives. Te techniques we’ve discussed in this book are among a body of techniques that let you reality check your vision, and optimize the path you will take to achieve your vision. How To 65 Conclusion Toughtful qualitative research is a critical tool for any entrepreneur. Hopefully this book has given you some new strategies for how to put it to work for your needs. Creating a new business is tremendously challenging. Te ways you can fail are numerous. t You have to get the customer and market right t You have to get the revenue model right t You have to get the cost structure right t You have to get customer acquisition right t You have to get the product right t You have to get the team right t You have to get your timing right Screw up any one of those and you are toast. Tere is a reason why entrepreneurship is not for the faint of heart. But we’re not here to be faint of heart. We are here to change the world. Dream big. Be passionate. Just be ruthless with your ideas and assumptions. Customer discovery and lean experimentation can truly help you chart a better path and fnd success faster and with more capital efciency. Don’t forget that as your business grows and changes, so too will your customer base. Keep on reality-checking your hypotheses. Keep on talking to humans. Appendix PART THREE Appendix 67 Cold Approach Examples When you are trying to reach someone you do not know, there are a few things to remember: 1. Keep things concise 2. Keep things convenient (meet near their ofce, etc) 3. Name drop when you can 4. Follow up if you don’t hear an answer, but don’t be annoying 5. If you are leaving a voice mail, practice it frst (you might think it sounds practiced, but to others, it will sound more professional) Example Email 1 To: [email protected] From: [email protected] John, I received your name from James Smith. He said that you had a lot of expertise in an area I am researching and recommended that we speak. I’m trying to study how companies are handling their expense report management workfows and the frustrations they are experiencing. I would be happy to share my research conclusions with you. Would you have 30 minutes to spare next week when I could buy you a cup of coffee and ask you a few questions? Many thanks for your time and I look forward to hearing from you, Jane Doe 68 Talking to Humans Example Email 2 To: [email protected] From: [email protected] John, I have been working on some new solutions in the area of expense report management, and I was told that you have a lot of expertise in this area. We started this journey because of personal frustration, and we’re trying to fgure out how to make expense reporting much less painful. Would you have 30 minutes to give us some advice, and share some of your experiences in this domain? I assure you that I’m not selling anything. I would be happy to come by your offce or arrange a quick video conference, at your preference. Many thanks, Jane Doe Example Voice Mail Message “Hello, my name is Jane Doe. I was referred to you by James Smith, who said I would beneft from your advice. I am currently researching how companies are handling their expense management workfows. I understand you have a lot of expertise in this area. I was hoping to take just 30 minutes of your time to ask you a few questions. I’m not selling anything and I would be happy to share my research conclusions with you. You can reach me at 555-555-5555. Again, this is Jane Doe, at 555-555-5555, and thank you for your time.” Final Note Cold calling is never anyone’s favorite thing to do, but it isn’t nearly as painful as you imagine. You have nothing to lose and everything to gain. So give yourself a determined smile in the mirror, and go get them! Appendix 69 Business Assumptions Exercise I am agnostic about the framework you choose to use to map out your business assumptions. Alexander Osterwalder’s business model canvas and Ash Maurya’s lean canvas are both powerful tools. I also ofen fnd myself using this simple set of questions to lay out a belief system around an idea: Try to make your assumptions as concise and specifc as possible. You want to be able to run an experiment against it to see if it is true. My target customer will be? (Tip: how would you describe your primary target customer) The problem my customer wants to solve is? (Tip: what does your customer struggle with or what need do they want to fulfll) My customer’s need can be solved with? (Tip: give a very concise description / elevator pitch of your product) Why can’t my customer solve this today? (Tip: what are the obstacles that have prevented my customer from solving this already) The measurable outcome my customer wants to achieve is? (Tip: what measurable change in your your customer’s life makes them love your product) 70 Talking to Humans My primary customer acquisition tactic will be? (Tip: you will likely have multiple marketing channels, but there is often one method, at most two, that dominates your customer acquisition — what is your current guess) My earliest adopter will be? (Tip: remember that you can’t get to the mainstream customer without getting early adopters frst) I will make money (revenue) by? (Tip: don’t list all the ideas for making money, but pick your primary one) My primary competition will be? (Tip: think about both direct and indirect competition) I will beat my competitors primarily because of? (Tip: what truly differentiates you from the competition?) My biggest risk to fnancial viability is? (Tip: what could prevent you from getting to breakeven? is there something baked into your revenue or cost model that you can de-risk?) My biggest technical or engineering risk is? (Tip: is there a major technical challenge that might hinder building your product?) And then answer the following open-ended question. Be creative and really examine your points of failure. Appendix 71 What assumptions do we have that, if proven wrong, would cause this business to fail? 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Afer you have looked at your business holistically and also answered the broad fnal question, mark the assumptions that would have a large impact on your business and feel highly uncertain. Now you know your priorities for customer discovery and the experiments you need to run! 72 Talking to Humans Teaching Exercise #1: Mock Interviews If you are using this book to try to teach customer discovery/ development, there is nothing like real-world practice to make learning stick. Before you send your class out into the world to conduct their own interviews, however, you might try a compact exercise like the following: Tools All participants should have pen and paper Preface: Choose a Topic Everyone in the class will interview each other based on the same topic, which means it needs to be something most people can relate two. Tere are two angles you might take: 1. Something that helps the interviewer dig up past behavior. For example, “Tell me about the last thing you purchased over $100.” Have the interview subject explain what they bought, what the purchase process was like from desire to actual ownership, how they made their purchase decision, etc. 2. Something that helps the interviewer unlock deeper motivations and desires. For example, “Tell me about your dream car.” Prompt your students not just to get people to describe the car, but to dig into the reasons behind the choice; they can also prompt for whether the interview subject has ever experienced driving the car. Appendix 73 Exercise Step 1: Intro, 5 minutes Explain the exercise, the topic that the students will use, and give a few specifc suggestions for questions they might ask. Example questions for the dream car: when did you fall in love with the car and why? of the reasons you shared, why are these the most important to you? how have you imagined using the car? etc Step 2: Interview Plan, 2 minutes Give your class the topic and let them spend 5 minutes on their own. Tey should write down no more than 6 questions to ask. Step 3: Pair Interviews, 5 - 7 minutes each Pair up your students. One will begin as the interviewer, and their opposite will be interviewed. Give them 7 minutes, and then switch the roles, keeping the pairs unchanged. Te new interviewer gets 7 minutes. Te person doing the interviewing should also take notes, which will give them some exposure to doing an interview solo as opposed to bringing a note-taker to help (which is what most people prefer to do when possible). Step 4: Observations and Questions, 5-10 minutes Ask the room to share observations, challenges, lessons or questions on what it was like to do a live interview. 74 Talking to Humans Teaching Exercise #2: Mock Approach Dean Chang, the Associate VP of Entrepreneurship at the University of Maryland, recommends a class exercise where one or more teams of students takes on the role of cold calling an “expert.” Te team has to do it over and over until they get it right. For this exercise, select one team and have them come to the front of the classroom. Teir job is to “cold call” a selected member of the teaching team. Te teacher will pretend to be an expert in the team’s target feld. Te team needs to get the expert to take the call, and smoothly transition into asking questions. Te job of the person playing the “expert” is to block the team’s misguided attempts to engage. When the team does something wrong, the expert declines the interview request, or ends the conversation, or gives them a gong. Ten the team has to start over again. Classic mistakes that should trigger the team starting over include long or unclear introductions, pitching the product/technology too soon, implying that the expert has problems and desperately needs help, and/or generally making the expert feel uncomfortable with the line of questioning. As Dean describes it, “We let the other teams ofer critiques and suggest plans of attack for winning over the expert and then the chosen team tries it again. Eventually afer being gonged several times in a row, they stop making the same mistakes and start to Appendix 75 converge on a good elevator pitch that praises and disarms the expert and paves the way to entering into an interview. Ten we stop the exercise.” Te exercise will probably be humorous and painful at the same time, but there is nothing like stumbling, or watching a team stumble, to realize why best practices are best practices. 76 Talking to Humans Screwing Up Customer Discovery So how do people screw up customer discovery? Here are a few antipatterns: 1. You treat speculation as confrmation Here are some question types that I don’t like — and if you ask them, you should heavily discount the answer: “would you use this?” “would you pay for this?” “would you like this?” I can’t say that I never ask these questions, but I always prefer behavioral questions over speculation. As contrast, here is a behavior-focused interaction: “Tell me about a time when you bought airline tickets online.” “What did you enjoy about the process? What frustrated you about the process?” “What diferent systems or methods have you tried in the past to book tickets?” 2. You lead the witness Leading the witness is putting the answer in the interviewee’s mouth in the way you ask the question. For example: “We don’t think most people really want to book tickets online, but what do you think?” Examine both how you phrase your questions and your tone of voice. Are you steering the answer? Ask open-ended, neutral questions before you drill down: “what was that experience of buying online tickets like?” 3. You just can’t stop talking Some entrepreneurs can’t help themselves — they are overfowing with excitement and just have to pitch pitch pitch. Tere is nothing Appendix 77 wrong with trying to pre-sell your product — that is an interesting experiment unto itself — but you should not mix this in with behavioral learning. If you do try to pre-sell, don’t just ask, “Would you pay for this?” but rather ask them to actually pay, and see what happens. Some people ask the question, “How much would you pay for this?” but I do not. Instead, try actually selling at diferent price points (albeit one at a time). I much prefer having the potential customer experience something, rather than speculate over something. 4. You only hear what you want to hear I see some people go into interviews with strong beliefs about what they like and dislike. When you debrief afer their custdev conversation, it is magical how everything they heard aligns perfectly with their opinions. Our brains are amazing flters. Leave your agenda at the door before starting a conversation. One way to solve this is to have two people for each interview — one person to ask questions, and the other to take notes. 5. You treat a single conversation as ultimate truth You’ve just spoken to a potential customer and they have really strong opinions. One instinct is to jump to conclusions and rush to make changes. Instead, you need to be patient. Tere is no defnitive answer for how many similar answers equals the truth. Look for patterns and use your judgement. A clear, consistent pattern at even 5 or 10 people is a signal. 6. Fear of rejection wins out Tis is one of the biggest blockers to people doing qualitative research, in my experience, because of fear of a stranger rejecting your advance or rejecting your idea. Many excuses, such as “I don’t know how to fnd people to talk to,” are rooted in this fear. JFDI. Customer development isn’t just about street intercepts. You can 78 Talking to Humans recruit people on Craigslist, Facebook and LinkedIn groups, and good old fashioned networking. 7. You talk to anyone with a pulse I see some teams taking a shotgun approach. Instead, defne your assumptions around who your customer will be and who your early adopter will be. You might even do a lightweight persona (see the book Lean UX for examples). Zoom in on those people and try to validate or invalidate your assumptions about your customers. It is ok to occasionally go outside your target zone for learning, but don’t boil the ocean. Focus, learn, and pivot if necessary. 8. You wing the conversation If you go into a conversation unprepared, it will be evident. Write up your questions ahead of time and force-rank them based on the risks and assumptions you are worried about. To defne your assumptions, you can answer the questions in the business assumptions exercise (previous section), or do a business model canvas or a lean canvas. Your exact method doesn’t matter as much as the act of prioritizing your risk areas. During your actual interview, do not literally read your questions from a piece of paper, but rather keep things conversational (remember, you are getting the subject to tell you stories). If you uncover something interesting, follow your nose and don’t be afraid to diverge from your initial priorities. 9. You try to learn everything in one sitting Rather than trying to go as broad as possible in every conversation, you are actually better of zooming in on a few areas which are critical to your business. If you have a huge range of questions, do more interviews and split the questions. Appendix 79 10. Only the designer does qualitative research It is ok to divide and conquer most of the time, but everyone on the team should be forced to get out and talk to real people. Note: you will probably have to coach newcomers on #5’s point about not jumping to conclusions. 11. You did customer development your frst week, but haven’t felt a need to do it since It is always sad to see product teams start things of with customer development, and then completely stop once they get going. It is perfectly fne to let customer discovery work ebb and fow. If your learning curve fattens, it can make sense to press pause or change up your approach. However, you want to build a regular qualitative cadence into your product process. It will provide a necessary complement to your quantitative metrics, because it will help you understand the reasons why things are happening. 12. You ask the customer to design your product for you Tere’s a famous line attributed to Henry Ford, “If I had asked people what they wanted, they would have said faster horses.” Remember, it is not the customer’s job to design the solution. It is your job. It is the customer’s job to tell you if your solution sucks. Get feedback, yes. Remember that the further away you are from a working product, the more you have to flter what you hear through your judgement and vision. Disclaimer As with all tips on lean and agile, there are always places and times to break the rules and do what is right for your context, and your business. 80 Talking to Humans Glossary Concierge and “Wizard of Oz” Experiments A concierge experiment is where you manually act out your product. An example in Eric Ries’ book Te Lean Startup shows an entrepreneur serving as a personal shopper for people before trying to design an automated solution. When my colleagues were testing a diet plan service, we did not want to rush to sofware before testing our assumptions. Instead, we interviewed participants about their food preferences, manually created meal plans which were emailed to them over two weeks, and interviewed them at various points in the process. At the end of the two weeks, we asked them to pay a set amount to continue, and tracked the conversion rate. A “Wizard of Oz” experiment is similar, with the diference being that the manual work is hidden from the customer. For example, another set of colleagues tested an idea for a smart task management system for married couples. Te twenty couples participating in the test thought that they were interacting with a computer system, but in reality they were emailing in to our team, who then processed the emails accordingly. We just said that the servers would be “down” at night! Minimum Viable Product (MVP) An MVP is the smallest thing you can create that gives you meaningful learning about your product. MVP is ofen used interchangeably with “experiment” in the broader community. I personally tend to reserve it specifcally for tests around the product, and not for experiments related to other business assumptions. It is best to think about MVPs as an ongoing process, rather than a single release. Validation is rarely that neat and tidy. Appendix 81 Scientifc Method I think the best way to explain the scientifc method is to quote the theoretical physicist, Richard Feynman: “In general we look for a new law by the following process: frst we guess it. Don’t laugh -- that’s really true. Ten we compute the consequences of the guess to see what, if this law is right, what it would imply. Ten we compare those computation results to nature, i.e. experiment and experience. We compare it directly to observation to see if it works. “If it disagrees with experiment, it’s wrong. Tat simple statement is the key to science. It doesn’t make a diference how beautiful your guess is, it doesn’t make a diference how smart you are, who made the guess or what his name is -- if it disagrees with experiment, it’s wrong. Tat’s all there is to it.” (Cornell lecture, 1964) It is relatively straightforward to apply the scientifc method to business. You accept that your ideas are hypotheses. You make them as specifc as possible so that you can guess the results, i.e. the implications, of your hypotheses. You design and run an experiment. If your hypothesized results do not match the results of your experiment, your hypothesis is proven wrong. However, business is about people, and people are highly complex and inconsistent compared to laws of nature. So if your experiment fails, you will still need to apply judgement about whether the errors are in the hypothesis or in the experiment. 82 Talking to Humans Other Learning Resources Authors Te two seminal books on the topics of lean innovation and customer development are Steve Blank and Bob Dorf ’s Te Startup Owner’s Manual and Eric Ries’ Te Lean Startup. Tere are a ton of other resources out there, from books to videos and blog posts. Rather than link to particular items and thus miss out on newer developments, here are a few names that I recommend you pay attention to: Alex Osterwalder, Alistair Croll, Ash Maurya, Ben Yoskowitz, Brant Cooper, Cindy Alvarez, David Bland, Jef Gothelf, Joel Gascoigne, Josh Seiden, Kevin Dewalt, Laura Klein, Patrick Vlaskovits, Rob Fitzpatrick, Salim Virani, and Tristan Kromer. Talking to Humans Website On our website talkingtohumans.com, you can get worksheet pdfs and sign up for our email list, where we send occasional notes based on useful resources we discover. Behind the Book 83 Gif Constable (gifconstable.com) is a repeat entrepreneur and currently the CEO of Neo, a global product innovation consulting company. He has held product design and business roles in six startups, and provided M&A and IPO services to technology frms while at Broadview/Jeferies. He was one of the earliest adopters & bloggers of the Lean Startup movement, co-organizes the 4,700-person Lean Lessons Learned meetup in New York, and tries to give back to the entrepreneurial community through mentoring and speaking engagements. He lives outside of New York City with his wife, two children, and an excessively rambunctious retriever. Giff Constable Talking to Humans was written by Gif Constable, at the instigation and with the collaboration of Frank Rimalovski of NYU’s Entrepreneurial Institute, and with the wonderful illustrations of Tom Fishburne. Behind the Book 84 Guide to Customer Discovery Frank Rimalovski brings over 20 years of experience in technology commercialization, startups and early-stage venture capital investing. He is executive director of the NYU Entrepreneurial Institute, managing director of the NYU Innovation Venture Fund, Adjunct Faculty at NYU’s Polytechnic School of Engineering, and an Instructor in the NSF’s I-Corps program, having trained and mentored hundreds of entrepreneurs in customer development and lean startup methodologies. Previously, he was a founding partner of New Venture Partners, director/entrepreneur-in-residence at Lucent’s New Ventures Group, and has held various positions in product management, marketing and business development at Sun Microsystems, Apple and NeXT. He lives outside of New York City with his wife, two daughters and his increasingly mellow mutt. Frank Rimalovski Tom Fishburne (marketoonist.com) started drawing cartoons on the backs of Harvard Business School cases. His cartoons have grown by word of mouth to reach 100,000 business readers a week and have been featured by the Wall Street Journal, Fast Company, and the New York Times. Tom is the Founder and CEO of Marketoon Studios, a content marketing studio that helps businesses such as Google, Kronos, and Rocketfuel reach their audiences with cartoons. Tom draws from 19 years in the marketing and innovation trenches at Method Products, Nestle, and General Mills. He lives near San Francisco with his wife and two daughters. Tom Fishburne Behind the Book 85 Like The Book? When Frank approached me to write this book, we both had the same goal of giving back to the community. We debated charging for the book, and pondered whether the question of free versus paid would afect how it was perceived. But ultimately, we decided to put it out into the world for free. Should you like Talking to Humans, and feel a need to contribute back to something, we would encourage you to think about doing one or all of the following: 1. Pay it back (and forward!) by mentoring another student or entrepreneur 2. Donate to one of our favorite causes: Charity: Water, Girls Who Code, Kiva or the NYU Entrepreneurial Institute 3. Share a link to the talkingtohumans.com website or give someone a copy of the book If this book has helped you in some small way, then that is reward enough for us. It’s why we did it. Gif Constable and Frank Rimalovski September 2014 talkingtohumans.com page intentionally blank Acclaim for Talking to Humans “Talking to Humans is the perfect complement to the existing body of work on customer development. If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have.” Steve Blank, entrepreneur and author of The Startup Owner’s Manual “Getting started on your Customer Discovery journey is the most important step to becoming a successful entrepreneur and reading Talking To Humans is the smartest frst step to fnding and solving real problems for paying customers.” Andre Marquis, Executive Director, Lester Center for Entrepreneurship, University of California Berkeley “If entrepreneurship 101 is talking to customers, this is the syllabus. Talking to Humans is a thoughtful guide to the customer informed product development that lies at the foundation of successful start-ups.” Phin Barnes, Partner, First Round Capital “A lot of entrepreneurs pay lip service to talking to customers but you have to know how. Talking to Humans ofers concrete examples on how to how to recruit candidates, how to conduct interviews, and how to prioritize learning from customers more through listening versus talking.” Ash Maurya, Founder of Spark59 and author of Running Lean “When getting ‘out of the building,’ too many people crash and burn right out of the gate and wonder what happened. Talking to Humans is a quick and efective guide for how Lean Startup interviews should be done.” Dean Chang, Associate VP for Innovation & Entrepreneurship, University of Maryland #talkingtohumans talkingtohumans.com	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 are the essential steps and key points from the customer discovery process outlined in "Talking to Humans"? TALKING TO HUMANS Success starts with understanding your customers GIFF CONSTABLE with Frank Rimalovski illustrations by Tom Fishburne and foreword by Steve Blank Copyright ©2014 Gif Constable First edition, v1.71 All rights reserved. Book design: Gif Constable Illustrations by Tom Fishburne Cover design assistance: Jono Mallanyk Lean Startup is trademarked by Eric Ries Customer Discovery is a phrase coined by Steve Blank ISBN: 978-0-9908009-0-3 Special thanks to the NYU Entrepreneurial Institute for their collaboration and support in the creation of Talking to Humans Acclaim for Talking to Humans “If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have.” Steve Blank, entrepreneur, educator and author of Four Steps to the Epiphany and The Startup Owner’s Manual “If entrepreneurship 101 is talking to customers, this is the syllabus. Talking to Humans is a thoughtful guide to the customer informed product development that lies at the foundation of successful start-ups.” Phin Barnes, Partner, First Round Capital “Getting started on your Customer Discovery journey is the most important step to becoming a successful entrepreneur and reading Talking To Humans is the smartest frst step to fnding and solving real problems for paying customers.” Andre Marquis, Executive Director, Lester Center for Entrepreneurship University of California Berkeley “A lot of entrepreneurs pay lip service to talking to customers but you have to know how. Talking to Humans ofers concrete examples on how to how to recruit candidates, how to conduct interviews, and how to prioritize learning from customers more through listening versus talking.” Ash Maurya, Founder Spark59 and Author of Running Lean “Tis is a great how-to guide for entrepreneurs that provides practical guidance and examples on one of the most important and ofen under practiced requirements of building a great startup—getting out of the ofce, talking directly with customers and partners, and beginning the critical process of building a community.” David Aronoff, General Partner, Flybridge Capital “Gif has been one of the thought leaders in the lean startup movement from the very beginning. Entrepreneurs in all industries will fnd Talking to Humans practical, insightful, and incredibly useful.” Patrick Vlaskovits, New York Times bestselling author of The Lean Entpreneur “Current and future customers are the best source of feedback and insight for your new product ideas. Talking to them is intimidating and seemingly time-consuming. In this focused, practical, down-to-earth book Gif Constable demystifes the art (not science) of customer discovery helping entrepreneurs and product veterans alike learn how to build a continuous conversation with their market and ensure the best chances of success for their ideas. Want to know what your audience is thinking? Read this book!” Jeff Gothelf, author of LeanUX “When getting ‘out of the building,’ too many people crash and burn right out of the gate and wonder what happened. Talking to Humans is a quick and efective guide for how Lean Startup interviews should be done: who to talk to, how to talk your way in the door, and how to gain the most insight and learning. Don’t crash and burn – read Talking to Humans!” Dean Chang, Associate Vice President for Innovation & Entrepreneurship University of Maryland “A must read for anyone who is considering creating a startup, developing a new product or starting a new division. Read this book frst – a great guide to the evolving art of customer discovery. Don’t waste your time building products that your customer may or may not want. Before you write the frst line of code, pitch your idea to investors or build the frst prototype, do your self a favor, read this book and follow the advice! I guarantee you will make better decisions, build a better product and have a more successful company.” John Burke, Partner, True Ventures “Primary market research has been around for a long time because it has stood the test of time and proved that it is fundamental to building a successful venture; it underlies all that we do at MIT in entrepreneurship. Te question is how we more broadly deployed appropriate skills to entrepreneurs so they can be guided to do this in an efcient and efective manner while maintaining rigor. With all the sloganeering out there on the topic, this book stands out in that it delivers real value to the practitioner in this regard.” Bill Aulet, Managing Director, Martin Trust Center for MIT Entrepreneurship “Talking to strangers can be scary, but it’s vital to launching any new product. Trough storytelling, Gif Constable makes customer development concepts accessible. Tis book will show you how to articulate assumptions, get useful information and turn it into meaningful insights. Ten it delivers practical advice you can use immediately to test your ideas. Fear holds people back. Tis book will give you the confdence to jump.” Andres Glusman, Chief Strategy Offcer, Meetup.com Table of Contents 8 Foreword 11 Introduction 14 The Story 28 Lessons Learned 30 How To 31 Getting Started with Customer Discovery 32 Who Do You Want to Learn From? 36 What Do You Want to Learn? 44 How Do You Find Your Interview Subjects? 52 How to Ensure an Effective Session? 58 How Do You Make Sense of What You Learn? 65 Conclusion 66 Appendix 67 Cold Approach Examples 69 Business Assumptions Exercise 72 Teaching Exercise #1: Mock Interviews 74 Teaching Exercise #2: Mock Approach 76 Screwing Up Customer Discovery 80 Glossary 82 Other Learning Resources 83 Behind the Book 8 Talking to Humans Foreword “Get out of the building!” Tat’s been the key lesson in building startups since I frst started teaching customer development and the Lean Launchpad curriculum in 2002. Since then, a lot has happened. Te concepts I frst outlined in my book Te Four Steps to the Epiphany have grown into an international movement: Te Lean Startup. Te class I developed - Te Lean Launchpad - is now taught at Stanford, UC Berkeley, Columbia University, UCSF, and most recently New York University (NYU). More than 200 college and university faculty have taken my Lean Launchpad Educators Seminar, and have gone on to teach the curriculum at hundreds of universities around the globe. Te National Science Foundation, and now the National Institute of Health, use it to commercialize scientifc research as part of their Innovation Corps (I-Corps) program. My How to Build a Startup class on Udacity has been viewed by over 225,000 students worldwide. During the past few years, we’ve seen dozens of large companies including General Electric, Qualcomm and Intuit begin to adopt the lean startup methodology. Te Lean Startup turns the decades-old formula of writing a business plan, pitching it to investors, assembling a team, and launching and selling a product on its head. While terms like “pivot” and “minimum viable product” have become widely used, they are not understood by many. Te same can be said of “getting out of the building”. Many entrepreneurs “get out” and get in front of customers, but take a simplistic view and ask their customers what they want, or if they would buy their startup’s (half-baked) product. Te “getting out” part is easy. It is the application of the customer Foreword & Introduction 9 development methodology and the testing of their hypotheses with users, customers and partners that is both critical and ofen difcult for entrepreneurs to grasp in the search for a scalable and repeatable business model. Since the Four Steps, many other books have been written on customer development including Te Startup Owner’s Manual, Business Model Generation, Te Lean Startup, and others. Each of these texts has advanced our understanding of the customer development methodology in one way or another, teaching aspiring students and entrepreneurs the what, when and why we should get out of the building, but have only skimmed the surface on “how” to get out of the building. For both my own classes as well as I-Corps, I always made Gif Constable’s blog post “12 Tips for Early Customer Development Interviews” required reading. It answered the “how” question as well. Now Gif has turned those 12 tips into an entire book of great advice. In a comprehensive, yet concise and accessible manner, Talking to Humans teaches you how to get out of the building. It guides students and entrepreneurs through the critical elements: how to fnd interview candidates, structure and conduct efective interviews and synthesize your learning. Gif provides ample anecdotes as well as useful strategies, tactics and best practices to help you hit the ground running in your customer discovery interviews. If you are a student, aspiring entrepreneur or product manager trying to bring the value of getting out of the building to an existing company, Talking to Humans is a must read. It is chock full of lessons learned and actionable advice that will enable you to make the most of your time out of the building. Talking to Humans is the perfect complement to the existing 10 Talking to Humans body of work on customer development. If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have. Steve Blank September 3, 2014 Foreword & Introduction 11 Introduction 12 Talking to Humans Te art of being a great entrepreneur is fnding the right balance between vision and reality. You are probably opening this book because you want to put something new in the world. Tat’s an incredibly powerful and meaningful endeavor. It’s also scary and extremely risky. How can you get ahead of that risk and beat the odds? Every new business idea is built upon a stack of assumptions. We agree with Steve Blank’s insight that it is better to challenge your risky assumptions right at the start. You can’t challenge anything sitting in a conference room. You have to get into the market, or, as Blank likes to say, “Get out of the building!” Tere are two efective ways to do this: 1. talk directly to your customers and partners, and observe their behavior; 2. run experiments in which you put people through an experience and track what happens. Tis book focuses on the frst. Te qualitative part of customer discovery is surprisingly hard for most people, partly because talking to strangers can feel intimidating, and partially because our instincts on how to do it are ofen wrong. Here’s what customer discovery is not: It is not asking people to design your product for you. It is not about abdicating your vision. It is also not about pitching. A natural tendency is to try to sell other people on your idea, but your job in customer discovery is to learn. You are a detective. You are looking for clues that help confrm or deny your assumptions. Whether you are a tiny startup or an intrapreneurial team within a big company, your goal is not to compile statistically signifcant answers. Instead you want to look for patterns that will help you make better decisions. Tose decisions should lead to action, and smart action is what you need for success. Foreword & Introduction 13 Tis book was written as a focused primer on qualitative research to help you get started. You should view it as a complement to the other excellent resources out there on customer development and lean innovation. It is not a rulebook, but hopefully you will fnd the principles included here useful. Te book comes in two parts. It begins with a fctional story of two entrepreneurs doing customer research for the frst time. Te second part is a mix of theory and tactics to guide you through the core steps of customer discovery. While the fctional story highlights a consumer-facing business, I should note that there are plenty of tips in this book for teams who sell to the enterprise. Some last words to kick things of: entrepreneurs have a tendency to over-obsess about their product to the neglect of other business risks. Tey also tend to stay inside their heads for far too long. I urge you to be brave, get out of the building, and go talk to real human beings. Gif Constable August 2014 Some Thanks Are Due Many thanks to Frank Rimalovski for encouraging me to write this, and his students and team at NYU for providing early feedback, Steve Blank for the foreword and his inspiration and leadership on the topic of entrepreneurship, Tom Fishburne for his great illustrations, Josh Seiden and Jef Gothelf for their insights, my colleagues at Neo for continuing to push forward the craf of customer development, the many speakers and members of New York’s Lean Lessons Learned meetup who have shared their stories with me, and Eric Ries for inspiring me and so many others. The Story PART ONE The Story 15 Breakthrough Koshi and Roberta had so much adrenaline pumping through their systems that neither could sleep that night. Afer a year of challenging lab work, they had fnally cracked it. Tey were now sure they could manufacture artifcial down feathers cost-efectively. Teir insomnia was ironic, since their very dream was to transform the quality of people’s sleep through the invention of a better pillow. Tey knew they had a technical advantage. Teir artifcial down had heightened levels of insulation, a better resilience/resistance quotient, and was kinder to both animals and the environment. Now the question was, did they have a business? The Advisor Tey called a meeting with their entrepreneurial advisor the next day. Samantha had built four companies, successfully exiting two of them. She was now an angel investor and believed frmly in giving back by working with frst-time entrepreneurs. “We fnally cracked it!” Roberta blurted out. “What she means,” Koshi said, “is that we’re convinced we can manufacture NewDown in a cost-efective and repeatable manner. Now we think we can make a real business.” “So you want to know if the time has come to jump in feet frst?” asked Samantha. Te two scientists nodded. “If you want to be successful bringing something to market, you need to understand the market. Do you feel like you know when and why people buy pillows today?” “Not really,” Roberta said. “We’ve spent our time in the lab focused on the product side.” “I suspected so. Founders commonly obsess about product at the 16 Talking to Humans expense of the understanding the customer or the business model. You need to work on it all, and you have to challenge your thinking. Behind your startup is a belief system about how your business will work. Some of your assumptions will be right, but the ones that are wrong could crater your business. I want you to get ahead of the risky hypotheses that might cause failure.” Samantha had the founders list out the riskiest hypotheses. 1. We believe that people care about sleep quality when making a pillow purchase decision. 2. We believe that we can sell online directly to customers. 3. We believe that our customers will be young urban professionals. 4. We believe that our very frst customers will be new graduates who need to outft their apartments. 5. We believe that we can sell our pillows at a high enough price to cover our costs. 6. We believe that we can raise enough capital to cover investments in manufacturing. “Let’s put aside the fundraising risk right now,” Samantha said. “It’s what everyone jumps to, but you need to strengthen your story frst. Many of your risks are tied to your customer. I like attacking a problem from multiple directions and recommend three approaches. First, I want you to walk a day in your customer’s shoes and actually go out and buy a pillow. Second, I want you to observe people in the process of buying a pillow. And third, I want you to talk directly to them.” “Talk to people?” said Koshi. “I’m a scientist, not a salesperson. If I simply asked someone if my pillow was better, they would have no idea. If I asked them if they would buy my pillow, I couldn’t trust The Story 17 the answer. So what is the point?” “Your job right now isn’t to sell, but rather to learn. You are right, though: getting the customer to speculate is rarely useful,” Samantha said. “You need to understand your market. How does your customer buy? When do they buy? Why do they buy? Where do they buy? As a scientist, you are fully capable of doing research, gathering data, and seeing if your data supports your hypotheses. I promise you, if you are polite and creative, people will be more receptive to you than you might think.” “Buying. Observing. Talking. Do we really need to do all three? Can we really aford to spend the time?” “Can you aford not to? Each of the three approaches is imperfect, but together you should see patterns. By walking in your customer’s shoes you will gain empathy and personal understanding, but you don’t want to rely solely on your own experience. By watching people shop, you can witness honest behavior, but you won’t be able to get into their heads to know their motivations. By talking to people, you gather intel on both behavior and motivation, but you have to be careful not to take what you hear too literally. Each method has strengths and weaknesses, but taken together you will learn a ton. You will have a lot more confdence that you are either on the right track, or that you have to make changes to your plans. It is far better to discover bad assumptions now, before you have invested a lot! Now, how do you think you should proceed?” “We want our customers to buy online from us, so I guess we should also buy our own pillow online,” said Roberta. “And we can observe people shopping by going to a home goods store.” “Tat sounds good,” said Samantha. “You will want to talk to some of those people in the store as well. I see one catch: you will be 18 Talking to Humans targeting the moment of purchase but not the type of customer you are hoping for. One of your risk assumptions was specifcally about young urban professionals and new graduates, so what can you also do to target and connect with them?” “What about going to a cofee shop near the downtown ofce buildings as people are going to work?” Koshi said. “Can’t we just hit up some of the people we used to know in college who are now in the working world?” Roberta said. “Why don’t you try both, and see which approach works better,” said Samantha. “Roberta, I would also ask your friends if they will refer you to their friends. It’s best to talk to people who aren’t too close to you. You don’t want a someone’s afection for you to steer what they have to say. “Let’s start by thinking through the questions you want to ask. It always makes sense to prioritize what you want to learn. You should write down an interview plan, even if you don’t completely stick to it. Break the ice, and then get them to tell you a story about buying a pillow!” Te scientists sketched out a plan: Intro: hello, I’m a PhD candidate at Hillside University and I’m researching sleep quality. I’m asking people about the last time they bought a pillow. Would you mind if I asked a few questions? When was the last time you bought a pillow? Why did you go looking for a pillow? How did you start shopping for a pillow? Why did you choose the one you bought? After you bought, how did you feel about the pillow you purchased? The Story 19 Are you going to be in the market for a pillow anytime soon? “Tat’s a great start,” Samantha said. “Keep good notes as you go, and remember to regularly regroup to review your fndings and look for patterns. Be mindful of which method you used as you discuss your observations.” Walking in the Customer’s Shoes Koshi and Roberta got together the next day afer both purchasing a pillow online. “I found it all a bit frustrating,” said Roberta. “It was hard to learn why you would choose down feathers, cotton, or foam. Te manufacturer websites felt like they were from the 1990s. Tere were some reviews available on Amazon and Bed Bath & Beyond, which helped. In my interpretation, about 65% of reviews talked about sleep quality, which seems like a good sign for our frst risk. A lot of the reviews had to do with personal preference for frm versus sof pillows. I think we can ofer both kinds eventually, but we likely need to choose one at the beginning and that could impact some of our assumptions around market size. ” “I started out by searching Google,” said Koshi. “Amazon and BB&B dominated the results, as we expected, but there were a few specialty providers like BestPillow that ranked high. BestPillow lets you navigate their website by sleep issue, such as snoring or neck pain, which I found interesting. While I see some makers pushing hypoallergenic oferings, I didn’t see anyone who could meet our claims of being environmentally friendly. I agree that all the manufacturer websites felt ancient. I think there’s an opportunity to be smart about search engine optimization and really stand out if we can get the messaging right. I guess our next step is to visit the retail 20 Talking to Humans stores.” Observing the Customer Roberta ended up going to a Bed Bath & Beyond while Koshi went to a local department store. She watched three diferent people come in and pick through several diferent pillows, puzzling over the packaging material. One of them asked a store employee for help, and two pulled out their mobile phones to look online. She then watched a woman go right to a particular shelf, grab a pillow and head back to the aisle. Roberta’s plan was to balance observation and interaction, so she decided to jump in. “Pardon me,” she said “I am trying to fgure out which pillow to purchase and noticed that you went right to that one. Might I ask why you chose that pillow?” “Oh, I replaced some ratty old pillows in my house a few weeks ago,” the woman said, “and I liked this one so much that I thought I would replace my whole set.” “Do you mind if I ask how you decided to buy that pillow in the frst place? My name is Roberta, by the way.” “Nice to meet you, Roberta. I’m Susan. Well, I guess I started by researching online and...” A day later, the founders met to compare notes. “Te BB&B had good foot trafc,” Roberta said, “and I was able to watch ffeen people, and speak to ten. Of the ten, one knew what she wanted going into the store, three were basing their purchase just on packaging and store price, and six did Google searches on their phones, right there in the store. Tey were looking up reviews and pricing. You mentioned search engine optimization earlier — I think it could be even stronger with a fabulous mobile experience.” She looked down at her notes. “I also found that seven out of ten were trying to choose a pillow specifcally for better sleep, although their sleep problems were diverse. Finally, when I asked The Story 21 them why they were buying a pillow, the folks over 40 seemed to be in replacement mode, while the folks under 40 seemed to be reacting to a life change. Two people were moving to a bigger house from an apartment. Another person was moving in with their girlfriend, and another said that she got a new job and could now aford nicer things.” “I went to the home goods section of a high-end department store,” said Koshi. “I saw eighteen people, and fve of them knew what they wanted already. Te rest spent time puzzling over the packaging and, like your group, going online with their mobile phone. I spoke to nine shoppers. I said that I was a scientist trying to invent a new pillow. People thought that was pretty cool. Two of them admitted that they were buying the highest price pillow because they assumed that it had to be the best. Two got the cheapest because it was the cheapest. Te others had specifc preferences for down, cotton or foam based on the frmness they were looking for in a pillow. Te frmness preference seemed to be tied to a belief that they would sleep more soundly. On price, I was relieved to see that the prices of the better pillows were in line with what we were hoping to charge.” Roberta pulled out a pad. “So we saw thirty-three people and spoke to nineteen. Our sample set is still small, but Samantha told us to look for patterns and not worry about statistical signifcance right now. If we break our observations into a few metrics, what have we learned?” • 24% of shoppers knew what they wanted when they walked in • 52% looked up information on their phone in the store • 45% of shoppers purchased a mid-priced or high-priced pillow • 68% of the people we spoke to indicated that better sleep was a major driver of their choice 22 Talking to Humans • 37% of the people we spoke to were reacting to a life change • 37% of the people we spoke to were in replacement mode “I think the use of mobile phones is something we need to pay attention to and work into our strategy,” Koshi said. “I guess for our next step, we should follow Samantha’s suggestions to target urban professionals.” Regrouping A week and many interviews later, the team sat down with Samantha. “How did things go?” she asked. “I went to a downtown cofee shop at peak hour,” Koshi said. “At frst, everyone was in such a hurry to get to work that I didn’t get much response, but then I made a little sign I held up outside that promised ‘cofee for science,’ which started to get laughs and a lot of curiosity. I ended up talking to about ffeen people who matched our target of young urban professionals. I got to talk to them for about fve to twenty minutes each. It was actually very enjoyable. “One clear pattern was that people right out of school tended to have no clue. Tey either had never bought a pillow themselves, or if they had, it had been the cheapest thing they could get. A few admitted that they were probably going to buy new bedding. I know it is speculation, but I asked them to guess how they might go about looking for a pillow, based on how they shop for other things. Te common responses were searching on Google or Amazon, or walking into a Bed Bath & Beyond. “Te few folks in their later twenties or thirties whom I spoke to had usually bought at least one pillow — some from Amazon and some from retailers. Te ones who liked a frm pillow avoided The Story 23 down feathers. Te ones who wanted to upgrade to fancier duvets and high thread-count sheets all seemed to go with duck and goose feathers. Tey didn’t know any brands and instead relied on product packaging. Amazon buyers did actually read the reviews. All these folks were only planning on buying new pillows when they were moving to a bigger apartment because they were getting married or something.” “Yes, that aligns with what we learned when we spoke to people in the retail stores and what I saw with my other interviews,” said Roberta. “Pillow buying seems to be tied to life events like moving and marriage and such. I interviewed a diferent group. A whole bunch of our old classmates responded to my email or my Facebook post. I even had some folks pass me on to their friends, and so I got to talk to some people who didn’t go to school with us. “Like you, I saw a lag efect afer someone graduated from college. When new graduates told me that they had not spent any money on their linens yet, I inquired further and found out that their initial spending money was predominately going towards clothes. I spoke to twelve people between 22 and 25, and roughly 60% had actually bought a pillow in the last few years. I saw similar trends as you, although most went right to Google, Amazon or a few specialty online retailers. It seemed like a very online crowd. Te price sensitive ones stayed away from down. Tey didn’t have much to go on for brand, but the reviews helped. Te women defnitely cared more about quality and put more efort into their hunt.” “Te good news is that everyone thought inventing a new pillow was an awesome idea!” said Koshi. Samantha chuckled. “Of everything I’ve heard you say, that last bit is probably the least useful. It’s easy to say something is cool. It’s another thing to actually buy. Te good news is, you are a lot more educated about your market than you were last time we met. 24 Talking to Humans I see from your notes that you have either spoken to or observed 72 people. We should be able to see some patterns from that. Let’s revisit our critical assumptions.” Challenging Assumptions Te team looked at their initial list. 1. We believe that people care about sleep quality when making a purchase decision. “68% of the retail shoppers indicated that this was a major factor,” said Roberta. “Of our young urban professionals, we were able to ask this of only a portion of our interviewees. Only 56% indicated that it was a factor, but if we factor out the new graduates, it was more like 70%. We’ve also read a lot of online reviews and have seen this come up repeatedly. We feel reasonably confdent that this is a common decision point in choosing a pillow,” said Koshi. “I’m glad you are approaching this with rigor and actually calculating metrics from your observations,” said Samantha. “Tat will prevent you from letting innate biases override your actual results. However, one word of advice. At this stage, don’t take any of your statistics too literally and don’t let any single number dominate your strategic thinking. Just as we’re not looking for statistical signifcance at this point, we also don’t want to start treating our results as if they are indisputable facts. How about the next assumption?” 2. We believe that we can sell online directly to customers. “We have seen some promising signs. 77% of our urban professionals start researching purchases with a search engine. Te question is whether they would discover, visit, or convert with our The Story 25 online store. We did see a ton of mobile usage in the retail stores and think there might be a chance to steal those customers if we have good enough search engine optimization. Overall, our conclusion is that we need more data here.” 3. We believe that our customers will be young urban professionals. “I need to run some numbers on size of market and the number of purchases we might expect from this group, but we still feel like this is a good group for us. We clearly saw purchase behavior. Tey want, and can aford, quality things, and prefer to buy things online.” 4. We believe that our very frst customers will be new graduates who need to outft their apartments. “Tis is where we were totally wrong. Buying behavior, or at least the willingness to buy something that isn’t the cheapest option, did not seem to be very prevalent among new grads. Only 25% of the newly minted grads we spoke with had purchased a pillow on their own. Instead, the evidence points us towards people in their mid-tolate twenties or early thirties. “We also saw a correlation between purchasing and life changes. While this was only 37% with our retail shoppers, it was 70% of our urban professionals. From an early adopter perspective, I wonder if we can do well targeting people who are getting married or moving to a larger apartment or house?” 5. We believe we can sell our pillows at a high enough price to cover our costs. “45% of our retail shoppers bought at least a mid-priced pillow. We admit that we visited reasonably high-end stores, but that was still a nice statistic to see. Te good news is that our initial target price is comparable with the high-end of the current market. We 26 Talking to Humans won’t be proftable at the beginning, but if we can scale and improve our manufacturing process then we can move into the black. Of course, they have to want to buy our pillow.” Samantha nodded. “To test that, you will need to actually try selling a few, which ties back to your second risk. But I’m glad you have spent time learning rather than rushing to sell. Overall, it sounds like you have gotten some solid intel. I’m also glad you caught the issue with college grads before you spent a lot of money and energy trying to target them. Have your eforts uncovered new risks or worries?” “I’m both excited and worried by how confused customers are,” Koshi said. “Every brand promises a better night’s sleep. I’m also worried about signals we picked up that the market might be divided into those who want a frm pillow versus a sof pillow. We think that’s erroneous thinking. Our pillow lands in the middle, and our studies show better results. I don’t know if people will believe our data. We really need to get the messaging right.” “As for me,” Roberta said, “I’m most worried about the size of our initial market, how quickly we could grow, and if we can survive to proftability.” “I’m not surprised,” said Samantha. “I have some suggestions. One of you should continue doing these interviews, but try adding a new spin. You are both worried about diferentiation and if people will understand or appreciate the proof from your scientifc studies. Let’s test some messaging. Given what you have said about mobile usage, maybe create an infographic that tries to make your case. Show it to people on a phone. Ask them to explain it to you. First you can see if they understand it, and then if they fnd it meaningful. “Expanding from qualitative research, I also think one of you should create a fnancial model that lets you play with how much The Story 27 you charge, how many items you might sell, and what your costs will be. Take into account what you have learned so far and see if your business model adds up. “Finally, I think you’ve learned enough to run some experiments around customer acquisition and sales. It is straightforward to create a basic online store using one of the hosted services. You can test selling a few pillows before you invest in manufacturing capability. Try driving trafc through Google or Facebook ads, and run some A/B tests around ad copy, landing-page messaging and price points. Study your metrics. Ten follow up with your customers and interview them on their buying process and decision.” Roberta’s eyes widened. “Wow. Maybe we can get our frst paying customer!” “Exactly,” said Samantha. “Just remember Steve Blank’s phrase about startups: you are in search of a scalable and repeatable business model. Run these experiments and keep in mind that your mission at this point is to learn before you scale. Don’t stop talking directly to customers. Your questions will likely evolve, but no matter what stage you are in, you’ll usually fnd that your best insights will come from talking to real people and observing real behavior.” 28 Talking to Humans Lessons Learned The Story 29 So what are the key takeaways from Roberta and Koshi’s adventure? 1. Customer discovery is about gaining much deeper insight into your customer, or your partners, or your market 2. Being told your idea is cool is not useful; seeing behavior that validates your customer’s willingness to buy is very useful 3. Prepare an interview guide before you get out of the building 4. To ask the right questions, you need to understand your risks and assumptions 5. Get creative when trying to recruit people — if at frst you don’t succeed, try something new 6. Sometimes observation is as powerful as interviews 7. Take good notes, especially on your key risks, so that you can calculate metrics later. Even better, set your target goals ahead of time! 8. Bring learning back and analyze your patterns as a team 9. Never stop asking hard questions about your business In the next section of this book, we’re going to dive into tactics and talk about all this and more in detail. How To PART TWO How To 31 Getting Started with Customer Discovery Qualitative research, i.e. talking to humans, is something you never want to stop doing, but it can defnitely feel intimidating at frst. Te good news is that if you go about it in a professional and thoughtful way, you will fnd lots of people who are willing to help and give you some of their valuable time. You need to begin with a core set of questions: t Who do you want to learn from? t What do you want to learn? t How will you get to them? t How can you ensure an efective session? t How do you make sense of what you learn? 32 Talking to Humans Who Do You Want to Learn From? How To 33 If your desired customer is a doctor, it stands to reason that it won’t help you much talking to a plumber. If you were aiming for teenagers, would you talk to grandparents? Te frst step in trying to learn from the market is having an opinion about who your market actually is. I recommend thinking about a few categories: t Te typical customer you envision if you get traction with your idea t Your early adopter, i.e. the people who will take a chance on your product before anyone else t Critical partners for distribution, fulfllment, or other parts of your business You might think you are creating a product for “everyone”, but that is not an actionable or useful description in the early stages. You need to get more specifc. Your job is to think through the kinds of people who have the problem you are interested in solving. Sometimes they have a particular job, or a state of mind, live in a particular part of the world, or belong to a certain age group. Standard demographics might be useful, or they might be irrelevant. What are the commonalities across your customer base? Here are some examples: • A hospital management system has to think about the hospital administrator who will buy their software and the actual hospital workers who would use it • An on-call veterinarian service needs to talk to pet owners • An online marketplace for plumbers might consider plumbers on the sell side, and home owners on the buy side 34 Talking to Humans You also want to think about your early adopters. Why do they matter? Most new products ft alongside a “technology adoption curve,” as illustrated below. New founders tend to obsess about their mainstream customer (represented in the chart as the early and late majority). However, by defnition, the mainstream is waiting for proof from early adopters before they try something. If you cannot get early adopters, you cannot move on. Early adopters are usually folks who feel a pain point acutely, or love to try new products and services. In our story of Koshi and Roberta, the scientists hypothesized that their early adopter would be urban professionals in their mid to late twenties. For the three customer examples we just gave, here are examples of early adopters: • Our hospital management system might target hospital chains still stuck with an archaic vendor • Our vet service might target busy 20-somethings in a major city • Our online market for plumbers might target solo practices on the sellside and frst-time home owners on the buy-side How To 35 Tere is no prescription for how narrowly or broadly you should cast your net for customer discovery interviews. However, the more focused you can be, the easier it is to make sense of your evidence. Special Note for B2B Products If you are selling to the enterprise, you should also think about the diferent kinds of participants in your sales process. In a classic enterprise sale, you will ofen have a strategic buyer (who is excited about the change you can bring), an economic buyer (who controls the purse), a technical buyer (who might have approval/blocker rights), and then the actual users of your product. Can you identify your champion? Can you identify who might be a saboteur? For B2B companies, Steve Blank also recommends that you start by talking to mid-level managers rather than the C-suite. It can be easier to get their time, it is ofen easier to get repeat conversations, and, most importantly, it will allow you to get better educated before you go up the chain. 36 Talking to Humans What Do You Want to Learn? How To 37 Go into every customer interview with a prepared list of questions. Tis list, which we refer to as an interview guide, will keep you organized. You will appear more professional, and it will ensure that you get to your most important questions early. How do you know your most important questions? I like to begin by understanding my most important, and most risky, assumptions. Tose tend to be the areas where you need to gather insights most urgently. You can uncover your assumptions in a myriad of ways. You can use Alex Osterwalder’s business model canvas or Ash Maurya’s lean canvas. Personally, I ask these questions (see the Appendix for a worksheet and tips): • My target customer will be? • The problem my customer wants to solve is? • My customer’s need can be solved with? • Why can’t my customer solve this today? • The measurable outcome my customer wants to achieve is? • My primary customer acquisition tactic will be? • My earliest adopter will be? • I will make money (revenue) by? • My primary competition will be? • I will beat my competitors primarily because of? • My biggest risk to fnancial viability is? • My biggest technical or engineering risk is? • What assumptions do we have that, if proven wrong, would cause this business to fail? (Tip: include market size in this list) You should be able to look at this list and spot the assumptions that are both highly important and fairly uncertain. Be honest. You want to focus on the most important issues. 38 Talking to Humans In the case of our pillow entrepreneurs, they chose six initial risks which drove their research approach and frst set of questions. To give another scenario, in the last chapter we shared the example of an on-call veterinarian service. Te founders might identify a set of risks: 1. Pet owners are frustrated having to go to a vet and would rather have someone come to them 2. Customers are willing to pay a big premium to have a vet show up at their door 3. We think busy urbanite pet owners will be our early adopters 4. We think people currently discover their vets either through word of mouth or online searches 5. We can affordably acquire our customers through targeted Google search ads 6. We can recruit enough vets across the country to make this a big enough business 7. With travel baked in, our vets can see enough people in a day to be fnancially viable Not every assumption can be tested efectively through qualitative research, but in this case, our founders can probably get some insights on risks 1, 3, 4, and 6 just by talking to people. Risks 1, 3 and 4 would be focused on pet owners, while #6 would be focused on vets. Get Stories, Not Speculation When you are contemplating your questions, be careful with speculation. Humans are spectacularly bad at predicting their future behavior. It is tempting to say, “Would you like this idea?” or “Would you buy this product?” Unfortunately, you really have to treat those How To 39 answers with a great deal of skepticism. It is more efective to ask your interview subject to share a story about the past. For example, when our fctional scientists Koshi and Roberta created their interview plan, the questions were focused on getting the interviewee to tell a story about their last pillow buying experience. Keeping with our second example of an on-call vet service, the team might have a loose interview plan that looks like the following: • Warm up: concise intro on the purpose of the conversation • Warm up: basic questions about person and pet (name, age, picture) • Who is your current vet? Can you tell me about how you found and chose him/her? • Please describe the last time you had to take your pet to the vet for a checkup • Walk me through the process of scheduling a time to visit the vet. • What was frustrating about that experience? • What did you like about that experience? • Have you ever had an emergency visit to a vet? if yes, can you describe that experience for me? • Have you ever thought about changing vets? why / why not? Ask Open-Ended Questions Your goal is to talk little and get the other person sharing openly. To that end, it is imperative that you structure open-ended questions, or at minimum follow up yes/no questions with an open-ended question that gets them talking. One tip is to try to ask questions that start with words like who, what, why and how. Avoid questions that start with is, are, would, and do you. But remember, if you do get a yes/no answer to a 40 Talking to Humans question, you can always follow up in a way that gets them talking. An interesting open-ended question, which Steve Blank likes to use to conclude his interviews, is: “What should I have asked you that I didn’t?” Testing for Price Two of the hardest questions to answer through qualitative research are: will people pay? and how much will they pay? Speculative answers on this topic are extremely suspect. You can learn a lot, however, by asking questions like: • How much do you currently spend to address this problem? • What budget do you have allocated to this, and who controls it? • How much would you pay to make this problem go away? (this can lead to interesting answers as long as you don’t take answers too literally) My recommendation is to set up a situation where the subject thinks they are actually buying something, even if they know the thing doesn’t exist yet. Kickstarter and other crowdfunding platforms are used by a lot of teams to test pre-order demand. For expensive corporate products, you can also try to get customers to buy in advance or sign a non-binding letter of intent to buy. Te key thing to remember is that people don’t honestly think about willingness to pay unless they feel like it is a real transaction. Getting Feedback on a Prototype Sometimes you will want to get reactions to a product solution. You can learn a lot by putting mockups or prototypes in front of people, but, as with all speculation, you should interpret reactions with a degree of skepticism. If you show your interview subject a proposed solution, you need to separate this step from your questions about their behavior. How To 41 Ask your questions about behavior and challenges frst, so that the discussion about product features does not poison or take over the conversation. People do love talking features! The Magic Wand Question Some people like to ask, “if you could wave a magic wand and have this product do whatever you want, what would it do?” Personally, I avoid questions like this because customers are too constrained by their current reality to design efective solutions. It is the customer’s job to explain their behavior, goals, and challenges. It is the product designer’s job to come up with the best solution. Tere is one variation to the magic wand question that I do like, however, because it focuses on problems and not solutions: “If you could wave a magic wand and solve any problem, what would you want to solve?” I suspect, however, that you will fnd many people struggle with such an open question. Design “Pass/Fail” Tests Customer discovery is made up of a lot of qualitative research, but it helps to take a quantitative mindset. Set goals for key questions and track results. For example, halfway through their initial research, our scientists Koshi and Roberta already knew stats like: • 24% of shoppers knew what they wanted when they walked in • 45% of shoppers purchased a mid-priced or high-priced pillow • 68% of the shoppers we spoke to indicated that better sleep was a major driver of their choice Even better would have been if they had set targets ahead of time. For example, they might have set the following goals: • Because we are a new brand, we are hoping that most shoppers are undecided. We want to see that 40% or fewer shoppers already know what 42 Talking to Humans they want when they walk in • Because our pillow is expensive, we want to see that at least 40% of the shoppers buy mid or high-end models • Because we believe that sleep quality is a major differentiator for our product, we want over 60% of shoppers to indicate that this is a major factor in their decision making process Te numerical target you choose can be an educated guess. You do not need to stress over picking the perfect number. It is more important that you set a goal and really track what is happening. Setting a target forces you carefully think through what you are hoping to see, and makes decisions and judgment calls a bit easier as you review your data. A Guide, Not a Script An interview guide is not a script. You do not need to read from it like an automaton. You should feel free to veer of of it if the conversation brings up something interesting and new. It will likely evolve as you learn from the market and unearth new questions. But always plan, prioritize and prep your questions before any session. Observation Can Be As Powerful As Questions Sometimes the best thing you can do is sit back and watch someone’s behavior. You might watch their purchase process, or examine how they go about solving a particular problem. As you think about what you want to learn, also think through how you might gather data through observation rather than direct interviews. In our story of Koshi and Roberta, the two got some of their most valuable insights by going to linen stores and watching potential customers struggle to buy a pillow. Tey observed behavior and only then jumped in to ask questions. Tis technique cannot always be used. For example, when my How To 43 team was trying to validate a weight loss product idea, it did not feel practical to watch people go about their diet. Instead we did interviews and then put a group of customers through a two-week concierge experiment (see Glossary) where we manually acted out the diet experience. But, where possible, observing uninfuenced behavior can lead to great insights. 44 Talking to Humans How Do You Find Your Interview Subjects? How To 45 Entrepreneurs new to customer development are ofen intimidated at the thought of approaching complete strangers. It might surprise you to hear that people are ofen very willing to help out. Tis is especially true if you are working on a topic that interests them and you approach them nicely and professionally. Tere are three general rules to keep in mind when recruiting candidates to speak with: 1. Try to get one degree of separation away (don’t interview your mom, your uncle, or your best friends) 2. Be creative (and don’t expect people to come to you) 3. Fish where the fsh are (and not where they are not) Get Creative One aspiring entrepreneur wanted to target mothers of young children. She had heard stories about talking to people in a cofee shop, but felt like it was too unfocused. So she tried hanging around school pickup zones, but the moms were too busy and refused to speak to her. Next, she tried the playground, where she fgured moms would be bored watching their kids play. Tis worked reasonably well, but she was only able to get a few minutes of anyone’s time. So instead, she started organizing evening events for moms at a local spa where she bought them pedicures and wine. Te time of day worked because the moms could leave the kids at home with their partner. Te attendees had a great time and were happy to talk while they were getting their nails done. Find the Moment of Pain If you can connect with people at the moment of their theoretical pain, it can be very illuminating. My colleague Alexa Roman was working with an automotive company and they had a concept tied 46 Talking to Humans to the experience of getting gas. So Alexa and team visited a series of gas stations. Tey watched consumers go through the process of buying gas. Ten they approached them and asked questions. By thinking about the moment of pain they wanted to address, they knew exactly where to fnd their consumers and they were able to gather valuable observational research. Make Referrals Happen Use referrals to your advantage. Let’s say you want to talk to doctors. Tey are busy and have strong gatekeepers. I bet you know how to get to at least one doctor, however. Tat doctor will know other doctors. Even if your doctor happens to be a close friend and thus breaks the “more than one degree of separation” guideline, she can still give you advice on when might be a good time to talk to a doctor. She can also connect you with other doctors. You should use referrals as much as possible. Set a goal of walking out of every interview with 2 or 3 new candidates. When you end an interview, ask the person if they know others who face the problem you are trying to solve. If they feel like you have respected their time, they will ofen be willing to introduce you to others. Conferences & Meetups Conferences and meetups can be an amazing recruiting ground, because they bring a group of people with shared interests into one place. You just need to be respectful of people’s time. I have found that it is extremely efective to ask people for their time, but for later, afer the conference or meetup. Get their business card, let them get back to networking, and then have an in-depth conversation when it fts their schedule. Immediately afer the conference while their memories are still fresh, send them a short email that reminds them where you met, and give your ask for a conversation. Tis How To 47 works as efectively for in-demand panel speakers as it does for other attendees. Meetups are usually inexpensive, but conference tickets can be pricey. If you are on a budget, you can “hack” expensive conferences by intercepting people outside of the building, or, if you can get access to the attendee or speaker lists ahead of time, contacting people directly and meeting them near the event. Meetup.com has decent search tools to discover relevant events in your area, and a few good Google search queries can usually get you to a short list of conferences that ft your needs. Enterprise Customers Finding interviewees can be harder when you are focused on an enterprise customer. You need laser-like targeting. In addition to conferences, LinkedIn can be extremely useful. If you have hypotheses on the titles of the people you are seeking, run searches on LinkedIn. You might be able to get to them through a referral over LinkedIn, or you might need to cold call them through their company’s main phone number. You then have to decide on your approach method. You can either ask for advice (where you make it clear that you are not selling anything), or you can go in as if you were selling something specifc. Advice vs Selling Asking for advice should be your default method early in your customer discovery process. You will have better luck gaining access. People like being asked (it makes them feel important). Steve Blank used to call people up and say something like, “My name is Steve and [dropped name] told me you were one of the smartest people in the industry and you had really valuable advice to ofer. I’m not trying to sell you anything, but was hoping to get 20 minutes of your time.” 48 Talking to Humans Another efective spin on “asking for advice” is to create a blog focused on your problem space, and ask people if you can interview them for an article. When do you approach someone as if you were selling a product? Tis method is useful if you are past initial learning and want to test your assumptions around customer acquisition and messaging. Just don’t jump into sales mode too early. Beneftting from Gatekeepers If LinkedIn isn’t helping you and you need to reach high up in an organization, another approach is to call the CEO’s ofce. Your goal is not to talk to the CEO but actually their executive assistant. His job is to be an efective gatekeeper, so if you explain, “I’m looking to talk to the person who handles X”, they will ofen connect you to the right person (especially if you are pleasant and professional — notice the trend on that one?). Te added advantage of this method is if you end up leaving a voice mail for your intended contact, you can say “Jim from [CEO’s name]’s ofce gave me your name”. Dropping the boss’ name tends to improve response rates. Another approach is to send a targeted email into an organization with a very short email that asks for an introduction to the right person to speak to. You can make guesses as to email addresses based on LinkedIn queries. For this tactic to work, you must keep your emails extremely concise. Students and Researchers While people are willing to grant time to polite people who ask for advice, you have an extra advantage if you are a student or academic researcher. In other words, if you are a student or researcher, say so. As an extra incentive, you might also ofer to share the results of your research with your interview subjects. How To 49 You Might Be Surprised Another colleague of mine, Jonathan Irwin, was working with a Fortune 50 company. Te client team wanted to interview a special kind of oil platform engineer, of which there were less than 20 in the world! To access these people required security clearance and safety training. We challenged the team to fnd a way, expecting that they would have to rely on video conferencing or phone calls. However, the team started researching this speciality profession through Google and discovered that there was an onshore training facility just an hour away. Te moral of the story is that it ofen isn’t as hard as you think. No Fish in the Sea When I say fsh where the fsh are, it is really important to remember the fip side to that statement: don’t fsh where the fsh are not. If a method isn’t working, try something new. We were doing a project with a major magazine testing out new product ideas. Our target was busy women, and we knew that the readership correlated closely with shoppers of Te Container Store (a retail store). So we parked out front of a store and intercepted folks as they came in and out. People were willing to speak for a few minutes, but many were in a bit too much of a rush. Ten one of our teammates discovered a sample sale happening around the corner. Tere were probably 200 bored women waiting in line, most of whom were happy to talk to us to pass the time. (Note: fnding bored people stuck in line is a common recruiting hack.) Still, we didn’t feel like we were targeting quite as narrowly as we wanted (busy, working women) or as geographically broadly (we didn’t want to just talk to New Yorkers). So we turned to the magazine’s social media presence. We created a short online survey to help us qualify responses, and the magazine posted a link to their Twitter and Facebook pages with a catchy sentence. We had hundreds of women fll out the survey, and then we picked our top 50 Talking to Humans thirty candidates and scheduled calls. Online Forms & Landing Pages In a similar vein, one efective tactic is to create an online form or landing page and build up a list of people to contact. Below is an example of a landing page. Our team was testing a product idea for better home organization. Tis landing page test actually consisted of a three-step funnel with a call to action, a price choice, and then a request for an email address. We tracked the conversion metrics carefully and used the emails to schedule interviews. Caveat: driving trafc is never a trivial process. If you have budget, Google or Facebook ads can work. Otherwise, you can try to generate some word of mouth on social media or through bloggers. How To 51 Conclusion Hopefully what you are picking up through these examples is that there is no single way to get to people. It takes some creativity and hustle, but it isn’t as hard as you might think. Trust me, people will not think you are rude if you carry yourself well and act professionally. Check Out the Appendix for Examples Te Appendix has more tips and examples for cold email and voice mail approaches. 52 Talking to Humans How to Ensure an Effective Session? How To 53 I recommend the following guidelines for running a productive interview session. Do Your Interviews In Person Te quality of your learning can vary a lot depending on your communication method. Talking in person is by far the best approach. You can read body language and build rapport much easier. Remember that a huge percentage of human communication is non-verbal, so why blind your senses if you don’t have to? Te next best approach is video conferencing, because at least you can still read someone’s facial expressions. Phone calls should be your method of last resort (sometimes there is no choice), and I would entirely avoid using text-based mediums like email or chat. Talk to One Person at a Time I believe in talking to one person at a time. It is useful to have a second person on your side quietly taking notes. I strongly recommend avoiding focus groups for two reasons: 1. you want to avoid group think; 2. you will really struggle to focus on one person’s stories, and drill into areas of interest, when you are juggling multiple people. Adding a Note Taker Bringing a note taker will allow you to stay in the moment without worrying about getting every bit down on paper. You can stay focused on the topics, the body language, and where to take the conversation. If you have to take your own notes, that’s not the end of the world. It can sometimes make for a more intimate conversation. Just remember to write up your notes right afer the session or you will lose a lot of detail and color that you weren’t able to write down. You can also ask the interview subject if you can record them, 54 Talking to Humans and many people are willing. Te risk is that a recorder can inhibit the conversation, but most people forget that they are being recorded once the discussion is fowing. I highly recommend that you play back the audio and write up your notes soon afer the session, both because writing up notes will reinforce what you learned in your own mind, and also because written notes are easier and faster for both you and your teammates to scan. I’ve found that once audio or video is more than a couple weeks old, somehow they never get touched again. Start With a Warm Up & Keep It Human When you kick things of, concisely explain why you are there, and thank them for the time. Launch into things with one or two easy warm up questions. For example, if you are talking to a consumer, you might ask where they are from and what they do for a living. If you are talking to enterprise, you might ask how long they have been with their company. You don’t want to spend a lot of time on this stuf, but it does get the ball rolling. Have a written or printed list of questions, but don’t rigidly read from your list. Be in the moment. Make the interview subject feel like you are really listening to them. Disarm Your Own Biases Human beings have an amazing ability to hear what they want to hear (this is called “confrmation bias”). Go into each session prepared to hear things that you might not want to hear. Some entrepreneurs even take the mindset that they are trying to kill their idea, rather than support it, just to set the bar high and prevent themselves from leading the witness. Get Them to Tell a Story As I mentioned in the chapter “What Do You Want to Learn,” How To 55 humans are terrible at predicting their own behavior. If you ask any speculative questions, be prepared to listen with a healthy dose of skepticism. I far prefer to get people telling stories about how they experienced a problem area in the past. In particular, try to fnd out if they have tried to solve the problem. What triggered their search for a solution? How did they look for a solution? What did they think the solution would do, before they tried it? How did that particular solution work out? And if they are struggling to remember specifcs, help them set the scene of their story: what part of the year or time of day? Were you with anyone? As they are telling their story, follow up with questions about their emotional state. You might get some historical revisionism, but what you hear can be very illuminating. Te researchers at Meetup.com, who borrow from Clayton Christensen’s Jobs To Be Done framework, use an interesting tactic to help their subjects get in story mode. When they are asking someone to take them through a purchase experience, from frst thought through purchase and then actual product usage, they say: “Imagine you are flming the documentary of your life. Pretend you are flming the scene, watching the actor playing you. At this moment, what is their emotion, what are they feeling?” Look for Solution Hacks One of the best indicators that the market needs a new or better solution is that some people are not just accepting their frustration with a particular problem, but they are actively trying to solve it. Maybe they have tried a few diferent solutions. Maybe they have tried hacking together their own solution. Tese stories are a great indicator of market need. Understanding Priority For someone to try a new product, their pain usually needs to be 56 Talking to Humans acute enough that they will change their behavior, take a risk, and even pay for it. If you feel like you are seeing good evidence that someone actually has a problem, it is worth asking where it ranks in their list of things to solve. Is it their #1 pain, or something too low in priority to warrant attention and budget? Listen, Don’t Talk Try to shut up as much as possible. Try to keep your questions short and unbiased (i.e. don’t embed the answer you want to hear into the question). Don’t rush to fll the “space” when the customer pauses, because they might be thinking or have more to say. Make sure you are learning, not selling! Or, at least make sure you are not in “sales” mode until the point when you actually do try to close a sale as part of an experiment. Follow Your Nose and Drill Down Anytime something tweaks your antenna, drill down with follow up questions. Don’t be afraid to ask for clarifcations and the “why” behind the “what.” You can even try drilling into multiple layers of “why” (run an Internet search for “Five Whys” for more info), as long as the interviewee doesn’t start getting annoyed. Parrot Back or Misrepresent to Confrm For important topics, try repeating back what the person said. You can occasionally get one of two interesting results. Tey might correct you because you’ve misinterpreted what they said. Or, by hearing their own thoughts, they’ll actually realize that their true opinion is slightly diferent, and they will give you a second, more sophisticated answer. Another approach is to purposefully misrepresent what they just said when you parrot it back, and then see if they correct you. But How To 57 use this technique sparingly, if at all. Do a Dry Run If you are a beginner at customer discovery, do a dry run with a friend or colleague. See how your questions feel coming out of your mouth. Get a sense of what it is like to listen carefully and occasionally improvise. Getting Feedback on Your Product If you want to get feedback on your product ideas, whether you show simple mockups or a more polished demo, there are a few important tips to keep in mind: As I mentioned before, separate the storytelling part of your session from the feedback part. People love to brainstorm on features and solutions, and this will end up infuencing the stories they might tell. So dig into their stories frst, and gather any feedback second. Second, disarm their politeness training. People are trained not to call your baby ugly. You need to make them feel safe to do this. Ask them up-front to be brutally honest, and explain that it is the very best way for them to help you. If they seem confused, explain that the worst thing that could happen is to build something people didn’t care about. Finally, keep in mind that it is incredibly easy for people to tell you that they like your product. Don’t trust this feedback. Instead, you need to put people through an actual experience and watch their behavior or try to get them to open their wallet. Tere is no right answer on how polished your early mockups need to be. If you are in the fashion space, you need to have a high degree of visual polish as table stakes. If you are creating a solution for engineers, you probably need much less. Just don’t wait for perfection, because initial product versions rarely get everything right. You need to spot your errors sooner rather than later. 58 Talking to Humans How Do You Make Sense of What You Learn? How To 59 Your goal is not to learn for learning’s sake. Your goal is to make better decisions that increase the odds of success. So how do you translate your observations into decisions? Te frst step is to make sense of your patterns. Take Good Notes To fnd your patterns, frst you need to track the data. Tis is easy if you bring a good notetaker to the interview, but otherwise, make sure that you write up your notes as soon afer your conversation as possible. Make them available to the entire team with Google Docs or the equivalent. At the start of every entry, note the following information: • Name of interview subject • Date and time • Name of interviewer • In person or video conference • Photo (if you have one) Ten at the start of your notes, include basic descriptive information of the interview subject. Quantitative Measures If you are setting specifc metric goals for your interviews, you might set up a shared spreadsheet that essentially acts as a running scorecard for how you are doing and how you are tracking to targets. EXAMPLE Let’s imagine that you have invented a new air purifer that triples the growth speed of greenhouse plants. Now you plan to talk to 20 60 Talking to Humans farmers, and you have a few core questions: • Will their business actually beneft from increased growth speed? You are assuming that increased volume will help rather than hurt. You plan to talk to growers of different crops with the goal of fnding crops where 60% or more of farmers want increased volume. • Are farmers spending any money today on growth accelerator solutions? Your qualitative research will drill into what and why, but your metrics goal says that you hope at least 50% of the market is already spending at least some money. • Do they have the facilities to support your purifer? In this case, you need your purifer to be both in a specifc location, but also have access to an electrical outlet. You are hoping that 70% of the farmers have an outlet 20 feet or closer to your spot. Here is the kind of spreadsheet that you and your team might track: As Samantha advised Koshi and Roberta in the fctional story, turning your observations into quantifable metrics is both useful and tricky. Our brains like to infuence our thinking with cognitive biases, especially fltering results for what we want to hear. Calculating actual metrics helps fght against that dynamic. How To 61 At the same time, you have to beware a diferent kind of bias: our desire to turn statistics into facts. Hopefully you are getting enough data points that you can trust the patterns, but do not confuse this with statistical signifcance or take your results too literally. My advice is to calculate metrics, but remain skeptical of them, don’t obsess over any one particular metric, and continue to question what is behind your numbers. Dump and Sort Exercise Bring your team together and arm them with sticky notes and sharpies. Give everyone 10 minutes to jot down as many patterns and observations as they saw during their interviews. Put all the sticky notes on a wall and have someone sort them into groups. As a team, discuss the patterns, and then re-review your assumptions or business canvas and see what might need to change or require greater investigation. Look for Patterns and Apply Judgement Customer development interviews will not give you statistically signifcant data, but they will give you insights based on patterns. Tey can be very tricky to interpret, because what people say is not always what they do. You don’t want to react too strongly to any single person’s comments. You don’t want to take things too literally. But neither do you want to be bogged down trying to talk to thousands of people before you can make a decision. You need to use your judgement to read between the lines, to read body language, to try to understand context and agendas, and to flter out biases based on the types of people in your pool of interviewees. But it is exactly the ability to use human judgement based on human connections that make interviews so much more useful than surveys. Ultimately, you are better of moving fast and making decisions 62 Talking to Humans from credible patterns than dithering about in analysis paralysis. Don’t Abdicate Your Role As Product Designer It is not the job of the customer to design your product. It is yours. As you are gathering information and making decisions, act like a intelligent flter, not an order-taker. Expect False Positives While all entrepreneurs get their fair share of naysayers and skeptics, you have to be wary of the opposite problem in customer development interviews. People will want to be helpful and nice, and your brain will want to hear nice things. As you are weighing what you have learned, just keep this in mind. The Truth Curve I am a big believer in qualitative research. I think a good product team should build a regular cadence of talking to relevant people into their process. However, you don’t want your only source of learning to be talking to people. You don’t really know the absolute truth about your product until it is live and people are truly using it and you are making real money from it. But that does not mean you should jump straight to a live product, because that is a very expensive and slow way to iterate your new business. Get into the market early and begin testing your assumptions right away, starting with conversations and proceeding from there. It will dramatically increase the odds that you will create a product that customers actually want. As you build confdence, test with increasing levels of fdelity. I think of it like peeling an onion in reverse. I created the accompanying chart to demonstrate the levels of believability for diferent kinds of experiments. How To 63 Talking to people is powerful. It tends to give you your biggest leaps of insight, but, as I keep on repeating, what people say is not what they do. You might show people mockups and that might give you another level of learning and feedback, but reactions still need to be taken with skepticism. Concierge and “Wizard of Oz” experiments, where you fake the product through manual labor (see Glossary) will give you stronger evidence, because you put people through an experience and watch their actions. Te next layers of the onion are to test with a truly functional “Minimum Viable Product” (see Glossary) and beyond. Te point I want to make is that all of the steps on the curve can be very useful to help you learn, make smarter decisions, and reduce risk, but you need to use your head, and apply judgement to everything you are learning. 64 Talking to Humans How many people to talk to? Tere is no pat answer to this question. A consumer business should talk to an order of magnitude more people than a business that sells to enterprise. If you are in the consumer space and haven’t spoken to at least 50 to 100 people, you probably have not done enough research. In his I-Corps course, Steve Blank requires his teams, many of which are B2B, to talk to at least 100 people over 7 weeks. I advise that you never stop talking to potential customers, but you will probably evolve what you seek to learn. If you see the same patterns over and over again, you might change things up and examine diferent assumptions and risks. For example, if you feel like you have a frm understanding of your customer’s true need, you might move on to exploring how they learn about and purchase solutions in your product category today. And don’t forget that observing your customers can be as powerful as directly talking to them. Lead with Vision Customer Development and lean startup techniques are some of the most powerful ways to increase your odds of success, but they are not a replacement for vision. You need to start with vision. You need to start with how you want to improve the world and add value to people’s lives. Te techniques we’ve discussed in this book are among a body of techniques that let you reality check your vision, and optimize the path you will take to achieve your vision. How To 65 Conclusion Toughtful qualitative research is a critical tool for any entrepreneur. Hopefully this book has given you some new strategies for how to put it to work for your needs. Creating a new business is tremendously challenging. Te ways you can fail are numerous. t You have to get the customer and market right t You have to get the revenue model right t You have to get the cost structure right t You have to get customer acquisition right t You have to get the product right t You have to get the team right t You have to get your timing right Screw up any one of those and you are toast. Tere is a reason why entrepreneurship is not for the faint of heart. But we’re not here to be faint of heart. We are here to change the world. Dream big. Be passionate. Just be ruthless with your ideas and assumptions. Customer discovery and lean experimentation can truly help you chart a better path and fnd success faster and with more capital efciency. Don’t forget that as your business grows and changes, so too will your customer base. Keep on reality-checking your hypotheses. Keep on talking to humans. Appendix PART THREE Appendix 67 Cold Approach Examples When you are trying to reach someone you do not know, there are a few things to remember: 1. Keep things concise 2. Keep things convenient (meet near their ofce, etc) 3. Name drop when you can 4. Follow up if you don’t hear an answer, but don’t be annoying 5. If you are leaving a voice mail, practice it frst (you might think it sounds practiced, but to others, it will sound more professional) Example Email 1 To: [email protected] From: [email protected] John, I received your name from James Smith. He said that you had a lot of expertise in an area I am researching and recommended that we speak. I’m trying to study how companies are handling their expense report management workfows and the frustrations they are experiencing. I would be happy to share my research conclusions with you. Would you have 30 minutes to spare next week when I could buy you a cup of coffee and ask you a few questions? Many thanks for your time and I look forward to hearing from you, Jane Doe 68 Talking to Humans Example Email 2 To: [email protected] From: [email protected] John, I have been working on some new solutions in the area of expense report management, and I was told that you have a lot of expertise in this area. We started this journey because of personal frustration, and we’re trying to fgure out how to make expense reporting much less painful. Would you have 30 minutes to give us some advice, and share some of your experiences in this domain? I assure you that I’m not selling anything. I would be happy to come by your offce or arrange a quick video conference, at your preference. Many thanks, Jane Doe Example Voice Mail Message “Hello, my name is Jane Doe. I was referred to you by James Smith, who said I would beneft from your advice. I am currently researching how companies are handling their expense management workfows. I understand you have a lot of expertise in this area. I was hoping to take just 30 minutes of your time to ask you a few questions. I’m not selling anything and I would be happy to share my research conclusions with you. You can reach me at 555-555-5555. Again, this is Jane Doe, at 555-555-5555, and thank you for your time.” Final Note Cold calling is never anyone’s favorite thing to do, but it isn’t nearly as painful as you imagine. You have nothing to lose and everything to gain. So give yourself a determined smile in the mirror, and go get them! Appendix 69 Business Assumptions Exercise I am agnostic about the framework you choose to use to map out your business assumptions. Alexander Osterwalder’s business model canvas and Ash Maurya’s lean canvas are both powerful tools. I also ofen fnd myself using this simple set of questions to lay out a belief system around an idea: Try to make your assumptions as concise and specifc as possible. You want to be able to run an experiment against it to see if it is true. My target customer will be? (Tip: how would you describe your primary target customer) The problem my customer wants to solve is? (Tip: what does your customer struggle with or what need do they want to fulfll) My customer’s need can be solved with? (Tip: give a very concise description / elevator pitch of your product) Why can’t my customer solve this today? (Tip: what are the obstacles that have prevented my customer from solving this already) The measurable outcome my customer wants to achieve is? (Tip: what measurable change in your your customer’s life makes them love your product) 70 Talking to Humans My primary customer acquisition tactic will be? (Tip: you will likely have multiple marketing channels, but there is often one method, at most two, that dominates your customer acquisition — what is your current guess) My earliest adopter will be? (Tip: remember that you can’t get to the mainstream customer without getting early adopters frst) I will make money (revenue) by? (Tip: don’t list all the ideas for making money, but pick your primary one) My primary competition will be? (Tip: think about both direct and indirect competition) I will beat my competitors primarily because of? (Tip: what truly differentiates you from the competition?) My biggest risk to fnancial viability is? (Tip: what could prevent you from getting to breakeven? is there something baked into your revenue or cost model that you can de-risk?) My biggest technical or engineering risk is? (Tip: is there a major technical challenge that might hinder building your product?) And then answer the following open-ended question. Be creative and really examine your points of failure. Appendix 71 What assumptions do we have that, if proven wrong, would cause this business to fail? 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Afer you have looked at your business holistically and also answered the broad fnal question, mark the assumptions that would have a large impact on your business and feel highly uncertain. Now you know your priorities for customer discovery and the experiments you need to run! 72 Talking to Humans Teaching Exercise #1: Mock Interviews If you are using this book to try to teach customer discovery/ development, there is nothing like real-world practice to make learning stick. Before you send your class out into the world to conduct their own interviews, however, you might try a compact exercise like the following: Tools All participants should have pen and paper Preface: Choose a Topic Everyone in the class will interview each other based on the same topic, which means it needs to be something most people can relate two. Tere are two angles you might take: 1. Something that helps the interviewer dig up past behavior. For example, “Tell me about the last thing you purchased over $100.” Have the interview subject explain what they bought, what the purchase process was like from desire to actual ownership, how they made their purchase decision, etc. 2. Something that helps the interviewer unlock deeper motivations and desires. For example, “Tell me about your dream car.” Prompt your students not just to get people to describe the car, but to dig into the reasons behind the choice; they can also prompt for whether the interview subject has ever experienced driving the car. Appendix 73 Exercise Step 1: Intro, 5 minutes Explain the exercise, the topic that the students will use, and give a few specifc suggestions for questions they might ask. Example questions for the dream car: when did you fall in love with the car and why? of the reasons you shared, why are these the most important to you? how have you imagined using the car? etc Step 2: Interview Plan, 2 minutes Give your class the topic and let them spend 5 minutes on their own. Tey should write down no more than 6 questions to ask. Step 3: Pair Interviews, 5 - 7 minutes each Pair up your students. One will begin as the interviewer, and their opposite will be interviewed. Give them 7 minutes, and then switch the roles, keeping the pairs unchanged. Te new interviewer gets 7 minutes. Te person doing the interviewing should also take notes, which will give them some exposure to doing an interview solo as opposed to bringing a note-taker to help (which is what most people prefer to do when possible). Step 4: Observations and Questions, 5-10 minutes Ask the room to share observations, challenges, lessons or questions on what it was like to do a live interview. 74 Talking to Humans Teaching Exercise #2: Mock Approach Dean Chang, the Associate VP of Entrepreneurship at the University of Maryland, recommends a class exercise where one or more teams of students takes on the role of cold calling an “expert.” Te team has to do it over and over until they get it right. For this exercise, select one team and have them come to the front of the classroom. Teir job is to “cold call” a selected member of the teaching team. Te teacher will pretend to be an expert in the team’s target feld. Te team needs to get the expert to take the call, and smoothly transition into asking questions. Te job of the person playing the “expert” is to block the team’s misguided attempts to engage. When the team does something wrong, the expert declines the interview request, or ends the conversation, or gives them a gong. Ten the team has to start over again. Classic mistakes that should trigger the team starting over include long or unclear introductions, pitching the product/technology too soon, implying that the expert has problems and desperately needs help, and/or generally making the expert feel uncomfortable with the line of questioning. As Dean describes it, “We let the other teams ofer critiques and suggest plans of attack for winning over the expert and then the chosen team tries it again. Eventually afer being gonged several times in a row, they stop making the same mistakes and start to Appendix 75 converge on a good elevator pitch that praises and disarms the expert and paves the way to entering into an interview. Ten we stop the exercise.” Te exercise will probably be humorous and painful at the same time, but there is nothing like stumbling, or watching a team stumble, to realize why best practices are best practices. 76 Talking to Humans Screwing Up Customer Discovery So how do people screw up customer discovery? Here are a few antipatterns: 1. You treat speculation as confrmation Here are some question types that I don’t like — and if you ask them, you should heavily discount the answer: “would you use this?” “would you pay for this?” “would you like this?” I can’t say that I never ask these questions, but I always prefer behavioral questions over speculation. As contrast, here is a behavior-focused interaction: “Tell me about a time when you bought airline tickets online.” “What did you enjoy about the process? What frustrated you about the process?” “What diferent systems or methods have you tried in the past to book tickets?” 2. You lead the witness Leading the witness is putting the answer in the interviewee’s mouth in the way you ask the question. For example: “We don’t think most people really want to book tickets online, but what do you think?” Examine both how you phrase your questions and your tone of voice. Are you steering the answer? Ask open-ended, neutral questions before you drill down: “what was that experience of buying online tickets like?” 3. You just can’t stop talking Some entrepreneurs can’t help themselves — they are overfowing with excitement and just have to pitch pitch pitch. Tere is nothing Appendix 77 wrong with trying to pre-sell your product — that is an interesting experiment unto itself — but you should not mix this in with behavioral learning. If you do try to pre-sell, don’t just ask, “Would you pay for this?” but rather ask them to actually pay, and see what happens. Some people ask the question, “How much would you pay for this?” but I do not. Instead, try actually selling at diferent price points (albeit one at a time). I much prefer having the potential customer experience something, rather than speculate over something. 4. You only hear what you want to hear I see some people go into interviews with strong beliefs about what they like and dislike. When you debrief afer their custdev conversation, it is magical how everything they heard aligns perfectly with their opinions. Our brains are amazing flters. Leave your agenda at the door before starting a conversation. One way to solve this is to have two people for each interview — one person to ask questions, and the other to take notes. 5. You treat a single conversation as ultimate truth You’ve just spoken to a potential customer and they have really strong opinions. One instinct is to jump to conclusions and rush to make changes. Instead, you need to be patient. Tere is no defnitive answer for how many similar answers equals the truth. Look for patterns and use your judgement. A clear, consistent pattern at even 5 or 10 people is a signal. 6. Fear of rejection wins out Tis is one of the biggest blockers to people doing qualitative research, in my experience, because of fear of a stranger rejecting your advance or rejecting your idea. Many excuses, such as “I don’t know how to fnd people to talk to,” are rooted in this fear. JFDI. Customer development isn’t just about street intercepts. You can 78 Talking to Humans recruit people on Craigslist, Facebook and LinkedIn groups, and good old fashioned networking. 7. You talk to anyone with a pulse I see some teams taking a shotgun approach. Instead, defne your assumptions around who your customer will be and who your early adopter will be. You might even do a lightweight persona (see the book Lean UX for examples). Zoom in on those people and try to validate or invalidate your assumptions about your customers. It is ok to occasionally go outside your target zone for learning, but don’t boil the ocean. Focus, learn, and pivot if necessary. 8. You wing the conversation If you go into a conversation unprepared, it will be evident. Write up your questions ahead of time and force-rank them based on the risks and assumptions you are worried about. To defne your assumptions, you can answer the questions in the business assumptions exercise (previous section), or do a business model canvas or a lean canvas. Your exact method doesn’t matter as much as the act of prioritizing your risk areas. During your actual interview, do not literally read your questions from a piece of paper, but rather keep things conversational (remember, you are getting the subject to tell you stories). If you uncover something interesting, follow your nose and don’t be afraid to diverge from your initial priorities. 9. You try to learn everything in one sitting Rather than trying to go as broad as possible in every conversation, you are actually better of zooming in on a few areas which are critical to your business. If you have a huge range of questions, do more interviews and split the questions. Appendix 79 10. Only the designer does qualitative research It is ok to divide and conquer most of the time, but everyone on the team should be forced to get out and talk to real people. Note: you will probably have to coach newcomers on #5’s point about not jumping to conclusions. 11. You did customer development your frst week, but haven’t felt a need to do it since It is always sad to see product teams start things of with customer development, and then completely stop once they get going. It is perfectly fne to let customer discovery work ebb and fow. If your learning curve fattens, it can make sense to press pause or change up your approach. However, you want to build a regular qualitative cadence into your product process. It will provide a necessary complement to your quantitative metrics, because it will help you understand the reasons why things are happening. 12. You ask the customer to design your product for you Tere’s a famous line attributed to Henry Ford, “If I had asked people what they wanted, they would have said faster horses.” Remember, it is not the customer’s job to design the solution. It is your job. It is the customer’s job to tell you if your solution sucks. Get feedback, yes. Remember that the further away you are from a working product, the more you have to flter what you hear through your judgement and vision. Disclaimer As with all tips on lean and agile, there are always places and times to break the rules and do what is right for your context, and your business. 80 Talking to Humans Glossary Concierge and “Wizard of Oz” Experiments A concierge experiment is where you manually act out your product. An example in Eric Ries’ book Te Lean Startup shows an entrepreneur serving as a personal shopper for people before trying to design an automated solution. When my colleagues were testing a diet plan service, we did not want to rush to sofware before testing our assumptions. Instead, we interviewed participants about their food preferences, manually created meal plans which were emailed to them over two weeks, and interviewed them at various points in the process. At the end of the two weeks, we asked them to pay a set amount to continue, and tracked the conversion rate. A “Wizard of Oz” experiment is similar, with the diference being that the manual work is hidden from the customer. For example, another set of colleagues tested an idea for a smart task management system for married couples. Te twenty couples participating in the test thought that they were interacting with a computer system, but in reality they were emailing in to our team, who then processed the emails accordingly. We just said that the servers would be “down” at night! Minimum Viable Product (MVP) An MVP is the smallest thing you can create that gives you meaningful learning about your product. MVP is ofen used interchangeably with “experiment” in the broader community. I personally tend to reserve it specifcally for tests around the product, and not for experiments related to other business assumptions. It is best to think about MVPs as an ongoing process, rather than a single release. Validation is rarely that neat and tidy. Appendix 81 Scientifc Method I think the best way to explain the scientifc method is to quote the theoretical physicist, Richard Feynman: “In general we look for a new law by the following process: frst we guess it. Don’t laugh -- that’s really true. Ten we compute the consequences of the guess to see what, if this law is right, what it would imply. Ten we compare those computation results to nature, i.e. experiment and experience. We compare it directly to observation to see if it works. “If it disagrees with experiment, it’s wrong. Tat simple statement is the key to science. It doesn’t make a diference how beautiful your guess is, it doesn’t make a diference how smart you are, who made the guess or what his name is -- if it disagrees with experiment, it’s wrong. Tat’s all there is to it.” (Cornell lecture, 1964) It is relatively straightforward to apply the scientifc method to business. You accept that your ideas are hypotheses. You make them as specifc as possible so that you can guess the results, i.e. the implications, of your hypotheses. You design and run an experiment. If your hypothesized results do not match the results of your experiment, your hypothesis is proven wrong. However, business is about people, and people are highly complex and inconsistent compared to laws of nature. So if your experiment fails, you will still need to apply judgement about whether the errors are in the hypothesis or in the experiment. 82 Talking to Humans Other Learning Resources Authors Te two seminal books on the topics of lean innovation and customer development are Steve Blank and Bob Dorf ’s Te Startup Owner’s Manual and Eric Ries’ Te Lean Startup. Tere are a ton of other resources out there, from books to videos and blog posts. Rather than link to particular items and thus miss out on newer developments, here are a few names that I recommend you pay attention to: Alex Osterwalder, Alistair Croll, Ash Maurya, Ben Yoskowitz, Brant Cooper, Cindy Alvarez, David Bland, Jef Gothelf, Joel Gascoigne, Josh Seiden, Kevin Dewalt, Laura Klein, Patrick Vlaskovits, Rob Fitzpatrick, Salim Virani, and Tristan Kromer. Talking to Humans Website On our website talkingtohumans.com, you can get worksheet pdfs and sign up for our email list, where we send occasional notes based on useful resources we discover. Behind the Book 83 Gif Constable (gifconstable.com) is a repeat entrepreneur and currently the CEO of Neo, a global product innovation consulting company. He has held product design and business roles in six startups, and provided M&A and IPO services to technology frms while at Broadview/Jeferies. He was one of the earliest adopters & bloggers of the Lean Startup movement, co-organizes the 4,700-person Lean Lessons Learned meetup in New York, and tries to give back to the entrepreneurial community through mentoring and speaking engagements. He lives outside of New York City with his wife, two children, and an excessively rambunctious retriever. Giff Constable Talking to Humans was written by Gif Constable, at the instigation and with the collaboration of Frank Rimalovski of NYU’s Entrepreneurial Institute, and with the wonderful illustrations of Tom Fishburne. Behind the Book 84 Guide to Customer Discovery Frank Rimalovski brings over 20 years of experience in technology commercialization, startups and early-stage venture capital investing. He is executive director of the NYU Entrepreneurial Institute, managing director of the NYU Innovation Venture Fund, Adjunct Faculty at NYU’s Polytechnic School of Engineering, and an Instructor in the NSF’s I-Corps program, having trained and mentored hundreds of entrepreneurs in customer development and lean startup methodologies. Previously, he was a founding partner of New Venture Partners, director/entrepreneur-in-residence at Lucent’s New Ventures Group, and has held various positions in product management, marketing and business development at Sun Microsystems, Apple and NeXT. He lives outside of New York City with his wife, two daughters and his increasingly mellow mutt. Frank Rimalovski Tom Fishburne (marketoonist.com) started drawing cartoons on the backs of Harvard Business School cases. His cartoons have grown by word of mouth to reach 100,000 business readers a week and have been featured by the Wall Street Journal, Fast Company, and the New York Times. Tom is the Founder and CEO of Marketoon Studios, a content marketing studio that helps businesses such as Google, Kronos, and Rocketfuel reach their audiences with cartoons. Tom draws from 19 years in the marketing and innovation trenches at Method Products, Nestle, and General Mills. He lives near San Francisco with his wife and two daughters. Tom Fishburne Behind the Book 85 Like The Book? When Frank approached me to write this book, we both had the same goal of giving back to the community. We debated charging for the book, and pondered whether the question of free versus paid would afect how it was perceived. But ultimately, we decided to put it out into the world for free. Should you like Talking to Humans, and feel a need to contribute back to something, we would encourage you to think about doing one or all of the following: 1. Pay it back (and forward!) by mentoring another student or entrepreneur 2. Donate to one of our favorite causes: Charity: Water, Girls Who Code, Kiva or the NYU Entrepreneurial Institute 3. Share a link to the talkingtohumans.com website or give someone a copy of the book If this book has helped you in some small way, then that is reward enough for us. It’s why we did it. Gif Constable and Frank Rimalovski September 2014 talkingtohumans.com page intentionally blank Acclaim for Talking to Humans “Talking to Humans is the perfect complement to the existing body of work on customer development. If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have.” Steve Blank, entrepreneur and author of The Startup Owner’s Manual “Getting started on your Customer Discovery journey is the most important step to becoming a successful entrepreneur and reading Talking To Humans is the smartest frst step to fnding and solving real problems for paying customers.” Andre Marquis, Executive Director, Lester Center for Entrepreneurship, University of California Berkeley “If entrepreneurship 101 is talking to customers, this is the syllabus. Talking to Humans is a thoughtful guide to the customer informed product development that lies at the foundation of successful start-ups.” Phin Barnes, Partner, First Round Capital “A lot of entrepreneurs pay lip service to talking to customers but you have to know how. Talking to Humans ofers concrete examples on how to how to recruit candidates, how to conduct interviews, and how to prioritize learning from customers more through listening versus talking.” Ash Maurya, Founder of Spark59 and author of Running Lean “When getting ‘out of the building,’ too many people crash and burn right out of the gate and wonder what happened. Talking to Humans is a quick and efective guide for how Lean Startup interviews should be done.” Dean Chang, Associate VP for Innovation & Entrepreneurship, University of Maryland #talkingtohumans talkingtohumans.com	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. EVIDENCE: TALKING TO HUMANS Success starts with understanding your customers GIFF CONSTABLE with Frank Rimalovski illustrations by Tom Fishburne and foreword by Steve Blank Copyright ©2014 Gif Constable First edition, v1.71 All rights reserved. Book design: Gif Constable Illustrations by Tom Fishburne Cover design assistance: Jono Mallanyk Lean Startup is trademarked by Eric Ries Customer Discovery is a phrase coined by Steve Blank ISBN: 978-0-9908009-0-3 Special thanks to the NYU Entrepreneurial Institute for their collaboration and support in the creation of Talking to Humans Acclaim for Talking to Humans “If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have.” Steve Blank, entrepreneur, educator and author of Four Steps to the Epiphany and The Startup Owner’s Manual “If entrepreneurship 101 is talking to customers, this is the syllabus. Talking to Humans is a thoughtful guide to the customer informed product development that lies at the foundation of successful start-ups.” Phin Barnes, Partner, First Round Capital “Getting started on your Customer Discovery journey is the most important step to becoming a successful entrepreneur and reading Talking To Humans is the smartest frst step to fnding and solving real problems for paying customers.” Andre Marquis, Executive Director, Lester Center for Entrepreneurship University of California Berkeley “A lot of entrepreneurs pay lip service to talking to customers but you have to know how. Talking to Humans ofers concrete examples on how to how to recruit candidates, how to conduct interviews, and how to prioritize learning from customers more through listening versus talking.” Ash Maurya, Founder Spark59 and Author of Running Lean “Tis is a great how-to guide for entrepreneurs that provides practical guidance and examples on one of the most important and ofen under practiced requirements of building a great startup—getting out of the ofce, talking directly with customers and partners, and beginning the critical process of building a community.” David Aronoff, General Partner, Flybridge Capital “Gif has been one of the thought leaders in the lean startup movement from the very beginning. Entrepreneurs in all industries will fnd Talking to Humans practical, insightful, and incredibly useful.” Patrick Vlaskovits, New York Times bestselling author of The Lean Entpreneur “Current and future customers are the best source of feedback and insight for your new product ideas. Talking to them is intimidating and seemingly time-consuming. In this focused, practical, down-to-earth book Gif Constable demystifes the art (not science) of customer discovery helping entrepreneurs and product veterans alike learn how to build a continuous conversation with their market and ensure the best chances of success for their ideas. Want to know what your audience is thinking? Read this book!” Jeff Gothelf, author of LeanUX “When getting ‘out of the building,’ too many people crash and burn right out of the gate and wonder what happened. Talking to Humans is a quick and efective guide for how Lean Startup interviews should be done: who to talk to, how to talk your way in the door, and how to gain the most insight and learning. Don’t crash and burn – read Talking to Humans!” Dean Chang, Associate Vice President for Innovation & Entrepreneurship University of Maryland “A must read for anyone who is considering creating a startup, developing a new product or starting a new division. Read this book frst – a great guide to the evolving art of customer discovery. Don’t waste your time building products that your customer may or may not want. Before you write the frst line of code, pitch your idea to investors or build the frst prototype, do your self a favor, read this book and follow the advice! I guarantee you will make better decisions, build a better product and have a more successful company.” John Burke, Partner, True Ventures “Primary market research has been around for a long time because it has stood the test of time and proved that it is fundamental to building a successful venture; it underlies all that we do at MIT in entrepreneurship. Te question is how we more broadly deployed appropriate skills to entrepreneurs so they can be guided to do this in an efcient and efective manner while maintaining rigor. With all the sloganeering out there on the topic, this book stands out in that it delivers real value to the practitioner in this regard.” Bill Aulet, Managing Director, Martin Trust Center for MIT Entrepreneurship “Talking to strangers can be scary, but it’s vital to launching any new product. Trough storytelling, Gif Constable makes customer development concepts accessible. Tis book will show you how to articulate assumptions, get useful information and turn it into meaningful insights. Ten it delivers practical advice you can use immediately to test your ideas. Fear holds people back. Tis book will give you the confdence to jump.” Andres Glusman, Chief Strategy Offcer, Meetup.com Table of Contents 8 Foreword 11 Introduction 14 The Story 28 Lessons Learned 30 How To 31 Getting Started with Customer Discovery 32 Who Do You Want to Learn From? 36 What Do You Want to Learn? 44 How Do You Find Your Interview Subjects? 52 How to Ensure an Effective Session? 58 How Do You Make Sense of What You Learn? 65 Conclusion 66 Appendix 67 Cold Approach Examples 69 Business Assumptions Exercise 72 Teaching Exercise #1: Mock Interviews 74 Teaching Exercise #2: Mock Approach 76 Screwing Up Customer Discovery 80 Glossary 82 Other Learning Resources 83 Behind the Book 8 Talking to Humans Foreword “Get out of the building!” Tat’s been the key lesson in building startups since I frst started teaching customer development and the Lean Launchpad curriculum in 2002. Since then, a lot has happened. Te concepts I frst outlined in my book Te Four Steps to the Epiphany have grown into an international movement: Te Lean Startup. Te class I developed - Te Lean Launchpad - is now taught at Stanford, UC Berkeley, Columbia University, UCSF, and most recently New York University (NYU). More than 200 college and university faculty have taken my Lean Launchpad Educators Seminar, and have gone on to teach the curriculum at hundreds of universities around the globe. Te National Science Foundation, and now the National Institute of Health, use it to commercialize scientifc research as part of their Innovation Corps (I-Corps) program. My How to Build a Startup class on Udacity has been viewed by over 225,000 students worldwide. During the past few years, we’ve seen dozens of large companies including General Electric, Qualcomm and Intuit begin to adopt the lean startup methodology. Te Lean Startup turns the decades-old formula of writing a business plan, pitching it to investors, assembling a team, and launching and selling a product on its head. While terms like “pivot” and “minimum viable product” have become widely used, they are not understood by many. Te same can be said of “getting out of the building”. Many entrepreneurs “get out” and get in front of customers, but take a simplistic view and ask their customers what they want, or if they would buy their startup’s (half-baked) product. Te “getting out” part is easy. It is the application of the customer Foreword & Introduction 9 development methodology and the testing of their hypotheses with users, customers and partners that is both critical and ofen difcult for entrepreneurs to grasp in the search for a scalable and repeatable business model. Since the Four Steps, many other books have been written on customer development including Te Startup Owner’s Manual, Business Model Generation, Te Lean Startup, and others. Each of these texts has advanced our understanding of the customer development methodology in one way or another, teaching aspiring students and entrepreneurs the what, when and why we should get out of the building, but have only skimmed the surface on “how” to get out of the building. For both my own classes as well as I-Corps, I always made Gif Constable’s blog post “12 Tips for Early Customer Development Interviews” required reading. It answered the “how” question as well. Now Gif has turned those 12 tips into an entire book of great advice. In a comprehensive, yet concise and accessible manner, Talking to Humans teaches you how to get out of the building. It guides students and entrepreneurs through the critical elements: how to fnd interview candidates, structure and conduct efective interviews and synthesize your learning. Gif provides ample anecdotes as well as useful strategies, tactics and best practices to help you hit the ground running in your customer discovery interviews. If you are a student, aspiring entrepreneur or product manager trying to bring the value of getting out of the building to an existing company, Talking to Humans is a must read. It is chock full of lessons learned and actionable advice that will enable you to make the most of your time out of the building. Talking to Humans is the perfect complement to the existing 10 Talking to Humans body of work on customer development. If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have. Steve Blank September 3, 2014 Foreword & Introduction 11 Introduction 12 Talking to Humans Te art of being a great entrepreneur is fnding the right balance between vision and reality. You are probably opening this book because you want to put something new in the world. Tat’s an incredibly powerful and meaningful endeavor. It’s also scary and extremely risky. How can you get ahead of that risk and beat the odds? Every new business idea is built upon a stack of assumptions. We agree with Steve Blank’s insight that it is better to challenge your risky assumptions right at the start. You can’t challenge anything sitting in a conference room. You have to get into the market, or, as Blank likes to say, “Get out of the building!” Tere are two efective ways to do this: 1. talk directly to your customers and partners, and observe their behavior; 2. run experiments in which you put people through an experience and track what happens. Tis book focuses on the frst. Te qualitative part of customer discovery is surprisingly hard for most people, partly because talking to strangers can feel intimidating, and partially because our instincts on how to do it are ofen wrong. Here’s what customer discovery is not: It is not asking people to design your product for you. It is not about abdicating your vision. It is also not about pitching. A natural tendency is to try to sell other people on your idea, but your job in customer discovery is to learn. You are a detective. You are looking for clues that help confrm or deny your assumptions. Whether you are a tiny startup or an intrapreneurial team within a big company, your goal is not to compile statistically signifcant answers. Instead you want to look for patterns that will help you make better decisions. Tose decisions should lead to action, and smart action is what you need for success. Foreword & Introduction 13 Tis book was written as a focused primer on qualitative research to help you get started. You should view it as a complement to the other excellent resources out there on customer development and lean innovation. It is not a rulebook, but hopefully you will fnd the principles included here useful. Te book comes in two parts. It begins with a fctional story of two entrepreneurs doing customer research for the frst time. Te second part is a mix of theory and tactics to guide you through the core steps of customer discovery. While the fctional story highlights a consumer-facing business, I should note that there are plenty of tips in this book for teams who sell to the enterprise. Some last words to kick things of: entrepreneurs have a tendency to over-obsess about their product to the neglect of other business risks. Tey also tend to stay inside their heads for far too long. I urge you to be brave, get out of the building, and go talk to real human beings. Gif Constable August 2014 Some Thanks Are Due Many thanks to Frank Rimalovski for encouraging me to write this, and his students and team at NYU for providing early feedback, Steve Blank for the foreword and his inspiration and leadership on the topic of entrepreneurship, Tom Fishburne for his great illustrations, Josh Seiden and Jef Gothelf for their insights, my colleagues at Neo for continuing to push forward the craf of customer development, the many speakers and members of New York’s Lean Lessons Learned meetup who have shared their stories with me, and Eric Ries for inspiring me and so many others. The Story PART ONE The Story 15 Breakthrough Koshi and Roberta had so much adrenaline pumping through their systems that neither could sleep that night. Afer a year of challenging lab work, they had fnally cracked it. Tey were now sure they could manufacture artifcial down feathers cost-efectively. Teir insomnia was ironic, since their very dream was to transform the quality of people’s sleep through the invention of a better pillow. Tey knew they had a technical advantage. Teir artifcial down had heightened levels of insulation, a better resilience/resistance quotient, and was kinder to both animals and the environment. Now the question was, did they have a business? The Advisor Tey called a meeting with their entrepreneurial advisor the next day. Samantha had built four companies, successfully exiting two of them. She was now an angel investor and believed frmly in giving back by working with frst-time entrepreneurs. “We fnally cracked it!” Roberta blurted out. “What she means,” Koshi said, “is that we’re convinced we can manufacture NewDown in a cost-efective and repeatable manner. Now we think we can make a real business.” “So you want to know if the time has come to jump in feet frst?” asked Samantha. Te two scientists nodded. “If you want to be successful bringing something to market, you need to understand the market. Do you feel like you know when and why people buy pillows today?” “Not really,” Roberta said. “We’ve spent our time in the lab focused on the product side.” “I suspected so. Founders commonly obsess about product at the 16 Talking to Humans expense of the understanding the customer or the business model. You need to work on it all, and you have to challenge your thinking. Behind your startup is a belief system about how your business will work. Some of your assumptions will be right, but the ones that are wrong could crater your business. I want you to get ahead of the risky hypotheses that might cause failure.” Samantha had the founders list out the riskiest hypotheses. 1. We believe that people care about sleep quality when making a pillow purchase decision. 2. We believe that we can sell online directly to customers. 3. We believe that our customers will be young urban professionals. 4. We believe that our very frst customers will be new graduates who need to outft their apartments. 5. We believe that we can sell our pillows at a high enough price to cover our costs. 6. We believe that we can raise enough capital to cover investments in manufacturing. “Let’s put aside the fundraising risk right now,” Samantha said. “It’s what everyone jumps to, but you need to strengthen your story frst. Many of your risks are tied to your customer. I like attacking a problem from multiple directions and recommend three approaches. First, I want you to walk a day in your customer’s shoes and actually go out and buy a pillow. Second, I want you to observe people in the process of buying a pillow. And third, I want you to talk directly to them.” “Talk to people?” said Koshi. “I’m a scientist, not a salesperson. If I simply asked someone if my pillow was better, they would have no idea. If I asked them if they would buy my pillow, I couldn’t trust The Story 17 the answer. So what is the point?” “Your job right now isn’t to sell, but rather to learn. You are right, though: getting the customer to speculate is rarely useful,” Samantha said. “You need to understand your market. How does your customer buy? When do they buy? Why do they buy? Where do they buy? As a scientist, you are fully capable of doing research, gathering data, and seeing if your data supports your hypotheses. I promise you, if you are polite and creative, people will be more receptive to you than you might think.” “Buying. Observing. Talking. Do we really need to do all three? Can we really aford to spend the time?” “Can you aford not to? Each of the three approaches is imperfect, but together you should see patterns. By walking in your customer’s shoes you will gain empathy and personal understanding, but you don’t want to rely solely on your own experience. By watching people shop, you can witness honest behavior, but you won’t be able to get into their heads to know their motivations. By talking to people, you gather intel on both behavior and motivation, but you have to be careful not to take what you hear too literally. Each method has strengths and weaknesses, but taken together you will learn a ton. You will have a lot more confdence that you are either on the right track, or that you have to make changes to your plans. It is far better to discover bad assumptions now, before you have invested a lot! Now, how do you think you should proceed?” “We want our customers to buy online from us, so I guess we should also buy our own pillow online,” said Roberta. “And we can observe people shopping by going to a home goods store.” “Tat sounds good,” said Samantha. “You will want to talk to some of those people in the store as well. I see one catch: you will be 18 Talking to Humans targeting the moment of purchase but not the type of customer you are hoping for. One of your risk assumptions was specifcally about young urban professionals and new graduates, so what can you also do to target and connect with them?” “What about going to a cofee shop near the downtown ofce buildings as people are going to work?” Koshi said. “Can’t we just hit up some of the people we used to know in college who are now in the working world?” Roberta said. “Why don’t you try both, and see which approach works better,” said Samantha. “Roberta, I would also ask your friends if they will refer you to their friends. It’s best to talk to people who aren’t too close to you. You don’t want a someone’s afection for you to steer what they have to say. “Let’s start by thinking through the questions you want to ask. It always makes sense to prioritize what you want to learn. You should write down an interview plan, even if you don’t completely stick to it. Break the ice, and then get them to tell you a story about buying a pillow!” Te scientists sketched out a plan: Intro: hello, I’m a PhD candidate at Hillside University and I’m researching sleep quality. I’m asking people about the last time they bought a pillow. Would you mind if I asked a few questions? When was the last time you bought a pillow? Why did you go looking for a pillow? How did you start shopping for a pillow? Why did you choose the one you bought? After you bought, how did you feel about the pillow you purchased? The Story 19 Are you going to be in the market for a pillow anytime soon? “Tat’s a great start,” Samantha said. “Keep good notes as you go, and remember to regularly regroup to review your fndings and look for patterns. Be mindful of which method you used as you discuss your observations.” Walking in the Customer’s Shoes Koshi and Roberta got together the next day afer both purchasing a pillow online. “I found it all a bit frustrating,” said Roberta. “It was hard to learn why you would choose down feathers, cotton, or foam. Te manufacturer websites felt like they were from the 1990s. Tere were some reviews available on Amazon and Bed Bath & Beyond, which helped. In my interpretation, about 65% of reviews talked about sleep quality, which seems like a good sign for our frst risk. A lot of the reviews had to do with personal preference for frm versus sof pillows. I think we can ofer both kinds eventually, but we likely need to choose one at the beginning and that could impact some of our assumptions around market size. ” “I started out by searching Google,” said Koshi. “Amazon and BB&B dominated the results, as we expected, but there were a few specialty providers like BestPillow that ranked high. BestPillow lets you navigate their website by sleep issue, such as snoring or neck pain, which I found interesting. While I see some makers pushing hypoallergenic oferings, I didn’t see anyone who could meet our claims of being environmentally friendly. I agree that all the manufacturer websites felt ancient. I think there’s an opportunity to be smart about search engine optimization and really stand out if we can get the messaging right. I guess our next step is to visit the retail 20 Talking to Humans stores.” Observing the Customer Roberta ended up going to a Bed Bath & Beyond while Koshi went to a local department store. She watched three diferent people come in and pick through several diferent pillows, puzzling over the packaging material. One of them asked a store employee for help, and two pulled out their mobile phones to look online. She then watched a woman go right to a particular shelf, grab a pillow and head back to the aisle. Roberta’s plan was to balance observation and interaction, so she decided to jump in. “Pardon me,” she said “I am trying to fgure out which pillow to purchase and noticed that you went right to that one. Might I ask why you chose that pillow?” “Oh, I replaced some ratty old pillows in my house a few weeks ago,” the woman said, “and I liked this one so much that I thought I would replace my whole set.” “Do you mind if I ask how you decided to buy that pillow in the frst place? My name is Roberta, by the way.” “Nice to meet you, Roberta. I’m Susan. Well, I guess I started by researching online and...” A day later, the founders met to compare notes. “Te BB&B had good foot trafc,” Roberta said, “and I was able to watch ffeen people, and speak to ten. Of the ten, one knew what she wanted going into the store, three were basing their purchase just on packaging and store price, and six did Google searches on their phones, right there in the store. Tey were looking up reviews and pricing. You mentioned search engine optimization earlier — I think it could be even stronger with a fabulous mobile experience.” She looked down at her notes. “I also found that seven out of ten were trying to choose a pillow specifcally for better sleep, although their sleep problems were diverse. Finally, when I asked The Story 21 them why they were buying a pillow, the folks over 40 seemed to be in replacement mode, while the folks under 40 seemed to be reacting to a life change. Two people were moving to a bigger house from an apartment. Another person was moving in with their girlfriend, and another said that she got a new job and could now aford nicer things.” “I went to the home goods section of a high-end department store,” said Koshi. “I saw eighteen people, and fve of them knew what they wanted already. Te rest spent time puzzling over the packaging and, like your group, going online with their mobile phone. I spoke to nine shoppers. I said that I was a scientist trying to invent a new pillow. People thought that was pretty cool. Two of them admitted that they were buying the highest price pillow because they assumed that it had to be the best. Two got the cheapest because it was the cheapest. Te others had specifc preferences for down, cotton or foam based on the frmness they were looking for in a pillow. Te frmness preference seemed to be tied to a belief that they would sleep more soundly. On price, I was relieved to see that the prices of the better pillows were in line with what we were hoping to charge.” Roberta pulled out a pad. “So we saw thirty-three people and spoke to nineteen. Our sample set is still small, but Samantha told us to look for patterns and not worry about statistical signifcance right now. If we break our observations into a few metrics, what have we learned?” • 24% of shoppers knew what they wanted when they walked in • 52% looked up information on their phone in the store • 45% of shoppers purchased a mid-priced or high-priced pillow • 68% of the people we spoke to indicated that better sleep was a major driver of their choice 22 Talking to Humans • 37% of the people we spoke to were reacting to a life change • 37% of the people we spoke to were in replacement mode “I think the use of mobile phones is something we need to pay attention to and work into our strategy,” Koshi said. “I guess for our next step, we should follow Samantha’s suggestions to target urban professionals.” Regrouping A week and many interviews later, the team sat down with Samantha. “How did things go?” she asked. “I went to a downtown cofee shop at peak hour,” Koshi said. “At frst, everyone was in such a hurry to get to work that I didn’t get much response, but then I made a little sign I held up outside that promised ‘cofee for science,’ which started to get laughs and a lot of curiosity. I ended up talking to about ffeen people who matched our target of young urban professionals. I got to talk to them for about fve to twenty minutes each. It was actually very enjoyable. “One clear pattern was that people right out of school tended to have no clue. Tey either had never bought a pillow themselves, or if they had, it had been the cheapest thing they could get. A few admitted that they were probably going to buy new bedding. I know it is speculation, but I asked them to guess how they might go about looking for a pillow, based on how they shop for other things. Te common responses were searching on Google or Amazon, or walking into a Bed Bath & Beyond. “Te few folks in their later twenties or thirties whom I spoke to had usually bought at least one pillow — some from Amazon and some from retailers. Te ones who liked a frm pillow avoided The Story 23 down feathers. Te ones who wanted to upgrade to fancier duvets and high thread-count sheets all seemed to go with duck and goose feathers. Tey didn’t know any brands and instead relied on product packaging. Amazon buyers did actually read the reviews. All these folks were only planning on buying new pillows when they were moving to a bigger apartment because they were getting married or something.” “Yes, that aligns with what we learned when we spoke to people in the retail stores and what I saw with my other interviews,” said Roberta. “Pillow buying seems to be tied to life events like moving and marriage and such. I interviewed a diferent group. A whole bunch of our old classmates responded to my email or my Facebook post. I even had some folks pass me on to their friends, and so I got to talk to some people who didn’t go to school with us. “Like you, I saw a lag efect afer someone graduated from college. When new graduates told me that they had not spent any money on their linens yet, I inquired further and found out that their initial spending money was predominately going towards clothes. I spoke to twelve people between 22 and 25, and roughly 60% had actually bought a pillow in the last few years. I saw similar trends as you, although most went right to Google, Amazon or a few specialty online retailers. It seemed like a very online crowd. Te price sensitive ones stayed away from down. Tey didn’t have much to go on for brand, but the reviews helped. Te women defnitely cared more about quality and put more efort into their hunt.” “Te good news is that everyone thought inventing a new pillow was an awesome idea!” said Koshi. Samantha chuckled. “Of everything I’ve heard you say, that last bit is probably the least useful. It’s easy to say something is cool. It’s another thing to actually buy. Te good news is, you are a lot more educated about your market than you were last time we met. 24 Talking to Humans I see from your notes that you have either spoken to or observed 72 people. We should be able to see some patterns from that. Let’s revisit our critical assumptions.” Challenging Assumptions Te team looked at their initial list. 1. We believe that people care about sleep quality when making a purchase decision. “68% of the retail shoppers indicated that this was a major factor,” said Roberta. “Of our young urban professionals, we were able to ask this of only a portion of our interviewees. Only 56% indicated that it was a factor, but if we factor out the new graduates, it was more like 70%. We’ve also read a lot of online reviews and have seen this come up repeatedly. We feel reasonably confdent that this is a common decision point in choosing a pillow,” said Koshi. “I’m glad you are approaching this with rigor and actually calculating metrics from your observations,” said Samantha. “Tat will prevent you from letting innate biases override your actual results. However, one word of advice. At this stage, don’t take any of your statistics too literally and don’t let any single number dominate your strategic thinking. Just as we’re not looking for statistical signifcance at this point, we also don’t want to start treating our results as if they are indisputable facts. How about the next assumption?” 2. We believe that we can sell online directly to customers. “We have seen some promising signs. 77% of our urban professionals start researching purchases with a search engine. Te question is whether they would discover, visit, or convert with our The Story 25 online store. We did see a ton of mobile usage in the retail stores and think there might be a chance to steal those customers if we have good enough search engine optimization. Overall, our conclusion is that we need more data here.” 3. We believe that our customers will be young urban professionals. “I need to run some numbers on size of market and the number of purchases we might expect from this group, but we still feel like this is a good group for us. We clearly saw purchase behavior. Tey want, and can aford, quality things, and prefer to buy things online.” 4. We believe that our very frst customers will be new graduates who need to outft their apartments. “Tis is where we were totally wrong. Buying behavior, or at least the willingness to buy something that isn’t the cheapest option, did not seem to be very prevalent among new grads. Only 25% of the newly minted grads we spoke with had purchased a pillow on their own. Instead, the evidence points us towards people in their mid-tolate twenties or early thirties. “We also saw a correlation between purchasing and life changes. While this was only 37% with our retail shoppers, it was 70% of our urban professionals. From an early adopter perspective, I wonder if we can do well targeting people who are getting married or moving to a larger apartment or house?” 5. We believe we can sell our pillows at a high enough price to cover our costs. “45% of our retail shoppers bought at least a mid-priced pillow. We admit that we visited reasonably high-end stores, but that was still a nice statistic to see. Te good news is that our initial target price is comparable with the high-end of the current market. We 26 Talking to Humans won’t be proftable at the beginning, but if we can scale and improve our manufacturing process then we can move into the black. Of course, they have to want to buy our pillow.” Samantha nodded. “To test that, you will need to actually try selling a few, which ties back to your second risk. But I’m glad you have spent time learning rather than rushing to sell. Overall, it sounds like you have gotten some solid intel. I’m also glad you caught the issue with college grads before you spent a lot of money and energy trying to target them. Have your eforts uncovered new risks or worries?” “I’m both excited and worried by how confused customers are,” Koshi said. “Every brand promises a better night’s sleep. I’m also worried about signals we picked up that the market might be divided into those who want a frm pillow versus a sof pillow. We think that’s erroneous thinking. Our pillow lands in the middle, and our studies show better results. I don’t know if people will believe our data. We really need to get the messaging right.” “As for me,” Roberta said, “I’m most worried about the size of our initial market, how quickly we could grow, and if we can survive to proftability.” “I’m not surprised,” said Samantha. “I have some suggestions. One of you should continue doing these interviews, but try adding a new spin. You are both worried about diferentiation and if people will understand or appreciate the proof from your scientifc studies. Let’s test some messaging. Given what you have said about mobile usage, maybe create an infographic that tries to make your case. Show it to people on a phone. Ask them to explain it to you. First you can see if they understand it, and then if they fnd it meaningful. “Expanding from qualitative research, I also think one of you should create a fnancial model that lets you play with how much The Story 27 you charge, how many items you might sell, and what your costs will be. Take into account what you have learned so far and see if your business model adds up. “Finally, I think you’ve learned enough to run some experiments around customer acquisition and sales. It is straightforward to create a basic online store using one of the hosted services. You can test selling a few pillows before you invest in manufacturing capability. Try driving trafc through Google or Facebook ads, and run some A/B tests around ad copy, landing-page messaging and price points. Study your metrics. Ten follow up with your customers and interview them on their buying process and decision.” Roberta’s eyes widened. “Wow. Maybe we can get our frst paying customer!” “Exactly,” said Samantha. “Just remember Steve Blank’s phrase about startups: you are in search of a scalable and repeatable business model. Run these experiments and keep in mind that your mission at this point is to learn before you scale. Don’t stop talking directly to customers. Your questions will likely evolve, but no matter what stage you are in, you’ll usually fnd that your best insights will come from talking to real people and observing real behavior.” 28 Talking to Humans Lessons Learned The Story 29 So what are the key takeaways from Roberta and Koshi’s adventure? 1. Customer discovery is about gaining much deeper insight into your customer, or your partners, or your market 2. Being told your idea is cool is not useful; seeing behavior that validates your customer’s willingness to buy is very useful 3. Prepare an interview guide before you get out of the building 4. To ask the right questions, you need to understand your risks and assumptions 5. Get creative when trying to recruit people — if at frst you don’t succeed, try something new 6. Sometimes observation is as powerful as interviews 7. Take good notes, especially on your key risks, so that you can calculate metrics later. Even better, set your target goals ahead of time! 8. Bring learning back and analyze your patterns as a team 9. Never stop asking hard questions about your business In the next section of this book, we’re going to dive into tactics and talk about all this and more in detail. How To PART TWO How To 31 Getting Started with Customer Discovery Qualitative research, i.e. talking to humans, is something you never want to stop doing, but it can defnitely feel intimidating at frst. Te good news is that if you go about it in a professional and thoughtful way, you will fnd lots of people who are willing to help and give you some of their valuable time. You need to begin with a core set of questions: t Who do you want to learn from? t What do you want to learn? t How will you get to them? t How can you ensure an efective session? t How do you make sense of what you learn? 32 Talking to Humans Who Do You Want to Learn From? How To 33 If your desired customer is a doctor, it stands to reason that it won’t help you much talking to a plumber. If you were aiming for teenagers, would you talk to grandparents? Te frst step in trying to learn from the market is having an opinion about who your market actually is. I recommend thinking about a few categories: t Te typical customer you envision if you get traction with your idea t Your early adopter, i.e. the people who will take a chance on your product before anyone else t Critical partners for distribution, fulfllment, or other parts of your business You might think you are creating a product for “everyone”, but that is not an actionable or useful description in the early stages. You need to get more specifc. Your job is to think through the kinds of people who have the problem you are interested in solving. Sometimes they have a particular job, or a state of mind, live in a particular part of the world, or belong to a certain age group. Standard demographics might be useful, or they might be irrelevant. What are the commonalities across your customer base? Here are some examples: • A hospital management system has to think about the hospital administrator who will buy their software and the actual hospital workers who would use it • An on-call veterinarian service needs to talk to pet owners • An online marketplace for plumbers might consider plumbers on the sell side, and home owners on the buy side 34 Talking to Humans You also want to think about your early adopters. Why do they matter? Most new products ft alongside a “technology adoption curve,” as illustrated below. New founders tend to obsess about their mainstream customer (represented in the chart as the early and late majority). However, by defnition, the mainstream is waiting for proof from early adopters before they try something. If you cannot get early adopters, you cannot move on. Early adopters are usually folks who feel a pain point acutely, or love to try new products and services. In our story of Koshi and Roberta, the scientists hypothesized that their early adopter would be urban professionals in their mid to late twenties. For the three customer examples we just gave, here are examples of early adopters: • Our hospital management system might target hospital chains still stuck with an archaic vendor • Our vet service might target busy 20-somethings in a major city • Our online market for plumbers might target solo practices on the sellside and frst-time home owners on the buy-side How To 35 Tere is no prescription for how narrowly or broadly you should cast your net for customer discovery interviews. However, the more focused you can be, the easier it is to make sense of your evidence. Special Note for B2B Products If you are selling to the enterprise, you should also think about the diferent kinds of participants in your sales process. In a classic enterprise sale, you will ofen have a strategic buyer (who is excited about the change you can bring), an economic buyer (who controls the purse), a technical buyer (who might have approval/blocker rights), and then the actual users of your product. Can you identify your champion? Can you identify who might be a saboteur? For B2B companies, Steve Blank also recommends that you start by talking to mid-level managers rather than the C-suite. It can be easier to get their time, it is ofen easier to get repeat conversations, and, most importantly, it will allow you to get better educated before you go up the chain. 36 Talking to Humans What Do You Want to Learn? How To 37 Go into every customer interview with a prepared list of questions. Tis list, which we refer to as an interview guide, will keep you organized. You will appear more professional, and it will ensure that you get to your most important questions early. How do you know your most important questions? I like to begin by understanding my most important, and most risky, assumptions. Tose tend to be the areas where you need to gather insights most urgently. You can uncover your assumptions in a myriad of ways. You can use Alex Osterwalder’s business model canvas or Ash Maurya’s lean canvas. Personally, I ask these questions (see the Appendix for a worksheet and tips): • My target customer will be? • The problem my customer wants to solve is? • My customer’s need can be solved with? • Why can’t my customer solve this today? • The measurable outcome my customer wants to achieve is? • My primary customer acquisition tactic will be? • My earliest adopter will be? • I will make money (revenue) by? • My primary competition will be? • I will beat my competitors primarily because of? • My biggest risk to fnancial viability is? • My biggest technical or engineering risk is? • What assumptions do we have that, if proven wrong, would cause this business to fail? (Tip: include market size in this list) You should be able to look at this list and spot the assumptions that are both highly important and fairly uncertain. Be honest. You want to focus on the most important issues. 38 Talking to Humans In the case of our pillow entrepreneurs, they chose six initial risks which drove their research approach and frst set of questions. To give another scenario, in the last chapter we shared the example of an on-call veterinarian service. Te founders might identify a set of risks: 1. Pet owners are frustrated having to go to a vet and would rather have someone come to them 2. Customers are willing to pay a big premium to have a vet show up at their door 3. We think busy urbanite pet owners will be our early adopters 4. We think people currently discover their vets either through word of mouth or online searches 5. We can affordably acquire our customers through targeted Google search ads 6. We can recruit enough vets across the country to make this a big enough business 7. With travel baked in, our vets can see enough people in a day to be fnancially viable Not every assumption can be tested efectively through qualitative research, but in this case, our founders can probably get some insights on risks 1, 3, 4, and 6 just by talking to people. Risks 1, 3 and 4 would be focused on pet owners, while #6 would be focused on vets. Get Stories, Not Speculation When you are contemplating your questions, be careful with speculation. Humans are spectacularly bad at predicting their future behavior. It is tempting to say, “Would you like this idea?” or “Would you buy this product?” Unfortunately, you really have to treat those How To 39 answers with a great deal of skepticism. It is more efective to ask your interview subject to share a story about the past. For example, when our fctional scientists Koshi and Roberta created their interview plan, the questions were focused on getting the interviewee to tell a story about their last pillow buying experience. Keeping with our second example of an on-call vet service, the team might have a loose interview plan that looks like the following: • Warm up: concise intro on the purpose of the conversation • Warm up: basic questions about person and pet (name, age, picture) • Who is your current vet? Can you tell me about how you found and chose him/her? • Please describe the last time you had to take your pet to the vet for a checkup • Walk me through the process of scheduling a time to visit the vet. • What was frustrating about that experience? • What did you like about that experience? • Have you ever had an emergency visit to a vet? if yes, can you describe that experience for me? • Have you ever thought about changing vets? why / why not? Ask Open-Ended Questions Your goal is to talk little and get the other person sharing openly. To that end, it is imperative that you structure open-ended questions, or at minimum follow up yes/no questions with an open-ended question that gets them talking. One tip is to try to ask questions that start with words like who, what, why and how. Avoid questions that start with is, are, would, and do you. But remember, if you do get a yes/no answer to a 40 Talking to Humans question, you can always follow up in a way that gets them talking. An interesting open-ended question, which Steve Blank likes to use to conclude his interviews, is: “What should I have asked you that I didn’t?” Testing for Price Two of the hardest questions to answer through qualitative research are: will people pay? and how much will they pay? Speculative answers on this topic are extremely suspect. You can learn a lot, however, by asking questions like: • How much do you currently spend to address this problem? • What budget do you have allocated to this, and who controls it? • How much would you pay to make this problem go away? (this can lead to interesting answers as long as you don’t take answers too literally) My recommendation is to set up a situation where the subject thinks they are actually buying something, even if they know the thing doesn’t exist yet. Kickstarter and other crowdfunding platforms are used by a lot of teams to test pre-order demand. For expensive corporate products, you can also try to get customers to buy in advance or sign a non-binding letter of intent to buy. Te key thing to remember is that people don’t honestly think about willingness to pay unless they feel like it is a real transaction. Getting Feedback on a Prototype Sometimes you will want to get reactions to a product solution. You can learn a lot by putting mockups or prototypes in front of people, but, as with all speculation, you should interpret reactions with a degree of skepticism. If you show your interview subject a proposed solution, you need to separate this step from your questions about their behavior. How To 41 Ask your questions about behavior and challenges frst, so that the discussion about product features does not poison or take over the conversation. People do love talking features! The Magic Wand Question Some people like to ask, “if you could wave a magic wand and have this product do whatever you want, what would it do?” Personally, I avoid questions like this because customers are too constrained by their current reality to design efective solutions. It is the customer’s job to explain their behavior, goals, and challenges. It is the product designer’s job to come up with the best solution. Tere is one variation to the magic wand question that I do like, however, because it focuses on problems and not solutions: “If you could wave a magic wand and solve any problem, what would you want to solve?” I suspect, however, that you will fnd many people struggle with such an open question. Design “Pass/Fail” Tests Customer discovery is made up of a lot of qualitative research, but it helps to take a quantitative mindset. Set goals for key questions and track results. For example, halfway through their initial research, our scientists Koshi and Roberta already knew stats like: • 24% of shoppers knew what they wanted when they walked in • 45% of shoppers purchased a mid-priced or high-priced pillow • 68% of the shoppers we spoke to indicated that better sleep was a major driver of their choice Even better would have been if they had set targets ahead of time. For example, they might have set the following goals: • Because we are a new brand, we are hoping that most shoppers are undecided. We want to see that 40% or fewer shoppers already know what 42 Talking to Humans they want when they walk in • Because our pillow is expensive, we want to see that at least 40% of the shoppers buy mid or high-end models • Because we believe that sleep quality is a major differentiator for our product, we want over 60% of shoppers to indicate that this is a major factor in their decision making process Te numerical target you choose can be an educated guess. You do not need to stress over picking the perfect number. It is more important that you set a goal and really track what is happening. Setting a target forces you carefully think through what you are hoping to see, and makes decisions and judgment calls a bit easier as you review your data. A Guide, Not a Script An interview guide is not a script. You do not need to read from it like an automaton. You should feel free to veer of of it if the conversation brings up something interesting and new. It will likely evolve as you learn from the market and unearth new questions. But always plan, prioritize and prep your questions before any session. Observation Can Be As Powerful As Questions Sometimes the best thing you can do is sit back and watch someone’s behavior. You might watch their purchase process, or examine how they go about solving a particular problem. As you think about what you want to learn, also think through how you might gather data through observation rather than direct interviews. In our story of Koshi and Roberta, the two got some of their most valuable insights by going to linen stores and watching potential customers struggle to buy a pillow. Tey observed behavior and only then jumped in to ask questions. Tis technique cannot always be used. For example, when my How To 43 team was trying to validate a weight loss product idea, it did not feel practical to watch people go about their diet. Instead we did interviews and then put a group of customers through a two-week concierge experiment (see Glossary) where we manually acted out the diet experience. But, where possible, observing uninfuenced behavior can lead to great insights. 44 Talking to Humans How Do You Find Your Interview Subjects? How To 45 Entrepreneurs new to customer development are ofen intimidated at the thought of approaching complete strangers. It might surprise you to hear that people are ofen very willing to help out. Tis is especially true if you are working on a topic that interests them and you approach them nicely and professionally. Tere are three general rules to keep in mind when recruiting candidates to speak with: 1. Try to get one degree of separation away (don’t interview your mom, your uncle, or your best friends) 2. Be creative (and don’t expect people to come to you) 3. Fish where the fsh are (and not where they are not) Get Creative One aspiring entrepreneur wanted to target mothers of young children. She had heard stories about talking to people in a cofee shop, but felt like it was too unfocused. So she tried hanging around school pickup zones, but the moms were too busy and refused to speak to her. Next, she tried the playground, where she fgured moms would be bored watching their kids play. Tis worked reasonably well, but she was only able to get a few minutes of anyone’s time. So instead, she started organizing evening events for moms at a local spa where she bought them pedicures and wine. Te time of day worked because the moms could leave the kids at home with their partner. Te attendees had a great time and were happy to talk while they were getting their nails done. Find the Moment of Pain If you can connect with people at the moment of their theoretical pain, it can be very illuminating. My colleague Alexa Roman was working with an automotive company and they had a concept tied 46 Talking to Humans to the experience of getting gas. So Alexa and team visited a series of gas stations. Tey watched consumers go through the process of buying gas. Ten they approached them and asked questions. By thinking about the moment of pain they wanted to address, they knew exactly where to fnd their consumers and they were able to gather valuable observational research. Make Referrals Happen Use referrals to your advantage. Let’s say you want to talk to doctors. Tey are busy and have strong gatekeepers. I bet you know how to get to at least one doctor, however. Tat doctor will know other doctors. Even if your doctor happens to be a close friend and thus breaks the “more than one degree of separation” guideline, she can still give you advice on when might be a good time to talk to a doctor. She can also connect you with other doctors. You should use referrals as much as possible. Set a goal of walking out of every interview with 2 or 3 new candidates. When you end an interview, ask the person if they know others who face the problem you are trying to solve. If they feel like you have respected their time, they will ofen be willing to introduce you to others. Conferences & Meetups Conferences and meetups can be an amazing recruiting ground, because they bring a group of people with shared interests into one place. You just need to be respectful of people’s time. I have found that it is extremely efective to ask people for their time, but for later, afer the conference or meetup. Get their business card, let them get back to networking, and then have an in-depth conversation when it fts their schedule. Immediately afer the conference while their memories are still fresh, send them a short email that reminds them where you met, and give your ask for a conversation. Tis How To 47 works as efectively for in-demand panel speakers as it does for other attendees. Meetups are usually inexpensive, but conference tickets can be pricey. If you are on a budget, you can “hack” expensive conferences by intercepting people outside of the building, or, if you can get access to the attendee or speaker lists ahead of time, contacting people directly and meeting them near the event. Meetup.com has decent search tools to discover relevant events in your area, and a few good Google search queries can usually get you to a short list of conferences that ft your needs. Enterprise Customers Finding interviewees can be harder when you are focused on an enterprise customer. You need laser-like targeting. In addition to conferences, LinkedIn can be extremely useful. If you have hypotheses on the titles of the people you are seeking, run searches on LinkedIn. You might be able to get to them through a referral over LinkedIn, or you might need to cold call them through their company’s main phone number. You then have to decide on your approach method. You can either ask for advice (where you make it clear that you are not selling anything), or you can go in as if you were selling something specifc. Advice vs Selling Asking for advice should be your default method early in your customer discovery process. You will have better luck gaining access. People like being asked (it makes them feel important). Steve Blank used to call people up and say something like, “My name is Steve and [dropped name] told me you were one of the smartest people in the industry and you had really valuable advice to ofer. I’m not trying to sell you anything, but was hoping to get 20 minutes of your time.” 48 Talking to Humans Another efective spin on “asking for advice” is to create a blog focused on your problem space, and ask people if you can interview them for an article. When do you approach someone as if you were selling a product? Tis method is useful if you are past initial learning and want to test your assumptions around customer acquisition and messaging. Just don’t jump into sales mode too early. Beneftting from Gatekeepers If LinkedIn isn’t helping you and you need to reach high up in an organization, another approach is to call the CEO’s ofce. Your goal is not to talk to the CEO but actually their executive assistant. His job is to be an efective gatekeeper, so if you explain, “I’m looking to talk to the person who handles X”, they will ofen connect you to the right person (especially if you are pleasant and professional — notice the trend on that one?). Te added advantage of this method is if you end up leaving a voice mail for your intended contact, you can say “Jim from [CEO’s name]’s ofce gave me your name”. Dropping the boss’ name tends to improve response rates. Another approach is to send a targeted email into an organization with a very short email that asks for an introduction to the right person to speak to. You can make guesses as to email addresses based on LinkedIn queries. For this tactic to work, you must keep your emails extremely concise. Students and Researchers While people are willing to grant time to polite people who ask for advice, you have an extra advantage if you are a student or academic researcher. In other words, if you are a student or researcher, say so. As an extra incentive, you might also ofer to share the results of your research with your interview subjects. How To 49 You Might Be Surprised Another colleague of mine, Jonathan Irwin, was working with a Fortune 50 company. Te client team wanted to interview a special kind of oil platform engineer, of which there were less than 20 in the world! To access these people required security clearance and safety training. We challenged the team to fnd a way, expecting that they would have to rely on video conferencing or phone calls. However, the team started researching this speciality profession through Google and discovered that there was an onshore training facility just an hour away. Te moral of the story is that it ofen isn’t as hard as you think. No Fish in the Sea When I say fsh where the fsh are, it is really important to remember the fip side to that statement: don’t fsh where the fsh are not. If a method isn’t working, try something new. We were doing a project with a major magazine testing out new product ideas. Our target was busy women, and we knew that the readership correlated closely with shoppers of Te Container Store (a retail store). So we parked out front of a store and intercepted folks as they came in and out. People were willing to speak for a few minutes, but many were in a bit too much of a rush. Ten one of our teammates discovered a sample sale happening around the corner. Tere were probably 200 bored women waiting in line, most of whom were happy to talk to us to pass the time. (Note: fnding bored people stuck in line is a common recruiting hack.) Still, we didn’t feel like we were targeting quite as narrowly as we wanted (busy, working women) or as geographically broadly (we didn’t want to just talk to New Yorkers). So we turned to the magazine’s social media presence. We created a short online survey to help us qualify responses, and the magazine posted a link to their Twitter and Facebook pages with a catchy sentence. We had hundreds of women fll out the survey, and then we picked our top 50 Talking to Humans thirty candidates and scheduled calls. Online Forms & Landing Pages In a similar vein, one efective tactic is to create an online form or landing page and build up a list of people to contact. Below is an example of a landing page. Our team was testing a product idea for better home organization. Tis landing page test actually consisted of a three-step funnel with a call to action, a price choice, and then a request for an email address. We tracked the conversion metrics carefully and used the emails to schedule interviews. Caveat: driving trafc is never a trivial process. If you have budget, Google or Facebook ads can work. Otherwise, you can try to generate some word of mouth on social media or through bloggers. How To 51 Conclusion Hopefully what you are picking up through these examples is that there is no single way to get to people. It takes some creativity and hustle, but it isn’t as hard as you might think. Trust me, people will not think you are rude if you carry yourself well and act professionally. Check Out the Appendix for Examples Te Appendix has more tips and examples for cold email and voice mail approaches. 52 Talking to Humans How to Ensure an Effective Session? How To 53 I recommend the following guidelines for running a productive interview session. Do Your Interviews In Person Te quality of your learning can vary a lot depending on your communication method. Talking in person is by far the best approach. You can read body language and build rapport much easier. Remember that a huge percentage of human communication is non-verbal, so why blind your senses if you don’t have to? Te next best approach is video conferencing, because at least you can still read someone’s facial expressions. Phone calls should be your method of last resort (sometimes there is no choice), and I would entirely avoid using text-based mediums like email or chat. Talk to One Person at a Time I believe in talking to one person at a time. It is useful to have a second person on your side quietly taking notes. I strongly recommend avoiding focus groups for two reasons: 1. you want to avoid group think; 2. you will really struggle to focus on one person’s stories, and drill into areas of interest, when you are juggling multiple people. Adding a Note Taker Bringing a note taker will allow you to stay in the moment without worrying about getting every bit down on paper. You can stay focused on the topics, the body language, and where to take the conversation. If you have to take your own notes, that’s not the end of the world. It can sometimes make for a more intimate conversation. Just remember to write up your notes right afer the session or you will lose a lot of detail and color that you weren’t able to write down. You can also ask the interview subject if you can record them, 54 Talking to Humans and many people are willing. Te risk is that a recorder can inhibit the conversation, but most people forget that they are being recorded once the discussion is fowing. I highly recommend that you play back the audio and write up your notes soon afer the session, both because writing up notes will reinforce what you learned in your own mind, and also because written notes are easier and faster for both you and your teammates to scan. I’ve found that once audio or video is more than a couple weeks old, somehow they never get touched again. Start With a Warm Up & Keep It Human When you kick things of, concisely explain why you are there, and thank them for the time. Launch into things with one or two easy warm up questions. For example, if you are talking to a consumer, you might ask where they are from and what they do for a living. If you are talking to enterprise, you might ask how long they have been with their company. You don’t want to spend a lot of time on this stuf, but it does get the ball rolling. Have a written or printed list of questions, but don’t rigidly read from your list. Be in the moment. Make the interview subject feel like you are really listening to them. Disarm Your Own Biases Human beings have an amazing ability to hear what they want to hear (this is called “confrmation bias”). Go into each session prepared to hear things that you might not want to hear. Some entrepreneurs even take the mindset that they are trying to kill their idea, rather than support it, just to set the bar high and prevent themselves from leading the witness. Get Them to Tell a Story As I mentioned in the chapter “What Do You Want to Learn,” How To 55 humans are terrible at predicting their own behavior. If you ask any speculative questions, be prepared to listen with a healthy dose of skepticism. I far prefer to get people telling stories about how they experienced a problem area in the past. In particular, try to fnd out if they have tried to solve the problem. What triggered their search for a solution? How did they look for a solution? What did they think the solution would do, before they tried it? How did that particular solution work out? And if they are struggling to remember specifcs, help them set the scene of their story: what part of the year or time of day? Were you with anyone? As they are telling their story, follow up with questions about their emotional state. You might get some historical revisionism, but what you hear can be very illuminating. Te researchers at Meetup.com, who borrow from Clayton Christensen’s Jobs To Be Done framework, use an interesting tactic to help their subjects get in story mode. When they are asking someone to take them through a purchase experience, from frst thought through purchase and then actual product usage, they say: “Imagine you are flming the documentary of your life. Pretend you are flming the scene, watching the actor playing you. At this moment, what is their emotion, what are they feeling?” Look for Solution Hacks One of the best indicators that the market needs a new or better solution is that some people are not just accepting their frustration with a particular problem, but they are actively trying to solve it. Maybe they have tried a few diferent solutions. Maybe they have tried hacking together their own solution. Tese stories are a great indicator of market need. Understanding Priority For someone to try a new product, their pain usually needs to be 56 Talking to Humans acute enough that they will change their behavior, take a risk, and even pay for it. If you feel like you are seeing good evidence that someone actually has a problem, it is worth asking where it ranks in their list of things to solve. Is it their #1 pain, or something too low in priority to warrant attention and budget? Listen, Don’t Talk Try to shut up as much as possible. Try to keep your questions short and unbiased (i.e. don’t embed the answer you want to hear into the question). Don’t rush to fll the “space” when the customer pauses, because they might be thinking or have more to say. Make sure you are learning, not selling! Or, at least make sure you are not in “sales” mode until the point when you actually do try to close a sale as part of an experiment. Follow Your Nose and Drill Down Anytime something tweaks your antenna, drill down with follow up questions. Don’t be afraid to ask for clarifcations and the “why” behind the “what.” You can even try drilling into multiple layers of “why” (run an Internet search for “Five Whys” for more info), as long as the interviewee doesn’t start getting annoyed. Parrot Back or Misrepresent to Confrm For important topics, try repeating back what the person said. You can occasionally get one of two interesting results. Tey might correct you because you’ve misinterpreted what they said. Or, by hearing their own thoughts, they’ll actually realize that their true opinion is slightly diferent, and they will give you a second, more sophisticated answer. Another approach is to purposefully misrepresent what they just said when you parrot it back, and then see if they correct you. But How To 57 use this technique sparingly, if at all. Do a Dry Run If you are a beginner at customer discovery, do a dry run with a friend or colleague. See how your questions feel coming out of your mouth. Get a sense of what it is like to listen carefully and occasionally improvise. Getting Feedback on Your Product If you want to get feedback on your product ideas, whether you show simple mockups or a more polished demo, there are a few important tips to keep in mind: As I mentioned before, separate the storytelling part of your session from the feedback part. People love to brainstorm on features and solutions, and this will end up infuencing the stories they might tell. So dig into their stories frst, and gather any feedback second. Second, disarm their politeness training. People are trained not to call your baby ugly. You need to make them feel safe to do this. Ask them up-front to be brutally honest, and explain that it is the very best way for them to help you. If they seem confused, explain that the worst thing that could happen is to build something people didn’t care about. Finally, keep in mind that it is incredibly easy for people to tell you that they like your product. Don’t trust this feedback. Instead, you need to put people through an actual experience and watch their behavior or try to get them to open their wallet. Tere is no right answer on how polished your early mockups need to be. If you are in the fashion space, you need to have a high degree of visual polish as table stakes. If you are creating a solution for engineers, you probably need much less. Just don’t wait for perfection, because initial product versions rarely get everything right. You need to spot your errors sooner rather than later. 58 Talking to Humans How Do You Make Sense of What You Learn? How To 59 Your goal is not to learn for learning’s sake. Your goal is to make better decisions that increase the odds of success. So how do you translate your observations into decisions? Te frst step is to make sense of your patterns. Take Good Notes To fnd your patterns, frst you need to track the data. Tis is easy if you bring a good notetaker to the interview, but otherwise, make sure that you write up your notes as soon afer your conversation as possible. Make them available to the entire team with Google Docs or the equivalent. At the start of every entry, note the following information: • Name of interview subject • Date and time • Name of interviewer • In person or video conference • Photo (if you have one) Ten at the start of your notes, include basic descriptive information of the interview subject. Quantitative Measures If you are setting specifc metric goals for your interviews, you might set up a shared spreadsheet that essentially acts as a running scorecard for how you are doing and how you are tracking to targets. EXAMPLE Let’s imagine that you have invented a new air purifer that triples the growth speed of greenhouse plants. Now you plan to talk to 20 60 Talking to Humans farmers, and you have a few core questions: • Will their business actually beneft from increased growth speed? You are assuming that increased volume will help rather than hurt. You plan to talk to growers of different crops with the goal of fnding crops where 60% or more of farmers want increased volume. • Are farmers spending any money today on growth accelerator solutions? Your qualitative research will drill into what and why, but your metrics goal says that you hope at least 50% of the market is already spending at least some money. • Do they have the facilities to support your purifer? In this case, you need your purifer to be both in a specifc location, but also have access to an electrical outlet. You are hoping that 70% of the farmers have an outlet 20 feet or closer to your spot. Here is the kind of spreadsheet that you and your team might track: As Samantha advised Koshi and Roberta in the fctional story, turning your observations into quantifable metrics is both useful and tricky. Our brains like to infuence our thinking with cognitive biases, especially fltering results for what we want to hear. Calculating actual metrics helps fght against that dynamic. How To 61 At the same time, you have to beware a diferent kind of bias: our desire to turn statistics into facts. Hopefully you are getting enough data points that you can trust the patterns, but do not confuse this with statistical signifcance or take your results too literally. My advice is to calculate metrics, but remain skeptical of them, don’t obsess over any one particular metric, and continue to question what is behind your numbers. Dump and Sort Exercise Bring your team together and arm them with sticky notes and sharpies. Give everyone 10 minutes to jot down as many patterns and observations as they saw during their interviews. Put all the sticky notes on a wall and have someone sort them into groups. As a team, discuss the patterns, and then re-review your assumptions or business canvas and see what might need to change or require greater investigation. Look for Patterns and Apply Judgement Customer development interviews will not give you statistically signifcant data, but they will give you insights based on patterns. Tey can be very tricky to interpret, because what people say is not always what they do. You don’t want to react too strongly to any single person’s comments. You don’t want to take things too literally. But neither do you want to be bogged down trying to talk to thousands of people before you can make a decision. You need to use your judgement to read between the lines, to read body language, to try to understand context and agendas, and to flter out biases based on the types of people in your pool of interviewees. But it is exactly the ability to use human judgement based on human connections that make interviews so much more useful than surveys. Ultimately, you are better of moving fast and making decisions 62 Talking to Humans from credible patterns than dithering about in analysis paralysis. Don’t Abdicate Your Role As Product Designer It is not the job of the customer to design your product. It is yours. As you are gathering information and making decisions, act like a intelligent flter, not an order-taker. Expect False Positives While all entrepreneurs get their fair share of naysayers and skeptics, you have to be wary of the opposite problem in customer development interviews. People will want to be helpful and nice, and your brain will want to hear nice things. As you are weighing what you have learned, just keep this in mind. The Truth Curve I am a big believer in qualitative research. I think a good product team should build a regular cadence of talking to relevant people into their process. However, you don’t want your only source of learning to be talking to people. You don’t really know the absolute truth about your product until it is live and people are truly using it and you are making real money from it. But that does not mean you should jump straight to a live product, because that is a very expensive and slow way to iterate your new business. Get into the market early and begin testing your assumptions right away, starting with conversations and proceeding from there. It will dramatically increase the odds that you will create a product that customers actually want. As you build confdence, test with increasing levels of fdelity. I think of it like peeling an onion in reverse. I created the accompanying chart to demonstrate the levels of believability for diferent kinds of experiments. How To 63 Talking to people is powerful. It tends to give you your biggest leaps of insight, but, as I keep on repeating, what people say is not what they do. You might show people mockups and that might give you another level of learning and feedback, but reactions still need to be taken with skepticism. Concierge and “Wizard of Oz” experiments, where you fake the product through manual labor (see Glossary) will give you stronger evidence, because you put people through an experience and watch their actions. Te next layers of the onion are to test with a truly functional “Minimum Viable Product” (see Glossary) and beyond. Te point I want to make is that all of the steps on the curve can be very useful to help you learn, make smarter decisions, and reduce risk, but you need to use your head, and apply judgement to everything you are learning. 64 Talking to Humans How many people to talk to? Tere is no pat answer to this question. A consumer business should talk to an order of magnitude more people than a business that sells to enterprise. If you are in the consumer space and haven’t spoken to at least 50 to 100 people, you probably have not done enough research. In his I-Corps course, Steve Blank requires his teams, many of which are B2B, to talk to at least 100 people over 7 weeks. I advise that you never stop talking to potential customers, but you will probably evolve what you seek to learn. If you see the same patterns over and over again, you might change things up and examine diferent assumptions and risks. For example, if you feel like you have a frm understanding of your customer’s true need, you might move on to exploring how they learn about and purchase solutions in your product category today. And don’t forget that observing your customers can be as powerful as directly talking to them. Lead with Vision Customer Development and lean startup techniques are some of the most powerful ways to increase your odds of success, but they are not a replacement for vision. You need to start with vision. You need to start with how you want to improve the world and add value to people’s lives. Te techniques we’ve discussed in this book are among a body of techniques that let you reality check your vision, and optimize the path you will take to achieve your vision. How To 65 Conclusion Toughtful qualitative research is a critical tool for any entrepreneur. Hopefully this book has given you some new strategies for how to put it to work for your needs. Creating a new business is tremendously challenging. Te ways you can fail are numerous. t You have to get the customer and market right t You have to get the revenue model right t You have to get the cost structure right t You have to get customer acquisition right t You have to get the product right t You have to get the team right t You have to get your timing right Screw up any one of those and you are toast. Tere is a reason why entrepreneurship is not for the faint of heart. But we’re not here to be faint of heart. We are here to change the world. Dream big. Be passionate. Just be ruthless with your ideas and assumptions. Customer discovery and lean experimentation can truly help you chart a better path and fnd success faster and with more capital efciency. Don’t forget that as your business grows and changes, so too will your customer base. Keep on reality-checking your hypotheses. Keep on talking to humans. Appendix PART THREE Appendix 67 Cold Approach Examples When you are trying to reach someone you do not know, there are a few things to remember: 1. Keep things concise 2. Keep things convenient (meet near their ofce, etc) 3. Name drop when you can 4. Follow up if you don’t hear an answer, but don’t be annoying 5. If you are leaving a voice mail, practice it frst (you might think it sounds practiced, but to others, it will sound more professional) Example Email 1 To: [email protected] From: [email protected] John, I received your name from James Smith. He said that you had a lot of expertise in an area I am researching and recommended that we speak. I’m trying to study how companies are handling their expense report management workfows and the frustrations they are experiencing. I would be happy to share my research conclusions with you. Would you have 30 minutes to spare next week when I could buy you a cup of coffee and ask you a few questions? Many thanks for your time and I look forward to hearing from you, Jane Doe 68 Talking to Humans Example Email 2 To: [email protected] From: [email protected] John, I have been working on some new solutions in the area of expense report management, and I was told that you have a lot of expertise in this area. We started this journey because of personal frustration, and we’re trying to fgure out how to make expense reporting much less painful. Would you have 30 minutes to give us some advice, and share some of your experiences in this domain? I assure you that I’m not selling anything. I would be happy to come by your offce or arrange a quick video conference, at your preference. Many thanks, Jane Doe Example Voice Mail Message “Hello, my name is Jane Doe. I was referred to you by James Smith, who said I would beneft from your advice. I am currently researching how companies are handling their expense management workfows. I understand you have a lot of expertise in this area. I was hoping to take just 30 minutes of your time to ask you a few questions. I’m not selling anything and I would be happy to share my research conclusions with you. You can reach me at 555-555-5555. Again, this is Jane Doe, at 555-555-5555, and thank you for your time.” Final Note Cold calling is never anyone’s favorite thing to do, but it isn’t nearly as painful as you imagine. You have nothing to lose and everything to gain. So give yourself a determined smile in the mirror, and go get them! Appendix 69 Business Assumptions Exercise I am agnostic about the framework you choose to use to map out your business assumptions. Alexander Osterwalder’s business model canvas and Ash Maurya’s lean canvas are both powerful tools. I also ofen fnd myself using this simple set of questions to lay out a belief system around an idea: Try to make your assumptions as concise and specifc as possible. You want to be able to run an experiment against it to see if it is true. My target customer will be? (Tip: how would you describe your primary target customer) The problem my customer wants to solve is? (Tip: what does your customer struggle with or what need do they want to fulfll) My customer’s need can be solved with? (Tip: give a very concise description / elevator pitch of your product) Why can’t my customer solve this today? (Tip: what are the obstacles that have prevented my customer from solving this already) The measurable outcome my customer wants to achieve is? (Tip: what measurable change in your your customer’s life makes them love your product) 70 Talking to Humans My primary customer acquisition tactic will be? (Tip: you will likely have multiple marketing channels, but there is often one method, at most two, that dominates your customer acquisition — what is your current guess) My earliest adopter will be? (Tip: remember that you can’t get to the mainstream customer without getting early adopters frst) I will make money (revenue) by? (Tip: don’t list all the ideas for making money, but pick your primary one) My primary competition will be? (Tip: think about both direct and indirect competition) I will beat my competitors primarily because of? (Tip: what truly differentiates you from the competition?) My biggest risk to fnancial viability is? (Tip: what could prevent you from getting to breakeven? is there something baked into your revenue or cost model that you can de-risk?) My biggest technical or engineering risk is? (Tip: is there a major technical challenge that might hinder building your product?) And then answer the following open-ended question. Be creative and really examine your points of failure. Appendix 71 What assumptions do we have that, if proven wrong, would cause this business to fail? 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Afer you have looked at your business holistically and also answered the broad fnal question, mark the assumptions that would have a large impact on your business and feel highly uncertain. Now you know your priorities for customer discovery and the experiments you need to run! 72 Talking to Humans Teaching Exercise #1: Mock Interviews If you are using this book to try to teach customer discovery/ development, there is nothing like real-world practice to make learning stick. Before you send your class out into the world to conduct their own interviews, however, you might try a compact exercise like the following: Tools All participants should have pen and paper Preface: Choose a Topic Everyone in the class will interview each other based on the same topic, which means it needs to be something most people can relate two. Tere are two angles you might take: 1. Something that helps the interviewer dig up past behavior. For example, “Tell me about the last thing you purchased over $100.” Have the interview subject explain what they bought, what the purchase process was like from desire to actual ownership, how they made their purchase decision, etc. 2. Something that helps the interviewer unlock deeper motivations and desires. For example, “Tell me about your dream car.” Prompt your students not just to get people to describe the car, but to dig into the reasons behind the choice; they can also prompt for whether the interview subject has ever experienced driving the car. Appendix 73 Exercise Step 1: Intro, 5 minutes Explain the exercise, the topic that the students will use, and give a few specifc suggestions for questions they might ask. Example questions for the dream car: when did you fall in love with the car and why? of the reasons you shared, why are these the most important to you? how have you imagined using the car? etc Step 2: Interview Plan, 2 minutes Give your class the topic and let them spend 5 minutes on their own. Tey should write down no more than 6 questions to ask. Step 3: Pair Interviews, 5 - 7 minutes each Pair up your students. One will begin as the interviewer, and their opposite will be interviewed. Give them 7 minutes, and then switch the roles, keeping the pairs unchanged. Te new interviewer gets 7 minutes. Te person doing the interviewing should also take notes, which will give them some exposure to doing an interview solo as opposed to bringing a note-taker to help (which is what most people prefer to do when possible). Step 4: Observations and Questions, 5-10 minutes Ask the room to share observations, challenges, lessons or questions on what it was like to do a live interview. 74 Talking to Humans Teaching Exercise #2: Mock Approach Dean Chang, the Associate VP of Entrepreneurship at the University of Maryland, recommends a class exercise where one or more teams of students takes on the role of cold calling an “expert.” Te team has to do it over and over until they get it right. For this exercise, select one team and have them come to the front of the classroom. Teir job is to “cold call” a selected member of the teaching team. Te teacher will pretend to be an expert in the team’s target feld. Te team needs to get the expert to take the call, and smoothly transition into asking questions. Te job of the person playing the “expert” is to block the team’s misguided attempts to engage. When the team does something wrong, the expert declines the interview request, or ends the conversation, or gives them a gong. Ten the team has to start over again. Classic mistakes that should trigger the team starting over include long or unclear introductions, pitching the product/technology too soon, implying that the expert has problems and desperately needs help, and/or generally making the expert feel uncomfortable with the line of questioning. As Dean describes it, “We let the other teams ofer critiques and suggest plans of attack for winning over the expert and then the chosen team tries it again. Eventually afer being gonged several times in a row, they stop making the same mistakes and start to Appendix 75 converge on a good elevator pitch that praises and disarms the expert and paves the way to entering into an interview. Ten we stop the exercise.” Te exercise will probably be humorous and painful at the same time, but there is nothing like stumbling, or watching a team stumble, to realize why best practices are best practices. 76 Talking to Humans Screwing Up Customer Discovery So how do people screw up customer discovery? Here are a few antipatterns: 1. You treat speculation as confrmation Here are some question types that I don’t like — and if you ask them, you should heavily discount the answer: “would you use this?” “would you pay for this?” “would you like this?” I can’t say that I never ask these questions, but I always prefer behavioral questions over speculation. As contrast, here is a behavior-focused interaction: “Tell me about a time when you bought airline tickets online.” “What did you enjoy about the process? What frustrated you about the process?” “What diferent systems or methods have you tried in the past to book tickets?” 2. You lead the witness Leading the witness is putting the answer in the interviewee’s mouth in the way you ask the question. For example: “We don’t think most people really want to book tickets online, but what do you think?” Examine both how you phrase your questions and your tone of voice. Are you steering the answer? Ask open-ended, neutral questions before you drill down: “what was that experience of buying online tickets like?” 3. You just can’t stop talking Some entrepreneurs can’t help themselves — they are overfowing with excitement and just have to pitch pitch pitch. Tere is nothing Appendix 77 wrong with trying to pre-sell your product — that is an interesting experiment unto itself — but you should not mix this in with behavioral learning. If you do try to pre-sell, don’t just ask, “Would you pay for this?” but rather ask them to actually pay, and see what happens. Some people ask the question, “How much would you pay for this?” but I do not. Instead, try actually selling at diferent price points (albeit one at a time). I much prefer having the potential customer experience something, rather than speculate over something. 4. You only hear what you want to hear I see some people go into interviews with strong beliefs about what they like and dislike. When you debrief afer their custdev conversation, it is magical how everything they heard aligns perfectly with their opinions. Our brains are amazing flters. Leave your agenda at the door before starting a conversation. One way to solve this is to have two people for each interview — one person to ask questions, and the other to take notes. 5. You treat a single conversation as ultimate truth You’ve just spoken to a potential customer and they have really strong opinions. One instinct is to jump to conclusions and rush to make changes. Instead, you need to be patient. Tere is no defnitive answer for how many similar answers equals the truth. Look for patterns and use your judgement. A clear, consistent pattern at even 5 or 10 people is a signal. 6. Fear of rejection wins out Tis is one of the biggest blockers to people doing qualitative research, in my experience, because of fear of a stranger rejecting your advance or rejecting your idea. Many excuses, such as “I don’t know how to fnd people to talk to,” are rooted in this fear. JFDI. Customer development isn’t just about street intercepts. You can 78 Talking to Humans recruit people on Craigslist, Facebook and LinkedIn groups, and good old fashioned networking. 7. You talk to anyone with a pulse I see some teams taking a shotgun approach. Instead, defne your assumptions around who your customer will be and who your early adopter will be. You might even do a lightweight persona (see the book Lean UX for examples). Zoom in on those people and try to validate or invalidate your assumptions about your customers. It is ok to occasionally go outside your target zone for learning, but don’t boil the ocean. Focus, learn, and pivot if necessary. 8. You wing the conversation If you go into a conversation unprepared, it will be evident. Write up your questions ahead of time and force-rank them based on the risks and assumptions you are worried about. To defne your assumptions, you can answer the questions in the business assumptions exercise (previous section), or do a business model canvas or a lean canvas. Your exact method doesn’t matter as much as the act of prioritizing your risk areas. During your actual interview, do not literally read your questions from a piece of paper, but rather keep things conversational (remember, you are getting the subject to tell you stories). If you uncover something interesting, follow your nose and don’t be afraid to diverge from your initial priorities. 9. You try to learn everything in one sitting Rather than trying to go as broad as possible in every conversation, you are actually better of zooming in on a few areas which are critical to your business. If you have a huge range of questions, do more interviews and split the questions. Appendix 79 10. Only the designer does qualitative research It is ok to divide and conquer most of the time, but everyone on the team should be forced to get out and talk to real people. Note: you will probably have to coach newcomers on #5’s point about not jumping to conclusions. 11. You did customer development your frst week, but haven’t felt a need to do it since It is always sad to see product teams start things of with customer development, and then completely stop once they get going. It is perfectly fne to let customer discovery work ebb and fow. If your learning curve fattens, it can make sense to press pause or change up your approach. However, you want to build a regular qualitative cadence into your product process. It will provide a necessary complement to your quantitative metrics, because it will help you understand the reasons why things are happening. 12. You ask the customer to design your product for you Tere’s a famous line attributed to Henry Ford, “If I had asked people what they wanted, they would have said faster horses.” Remember, it is not the customer’s job to design the solution. It is your job. It is the customer’s job to tell you if your solution sucks. Get feedback, yes. Remember that the further away you are from a working product, the more you have to flter what you hear through your judgement and vision. Disclaimer As with all tips on lean and agile, there are always places and times to break the rules and do what is right for your context, and your business. 80 Talking to Humans Glossary Concierge and “Wizard of Oz” Experiments A concierge experiment is where you manually act out your product. An example in Eric Ries’ book Te Lean Startup shows an entrepreneur serving as a personal shopper for people before trying to design an automated solution. When my colleagues were testing a diet plan service, we did not want to rush to sofware before testing our assumptions. Instead, we interviewed participants about their food preferences, manually created meal plans which were emailed to them over two weeks, and interviewed them at various points in the process. At the end of the two weeks, we asked them to pay a set amount to continue, and tracked the conversion rate. A “Wizard of Oz” experiment is similar, with the diference being that the manual work is hidden from the customer. For example, another set of colleagues tested an idea for a smart task management system for married couples. Te twenty couples participating in the test thought that they were interacting with a computer system, but in reality they were emailing in to our team, who then processed the emails accordingly. We just said that the servers would be “down” at night! Minimum Viable Product (MVP) An MVP is the smallest thing you can create that gives you meaningful learning about your product. MVP is ofen used interchangeably with “experiment” in the broader community. I personally tend to reserve it specifcally for tests around the product, and not for experiments related to other business assumptions. It is best to think about MVPs as an ongoing process, rather than a single release. Validation is rarely that neat and tidy. Appendix 81 Scientifc Method I think the best way to explain the scientifc method is to quote the theoretical physicist, Richard Feynman: “In general we look for a new law by the following process: frst we guess it. Don’t laugh -- that’s really true. Ten we compute the consequences of the guess to see what, if this law is right, what it would imply. Ten we compare those computation results to nature, i.e. experiment and experience. We compare it directly to observation to see if it works. “If it disagrees with experiment, it’s wrong. Tat simple statement is the key to science. It doesn’t make a diference how beautiful your guess is, it doesn’t make a diference how smart you are, who made the guess or what his name is -- if it disagrees with experiment, it’s wrong. Tat’s all there is to it.” (Cornell lecture, 1964) It is relatively straightforward to apply the scientifc method to business. You accept that your ideas are hypotheses. You make them as specifc as possible so that you can guess the results, i.e. the implications, of your hypotheses. You design and run an experiment. If your hypothesized results do not match the results of your experiment, your hypothesis is proven wrong. However, business is about people, and people are highly complex and inconsistent compared to laws of nature. So if your experiment fails, you will still need to apply judgement about whether the errors are in the hypothesis or in the experiment. 82 Talking to Humans Other Learning Resources Authors Te two seminal books on the topics of lean innovation and customer development are Steve Blank and Bob Dorf ’s Te Startup Owner’s Manual and Eric Ries’ Te Lean Startup. Tere are a ton of other resources out there, from books to videos and blog posts. Rather than link to particular items and thus miss out on newer developments, here are a few names that I recommend you pay attention to: Alex Osterwalder, Alistair Croll, Ash Maurya, Ben Yoskowitz, Brant Cooper, Cindy Alvarez, David Bland, Jef Gothelf, Joel Gascoigne, Josh Seiden, Kevin Dewalt, Laura Klein, Patrick Vlaskovits, Rob Fitzpatrick, Salim Virani, and Tristan Kromer. Talking to Humans Website On our website talkingtohumans.com, you can get worksheet pdfs and sign up for our email list, where we send occasional notes based on useful resources we discover. Behind the Book 83 Gif Constable (gifconstable.com) is a repeat entrepreneur and currently the CEO of Neo, a global product innovation consulting company. He has held product design and business roles in six startups, and provided M&A and IPO services to technology frms while at Broadview/Jeferies. He was one of the earliest adopters & bloggers of the Lean Startup movement, co-organizes the 4,700-person Lean Lessons Learned meetup in New York, and tries to give back to the entrepreneurial community through mentoring and speaking engagements. He lives outside of New York City with his wife, two children, and an excessively rambunctious retriever. Giff Constable Talking to Humans was written by Gif Constable, at the instigation and with the collaboration of Frank Rimalovski of NYU’s Entrepreneurial Institute, and with the wonderful illustrations of Tom Fishburne. Behind the Book 84 Guide to Customer Discovery Frank Rimalovski brings over 20 years of experience in technology commercialization, startups and early-stage venture capital investing. He is executive director of the NYU Entrepreneurial Institute, managing director of the NYU Innovation Venture Fund, Adjunct Faculty at NYU’s Polytechnic School of Engineering, and an Instructor in the NSF’s I-Corps program, having trained and mentored hundreds of entrepreneurs in customer development and lean startup methodologies. Previously, he was a founding partner of New Venture Partners, director/entrepreneur-in-residence at Lucent’s New Ventures Group, and has held various positions in product management, marketing and business development at Sun Microsystems, Apple and NeXT. He lives outside of New York City with his wife, two daughters and his increasingly mellow mutt. Frank Rimalovski Tom Fishburne (marketoonist.com) started drawing cartoons on the backs of Harvard Business School cases. His cartoons have grown by word of mouth to reach 100,000 business readers a week and have been featured by the Wall Street Journal, Fast Company, and the New York Times. Tom is the Founder and CEO of Marketoon Studios, a content marketing studio that helps businesses such as Google, Kronos, and Rocketfuel reach their audiences with cartoons. Tom draws from 19 years in the marketing and innovation trenches at Method Products, Nestle, and General Mills. He lives near San Francisco with his wife and two daughters. Tom Fishburne Behind the Book 85 Like The Book? When Frank approached me to write this book, we both had the same goal of giving back to the community. We debated charging for the book, and pondered whether the question of free versus paid would afect how it was perceived. But ultimately, we decided to put it out into the world for free. Should you like Talking to Humans, and feel a need to contribute back to something, we would encourage you to think about doing one or all of the following: 1. Pay it back (and forward!) by mentoring another student or entrepreneur 2. Donate to one of our favorite causes: Charity: Water, Girls Who Code, Kiva or the NYU Entrepreneurial Institute 3. Share a link to the talkingtohumans.com website or give someone a copy of the book If this book has helped you in some small way, then that is reward enough for us. It’s why we did it. Gif Constable and Frank Rimalovski September 2014 talkingtohumans.com page intentionally blank Acclaim for Talking to Humans “Talking to Humans is the perfect complement to the existing body of work on customer development. If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have.” Steve Blank, entrepreneur and author of The Startup Owner’s Manual “Getting started on your Customer Discovery journey is the most important step to becoming a successful entrepreneur and reading Talking To Humans is the smartest frst step to fnding and solving real problems for paying customers.” Andre Marquis, Executive Director, Lester Center for Entrepreneurship, University of California Berkeley “If entrepreneurship 101 is talking to customers, this is the syllabus. Talking to Humans is a thoughtful guide to the customer informed product development that lies at the foundation of successful start-ups.” Phin Barnes, Partner, First Round Capital “A lot of entrepreneurs pay lip service to talking to customers but you have to know how. Talking to Humans ofers concrete examples on how to how to recruit candidates, how to conduct interviews, and how to prioritize learning from customers more through listening versus talking.” Ash Maurya, Founder of Spark59 and author of Running Lean “When getting ‘out of the building,’ too many people crash and burn right out of the gate and wonder what happened. Talking to Humans is a quick and efective guide for how Lean Startup interviews should be done.” Dean Chang, Associate VP for Innovation & Entrepreneurship, University of Maryland #talkingtohumans talkingtohumans.com USER: What are the essential steps and key points from the customer discovery process outlined in "Talking to Humans"? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	24	18	17,791	null	566
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]	Give a summary, limited in 150 words, about the results of this paper, focusing on the comparisons between the stub design and the quarter wave transformer design.	Design and Analysis of a 170 GHz Antenna for Millimeter-wave Applications ABSTRACT: Microstrip patch antennas are low-profile and robust when mounted on rigid surfaces of the devices making them suitable for communication and millimeter-wave applications. In this paper, an antenna is designed for the resonant frequency of 170 GHz using microstrip technology concerning its miniaturization and cost-effectiveness. The designed antenna is a part of a stray radiation detection system for ECE diagnostic to be installed on fusion research machine ITER. It offers low-directivity to receive radiation from all directions, high bandwidth, low side-lobe-level and return loss of -50 dB, leading to its remarkable utilization in the detection system being designed to protect millimeter wave components of ITER ECE Diagnostic. Power-handling and power-capturing capability of the designed antenna have also been discussed in the paper. Far-field simulations have been performed using CST Microwave Studio software to study the radiation characteristics of the designed antenna. V. RESULTS Impedance matching always ensures the maximum power transfer between the source and the load. Hence, a noble matching circuit is required for a specific design ensuring its better performance. The corporate feed network can use either a quarter-wave transformer or a stub to match patch element impedance to standard 50-ohm input impedance. The preferences mentioned above for our design are configured in Fig. 3. The important properties of the designed system with both configurations are simulated using CST Microwave Studio software and examined below to check their reliability. A. S-Parameter and VSWR The amount of power reflected from the antenna is parametrized by 𝑆11 parameter and Voltage Standing Wave Ratio (VSWR) related to each other by the following relation 𝑆11 = 𝑅𝑒𝑡𝑢𝑟𝑛 𝐿𝑜𝑠𝑠(𝑑𝐵) = -20 log10 ( 𝑉𝑆𝑊𝑅 - 1 𝑉𝑆𝑊𝑅 + 1 ) The antenna bandwidth can also be measured from the VSWR plot over a range of frequencies where its value is ≤ 2. The variation of 𝑆11 over the range of frequencies for quarter-wave transformer and stub configuration is plotted in Fig. 4. At the resonant frequency, i.e., 170 GHz , the minimum value of 𝑆11 is -50 𝑑𝐵 for quarter-wave and -35 𝑑𝐵 for stub configuration. It articulates the impedance matching along the propagation path of the signal and effective power delivery for quarter-wave transformer configuration. B. Side Lobe Level and Beamwidth The performance of an antenna is usually measured in terms of gain and its relative 3D radiation pattern. The radiation pattern is represented by polar plots as shown in Fig. 5(a) and (b), measured in the far-field antenna range as mentioned earlier. It suggests that the main lobe direction is different for both the quarter-wave transformer and the stub configuration for the resonant frequency 170 GHz, which is 260 and 7 0 , respectively. However, they possess approximately the same magnitude of gain depicted in Fig. 5(c) and (d). Gain IEEE measured in both configurations does not include the losses associated with the polarization and impedance mismatching. Far-field characteristics also enable us to investigate two important parameters associated with antenna performance. One is Half-Power beamwidth (also known as angular width), defined as the angular separation of 3dB in the radiation pattern. It deals with the resolution capabilities of the system. And another is the Side-lobe level (SLL), measured by the ratio of the amplitude of the main lobe to that of the side lobe. Low SLL minimizes the false target indication through the side lobes. There is a trade-off between both parameters and one needs to be compromised over the other [21]. We designed a system with a wider reception angle in lieu of high SLL to meet our requirements. The major difference in both the configuration, i.e., stub and quarter-wave transformer, can be noted in Fig. 5. In the case of stub configuration, the value of angular width and SLL parameter are 31.5 0 and -3.6𝑑𝐵, respectively. However, for quarter-wave transformer these are 70.5 0 and -15.5𝑑𝐵. It is evident from here that the parameters such as bandwidth, gain, S-parameter and side-lobe level attain desirable values for antenna array with quarter-wave transformer as a matching circuit. In other words, the quarter-wave transformer dominates over the stub in terms of better impedance matching, which makes it suitable for our desired application. C. Efficiency The power supplied to the system generally dispenses into surface-wave excitation, radiation emission and conductor and dielectric dissipation. Radiation efficiency is defined as the ratio of power radiated to the power inserted into the antenna system which is plotted in Fig. 6 for the 2 × 2 antenna array. It also encompasses the total efficiency of the system that takes into account all 𝐼 2𝑅 losses and the reflections arise due to mismatching between the antenna and the transmission line. For better understanding, we summarized the above-discussed properties of the individual patch antenna and the antenna array (with two different matching circuit configurations) in tabular form in Table 2. Here, we conclude the superiority of the 2×2 antenna array with a quarter-wave 14 transformer over other systems in terms of return loss, bandwidth, efficiency, angular width and SLL. VI. CONCLUSION A 2 × 2 microstrip antenna array has been designed and simulated successfully for the resonant frequency of 170 GHz using CST Microwave Studio software. The dominance of the antenna array over the individual patch has been proved while investigating their properties and power handling capabilities. However, continuous increment in the number of patches of an antenna array enhances its directivity further and decreases its angular width. Hence, the 2 × 2 antenna geometry reasonably satisfies our desired requirements. Significant properties of the designed system such as S-parameter, VSWR, gain, beamwidth, side-lobe level, efficiency have been estimated and discussed. A comparative study of the two matching circuits, i.e., stub and quarterwave transformer, have also been performed. The designed system's power-handling capability is also evaluated to check its reliability. At resonant frequency 170 GHz, the return loss is -50 dB, angular width is 70.5 0 and the gain is 8.6dBi for the designed antenna. The simulation results show that the designed system fulfills required characteristics and is recommended for high-frequency detector applications. The future work is to design a detector system for application in ECE diagnostic components protection, utilizing this designed antenna.	<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> Give a summary, limited in 150 words, about the results of this paper, focusing on the comparisons between the stub design and the quarter wave transformer design. <TEXT> Design and Analysis of a 170 GHz Antenna for Millimeter-wave Applications ABSTRACT: Microstrip patch antennas are low-profile and robust when mounted on rigid surfaces of the devices making them suitable for communication and millimeter-wave applications. In this paper, an antenna is designed for the resonant frequency of 170 GHz using microstrip technology concerning its miniaturization and cost-effectiveness. The designed antenna is a part of a stray radiation detection system for ECE diagnostic to be installed on fusion research machine ITER. It offers low-directivity to receive radiation from all directions, high bandwidth, low side-lobe-level and return loss of -50 dB, leading to its remarkable utilization in the detection system being designed to protect millimeter wave components of ITER ECE Diagnostic. Power-handling and power-capturing capability of the designed antenna have also been discussed in the paper. Far-field simulations have been performed using CST Microwave Studio software to study the radiation characteristics of the designed antenna. V. RESULTS Impedance matching always ensures the maximum power transfer between the source and the load. Hence, a noble matching circuit is required for a specific design ensuring its better performance. The corporate feed network can use either a quarter-wave transformer or a stub to match patch element impedance to standard 50-ohm input impedance. The preferences mentioned above for our design are configured in Fig. 3. The important properties of the designed system with both configurations are simulated using CST Microwave Studio software and examined below to check their reliability. A. S-Parameter and VSWR The amount of power reflected from the antenna is parametrized by 𝑆11 parameter and Voltage Standing Wave Ratio (VSWR) related to each other by the following relation 𝑆11 = 𝑅𝑒𝑡𝑢𝑟𝑛 𝐿𝑜𝑠𝑠(𝑑𝐵) = -20 log10 ( 𝑉𝑆𝑊𝑅 - 1 𝑉𝑆𝑊𝑅 + 1 ) The antenna bandwidth can also be measured from the VSWR plot over a range of frequencies where its value is ≤ 2. The variation of 𝑆11 over the range of frequencies for quarter-wave transformer and stub configuration is plotted in Fig. 4. At the resonant frequency, i.e., 170 GHz , the minimum value of 𝑆11 is -50 𝑑𝐵 for quarter-wave and -35 𝑑𝐵 for stub configuration. It articulates the impedance matching along the propagation path of the signal and effective power delivery for quarter-wave transformer configuration. B. Side Lobe Level and Beamwidth The performance of an antenna is usually measured in terms of gain and its relative 3D radiation pattern. The radiation pattern is represented by polar plots as shown in Fig. 5(a) and (b), measured in the far-field antenna range as mentioned earlier. It suggests that the main lobe direction is different for both the quarter-wave transformer and the stub configuration for the resonant frequency 170 GHz, which is 260 and 7 0 , respectively. However, they possess approximately the same magnitude of gain depicted in Fig. 5(c) and (d). Gain IEEE measured in both configurations does not include the losses associated with the polarization and impedance mismatching. Far-field characteristics also enable us to investigate two important parameters associated with antenna performance. One is Half-Power beamwidth (also known as angular width), defined as the angular separation of 3dB in the radiation pattern. It deals with the resolution capabilities of the system. And another is the Side-lobe level (SLL), measured by the ratio of the amplitude of the main lobe to that of the side lobe. Low SLL minimizes the false target indication through the side lobes. There is a trade-off between both parameters and one needs to be compromised over the other [21]. We designed a system with a wider reception angle in lieu of high SLL to meet our requirements. The major difference in both the configuration, i.e., stub and quarter-wave transformer, can be noted in Fig. 5. In the case of stub configuration, the value of angular width and SLL parameter are 31.5 0 and -3.6𝑑𝐵, respectively. However, for quarter-wave transformer these are 70.5 0 and -15.5𝑑𝐵. It is evident from here that the parameters such as bandwidth, gain, S-parameter and side-lobe level attain desirable values for antenna array with quarter-wave transformer as a matching circuit. In other words, the quarter-wave transformer dominates over the stub in terms of better impedance matching, which makes it suitable for our desired application. C. Efficiency The power supplied to the system generally dispenses into surface-wave excitation, radiation emission and conductor and dielectric dissipation. Radiation efficiency is defined as the ratio of power radiated to the power inserted into the antenna system which is plotted in Fig. 6 for the 2 × 2 antenna array. It also encompasses the total efficiency of the system that takes into account all 𝐼 2𝑅 losses and the reflections arise due to mismatching between the antenna and the transmission line. For better understanding, we summarized the above-discussed properties of the individual patch antenna and the antenna array (with two different matching circuit configurations) in tabular form in Table 2. Here, we conclude the superiority of the 2×2 antenna array with a quarter-wave 14 transformer over other systems in terms of return loss, bandwidth, efficiency, angular width and SLL. VI. CONCLUSION A 2 × 2 microstrip antenna array has been designed and simulated successfully for the resonant frequency of 170 GHz using CST Microwave Studio software. The dominance of the antenna array over the individual patch has been proved while investigating their properties and power handling capabilities. However, continuous increment in the number of patches of an antenna array enhances its directivity further and decreases its angular width. Hence, the 2 × 2 antenna geometry reasonably satisfies our desired requirements. Significant properties of the designed system such as S-parameter, VSWR, gain, beamwidth, side-lobe level, efficiency have been estimated and discussed. A comparative study of the two matching circuits, i.e., stub and quarterwave transformer, have also been performed. The designed system's power-handling capability is also evaluated to check its reliability. At resonant frequency 170 GHz, the return loss is -50 dB, angular width is 70.5 0 and the gain is 8.6dBi for the designed antenna. The simulation results show that the designed system fulfills required characteristics and is recommended for high-frequency detector applications. The future work is to design a detector system for application in ECE diagnostic components protection, utilizing this designed antenna. https://arxiv.org/pdf/2208.10075	<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document] EVIDENCE: Design and Analysis of a 170 GHz Antenna for Millimeter-wave Applications ABSTRACT: Microstrip patch antennas are low-profile and robust when mounted on rigid surfaces of the devices making them suitable for communication and millimeter-wave applications. In this paper, an antenna is designed for the resonant frequency of 170 GHz using microstrip technology concerning its miniaturization and cost-effectiveness. The designed antenna is a part of a stray radiation detection system for ECE diagnostic to be installed on fusion research machine ITER. It offers low-directivity to receive radiation from all directions, high bandwidth, low side-lobe-level and return loss of -50 dB, leading to its remarkable utilization in the detection system being designed to protect millimeter wave components of ITER ECE Diagnostic. Power-handling and power-capturing capability of the designed antenna have also been discussed in the paper. Far-field simulations have been performed using CST Microwave Studio software to study the radiation characteristics of the designed antenna. V. RESULTS Impedance matching always ensures the maximum power transfer between the source and the load. Hence, a noble matching circuit is required for a specific design ensuring its better performance. The corporate feed network can use either a quarter-wave transformer or a stub to match patch element impedance to standard 50-ohm input impedance. The preferences mentioned above for our design are configured in Fig. 3. The important properties of the designed system with both configurations are simulated using CST Microwave Studio software and examined below to check their reliability. A. S-Parameter and VSWR The amount of power reflected from the antenna is parametrized by 𝑆11 parameter and Voltage Standing Wave Ratio (VSWR) related to each other by the following relation 𝑆11 = 𝑅𝑒𝑡𝑢𝑟𝑛 𝐿𝑜𝑠𝑠(𝑑𝐵) = -20 log10 ( 𝑉𝑆𝑊𝑅 - 1 𝑉𝑆𝑊𝑅 + 1 ) The antenna bandwidth can also be measured from the VSWR plot over a range of frequencies where its value is ≤ 2. The variation of 𝑆11 over the range of frequencies for quarter-wave transformer and stub configuration is plotted in Fig. 4. At the resonant frequency, i.e., 170 GHz , the minimum value of 𝑆11 is -50 𝑑𝐵 for quarter-wave and -35 𝑑𝐵 for stub configuration. It articulates the impedance matching along the propagation path of the signal and effective power delivery for quarter-wave transformer configuration. B. Side Lobe Level and Beamwidth The performance of an antenna is usually measured in terms of gain and its relative 3D radiation pattern. The radiation pattern is represented by polar plots as shown in Fig. 5(a) and (b), measured in the far-field antenna range as mentioned earlier. It suggests that the main lobe direction is different for both the quarter-wave transformer and the stub configuration for the resonant frequency 170 GHz, which is 260 and 7 0 , respectively. However, they possess approximately the same magnitude of gain depicted in Fig. 5(c) and (d). Gain IEEE measured in both configurations does not include the losses associated with the polarization and impedance mismatching. Far-field characteristics also enable us to investigate two important parameters associated with antenna performance. One is Half-Power beamwidth (also known as angular width), defined as the angular separation of 3dB in the radiation pattern. It deals with the resolution capabilities of the system. And another is the Side-lobe level (SLL), measured by the ratio of the amplitude of the main lobe to that of the side lobe. Low SLL minimizes the false target indication through the side lobes. There is a trade-off between both parameters and one needs to be compromised over the other [21]. We designed a system with a wider reception angle in lieu of high SLL to meet our requirements. The major difference in both the configuration, i.e., stub and quarter-wave transformer, can be noted in Fig. 5. In the case of stub configuration, the value of angular width and SLL parameter are 31.5 0 and -3.6𝑑𝐵, respectively. However, for quarter-wave transformer these are 70.5 0 and -15.5𝑑𝐵. It is evident from here that the parameters such as bandwidth, gain, S-parameter and side-lobe level attain desirable values for antenna array with quarter-wave transformer as a matching circuit. In other words, the quarter-wave transformer dominates over the stub in terms of better impedance matching, which makes it suitable for our desired application. C. Efficiency The power supplied to the system generally dispenses into surface-wave excitation, radiation emission and conductor and dielectric dissipation. Radiation efficiency is defined as the ratio of power radiated to the power inserted into the antenna system which is plotted in Fig. 6 for the 2 × 2 antenna array. It also encompasses the total efficiency of the system that takes into account all 𝐼 2𝑅 losses and the reflections arise due to mismatching between the antenna and the transmission line. For better understanding, we summarized the above-discussed properties of the individual patch antenna and the antenna array (with two different matching circuit configurations) in tabular form in Table 2. Here, we conclude the superiority of the 2×2 antenna array with a quarter-wave 14 transformer over other systems in terms of return loss, bandwidth, efficiency, angular width and SLL. VI. CONCLUSION A 2 × 2 microstrip antenna array has been designed and simulated successfully for the resonant frequency of 170 GHz using CST Microwave Studio software. The dominance of the antenna array over the individual patch has been proved while investigating their properties and power handling capabilities. However, continuous increment in the number of patches of an antenna array enhances its directivity further and decreases its angular width. Hence, the 2 × 2 antenna geometry reasonably satisfies our desired requirements. Significant properties of the designed system such as S-parameter, VSWR, gain, beamwidth, side-lobe level, efficiency have been estimated and discussed. A comparative study of the two matching circuits, i.e., stub and quarterwave transformer, have also been performed. The designed system's power-handling capability is also evaluated to check its reliability. At resonant frequency 170 GHz, the return loss is -50 dB, angular width is 70.5 0 and the gain is 8.6dBi for the designed antenna. The simulation results show that the designed system fulfills required characteristics and is recommended for high-frequency detector applications. The future work is to design a detector system for application in ECE diagnostic components protection, utilizing this designed antenna. USER: Give a summary, limited in 150 words, about the results of this paper, focusing on the comparisons between the stub design and the quarter wave transformer design. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	20	27	1,035	null	318
"================ <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."	I learned that Pokemon GO uses augmented reality technology. Discuss which aspects of augmented reality in Pokemon GO contribute to the health and wellness of its players.	The promise of an augmented reality game—Pokémon GO Recent advances in technology facilitate the promoting of physical activity (1-8). This is important due to the health effect of physical activity and the reach and disseminability of technology based programs/interventions. Specifically, Pokémon GO (released in 2016) may promote a higher degree of activity than many previous exergames such as Nintendo Wii Fit (released in 2007). Pokémon GO uses augmented reality (AR), which is similar to virtual reality but the key concept for it is ‘utility’ instead of ‘presence’. Pokémon GO encourages players to walk around, to socialize, and even to make friends. AR is a promising concept in that it allows for another type of tailoring of interventions, namely geographic tailoring to an individual’s environment. According to recent studies, Pokémon GO increased physical activity and decreased sedentary behaviors (1-3); however, its long-term effect is unknown at this point. In one of the studies, players had gone back to their baseline physical activity levels within six weeks of their first installing the game (2). The real test of the technology based AR game for promoting physical activity is whether participants continue to engage in the game over longer periods of time. It only took 19 days to reach 50 million downloads and in September, 2016 Pokémon GO reached 500 million downloads. However, since September, 2016 player numbers are on the decline which raises the question if this game is following the trajectory of most technology games and only be maintained by those who are hard core gamers. Data show that respondents were somewhat more likely to be younger, white, and female; however, there were no significant demographic interactions for any behavioral indicator (1-3). At least one study indicated that Pokémon GO may be more beneficial for more obese individuals (3). It was noted that if Pokémon GO players would increase 1,000 steps daily, and this behavior change would be sustained, about 41 days of additional life expectancy would be assumed (1). So the public health impact potential is substantial. It is recommended that researchers apply theoretical constructs of health behavior theory (HBT) for behavior change to promote physical activity (6,7). For example, SuperBetter includes tailored educational elements based on HBT, such as individualized assistance and feedback on each player’s achievement/improvement. Systematic reviews report that the most prevalent theoretical constructs of health intervention games were self-monitoring, goal setting, and self-reward (6,9). Health interventions, which are designed based on theoretical frameworks, are likely to lead to longer behavior change (7). Therefore, there is a need for researchers to assess theoretical contents and gamification elements of Pokémon GO (4,5). T h e r e a r e m a n y g a m e s d e v e l o p e d i n a c a d e m i a incorporating theoretical constructs for health behavior change interventions; however, very few become popular. Limited funding for development budgets and speed of implementation including testing, publishing, and implementing in a real-world make it challenging (10). Therefore, it is worth while studying which, either entertainment-based games or educational elements- based games, is more popular, engages long-term behavior change, and elevates player’s motivation (7). In addition, in order to increase the level of scientific evidence for the interventions, it is important to develop and adopt standardized protocols in terms of interventions, populations, and outcomes. This effort eventually will allow further comparison between differently designed experimental studies to translate evidence- based interventions to gaming-based approaches (10). Collaborations between game developers, app designers, and content experts in behavior health are necessary (7). It is also recommended that researchers explore the potential benefits of applying Pokémon GO to other areas such as depression, heart disease, type 2 diabetes, etc. and to diverse study subjects such as children, elders, and people with disabilities (1,2,8,10). It has been reported that older adult players have an awareness in playing games for favorable health outcomes (8). Further research, therefore, should be conducted to identify end user’s needs assessment and specific GUI (graphical user interface) elements, develop human-centered gaming design guidelines, and evaluate usability issues. Considering the characters (the Pokémons) of Pokémon GO appear to be “on top of” the real world, not “in” the real world, players may expect another stage of mixed reality (combining AR and virtual reality) with the concept of ‘flexibility’ where their illusion is not easily broken. In other words, when we lean in close the Pokémons get larger, and when we walk around the virtual landscape changes with respect to the position in the way a real object would (like Minecraft—latest update released in 2016—as an example of an interactive virtual world). This natural and intuitive way of interaction simplifies the communication between players and Pokémon GO, especially for players who have no previous experience. Therefore, with a mixed reality interface, it is expected that Pokémon GO would have the potential to be more sustainable and effective. Even though larger robust longitudinal studies employing rigorous methodologies and further research on negative effects such as injuries, road traffic incidents, game addiction, etc. are still needed (1-3,10,11), Pokémon GO is emerging as a potentially useful tool for motivational and behavioral impacts on physical activity.	"================ <TEXT PASSAGE> ======= The promise of an augmented reality game—Pokémon GO Recent advances in technology facilitate the promoting of physical activity (1-8). This is important due to the health effect of physical activity and the reach and disseminability of technology based programs/interventions. Specifically, Pokémon GO (released in 2016) may promote a higher degree of activity than many previous exergames such as Nintendo Wii Fit (released in 2007). Pokémon GO uses augmented reality (AR), which is similar to virtual reality but the key concept for it is ‘utility’ instead of ‘presence’. Pokémon GO encourages players to walk around, to socialize, and even to make friends. AR is a promising concept in that it allows for another type of tailoring of interventions, namely geographic tailoring to an individual’s environment. According to recent studies, Pokémon GO increased physical activity and decreased sedentary behaviors (1-3); however, its long-term effect is unknown at this point. In one of the studies, players had gone back to their baseline physical activity levels within six weeks of their first installing the game (2). The real test of the technology based AR game for promoting physical activity is whether participants continue to engage in the game over longer periods of time. It only took 19 days to reach 50 million downloads and in September, 2016 Pokémon GO reached 500 million downloads. However, since September, 2016 player numbers are on the decline which raises the question if this game is following the trajectory of most technology games and only be maintained by those who are hard core gamers. Data show that respondents were somewhat more likely to be younger, white, and female; however, there were no significant demographic interactions for any behavioral indicator (1-3). At least one study indicated that Pokémon GO may be more beneficial for more obese individuals (3). It was noted that if Pokémon GO players would increase 1,000 steps daily, and this behavior change would be sustained, about 41 days of additional life expectancy would be assumed (1). So the public health impact potential is substantial. It is recommended that researchers apply theoretical constructs of health behavior theory (HBT) for behavior change to promote physical activity (6,7). For example, SuperBetter includes tailored educational elements based on HBT, such as individualized assistance and feedback on each player’s achievement/improvement. Systematic reviews report that the most prevalent theoretical constructs of health intervention games were self-monitoring, goal setting, and self-reward (6,9). Health interventions, which are designed based on theoretical frameworks, are likely to lead to longer behavior change (7). Therefore, there is a need for researchers to assess theoretical contents and gamification elements of Pokémon GO (4,5). T h e r e a r e m a n y g a m e s d e v e l o p e d i n a c a d e m i a incorporating theoretical constructs for health behavior change interventions; however, very few become popular. Limited funding for development budgets and speed of implementation including testing, publishing, and implementing in a real-world make it challenging (10). Therefore, it is worth while studying which, either entertainment-based games or educational elements- based games, is more popular, engages long-term behavior change, and elevates player’s motivation (7). In addition, in order to increase the level of scientific evidence for the interventions, it is important to develop and adopt standardized protocols in terms of interventions, populations, and outcomes. This effort eventually will allow further comparison between differently designed experimental studies to translate evidence- based interventions to gaming-based approaches (10). Collaborations between game developers, app designers, and content experts in behavior health are necessary (7). It is also recommended that researchers explore the potential benefits of applying Pokémon GO to other areas such as depression, heart disease, type 2 diabetes, etc. and to diverse study subjects such as children, elders, and people with disabilities (1,2,8,10). It has been reported that older adult players have an awareness in playing games for favorable health outcomes (8). Further research, therefore, should be conducted to identify end user’s needs assessment and specific GUI (graphical user interface) elements, develop human-centered gaming design guidelines, and evaluate usability issues. Considering the characters (the Pokémons) of Pokémon GO appear to be “on top of” the real world, not “in” the real world, players may expect another stage of mixed reality (combining AR and virtual reality) with the concept of ‘flexibility’ where their illusion is not easily broken. In other words, when we lean in close the Pokémons get larger, and when we walk around the virtual landscape changes with respect to the position in the way a real object would (like Minecraft—latest update released in 2016—as an example of an interactive virtual world). This natural and intuitive way of interaction simplifies the communication between players and Pokémon GO, especially for players who have no previous experience. Therefore, with a mixed reality interface, it is expected that Pokémon GO would have the potential to be more sustainable and effective. Even though larger robust longitudinal studies employing rigorous methodologies and further research on negative effects such as injuries, road traffic incidents, game addiction, etc. are still needed (1-3,10,11), Pokémon GO is emerging as a potentially useful tool for motivational and behavioral impacts on physical activity. https://atm.amegroups.org/article/view/14051/pdf ================ <QUESTION> ======= I learned that Pokemon GO uses augmented reality technology. Discuss which aspects of augmented reality in Pokemon GO contribute to the health and wellness of its players. ================ <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: The promise of an augmented reality game—Pokémon GO Recent advances in technology facilitate the promoting of physical activity (1-8). This is important due to the health effect of physical activity and the reach and disseminability of technology based programs/interventions. Specifically, Pokémon GO (released in 2016) may promote a higher degree of activity than many previous exergames such as Nintendo Wii Fit (released in 2007). Pokémon GO uses augmented reality (AR), which is similar to virtual reality but the key concept for it is ‘utility’ instead of ‘presence’. Pokémon GO encourages players to walk around, to socialize, and even to make friends. AR is a promising concept in that it allows for another type of tailoring of interventions, namely geographic tailoring to an individual’s environment. According to recent studies, Pokémon GO increased physical activity and decreased sedentary behaviors (1-3); however, its long-term effect is unknown at this point. In one of the studies, players had gone back to their baseline physical activity levels within six weeks of their first installing the game (2). The real test of the technology based AR game for promoting physical activity is whether participants continue to engage in the game over longer periods of time. It only took 19 days to reach 50 million downloads and in September, 2016 Pokémon GO reached 500 million downloads. However, since September, 2016 player numbers are on the decline which raises the question if this game is following the trajectory of most technology games and only be maintained by those who are hard core gamers. Data show that respondents were somewhat more likely to be younger, white, and female; however, there were no significant demographic interactions for any behavioral indicator (1-3). At least one study indicated that Pokémon GO may be more beneficial for more obese individuals (3). It was noted that if Pokémon GO players would increase 1,000 steps daily, and this behavior change would be sustained, about 41 days of additional life expectancy would be assumed (1). So the public health impact potential is substantial. It is recommended that researchers apply theoretical constructs of health behavior theory (HBT) for behavior change to promote physical activity (6,7). For example, SuperBetter includes tailored educational elements based on HBT, such as individualized assistance and feedback on each player’s achievement/improvement. Systematic reviews report that the most prevalent theoretical constructs of health intervention games were self-monitoring, goal setting, and self-reward (6,9). Health interventions, which are designed based on theoretical frameworks, are likely to lead to longer behavior change (7). Therefore, there is a need for researchers to assess theoretical contents and gamification elements of Pokémon GO (4,5). T h e r e a r e m a n y g a m e s d e v e l o p e d i n a c a d e m i a incorporating theoretical constructs for health behavior change interventions; however, very few become popular. Limited funding for development budgets and speed of implementation including testing, publishing, and implementing in a real-world make it challenging (10). Therefore, it is worth while studying which, either entertainment-based games or educational elements- based games, is more popular, engages long-term behavior change, and elevates player’s motivation (7). In addition, in order to increase the level of scientific evidence for the interventions, it is important to develop and adopt standardized protocols in terms of interventions, populations, and outcomes. This effort eventually will allow further comparison between differently designed experimental studies to translate evidence- based interventions to gaming-based approaches (10). Collaborations between game developers, app designers, and content experts in behavior health are necessary (7). It is also recommended that researchers explore the potential benefits of applying Pokémon GO to other areas such as depression, heart disease, type 2 diabetes, etc. and to diverse study subjects such as children, elders, and people with disabilities (1,2,8,10). It has been reported that older adult players have an awareness in playing games for favorable health outcomes (8). Further research, therefore, should be conducted to identify end user’s needs assessment and specific GUI (graphical user interface) elements, develop human-centered gaming design guidelines, and evaluate usability issues. Considering the characters (the Pokémons) of Pokémon GO appear to be “on top of” the real world, not “in” the real world, players may expect another stage of mixed reality (combining AR and virtual reality) with the concept of ‘flexibility’ where their illusion is not easily broken. In other words, when we lean in close the Pokémons get larger, and when we walk around the virtual landscape changes with respect to the position in the way a real object would (like Minecraft—latest update released in 2016—as an example of an interactive virtual world). This natural and intuitive way of interaction simplifies the communication between players and Pokémon GO, especially for players who have no previous experience. Therefore, with a mixed reality interface, it is expected that Pokémon GO would have the potential to be more sustainable and effective. Even though larger robust longitudinal studies employing rigorous methodologies and further research on negative effects such as injuries, road traffic incidents, game addiction, etc. are still needed (1-3,10,11), Pokémon GO is emerging as a potentially useful tool for motivational and behavioral impacts on physical activity. USER: I learned that Pokemon GO uses augmented reality technology. Discuss which aspects of augmented reality in Pokemon GO contribute to the health and wellness of its players. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	49	27	867	null	655
You must respond only using information provided in the prompt. Explain your reasoning using at least three supporting points.	Does Malawi support big families?	CHAPTER THREE: POLICY PRIORITY AREAS The Policy has the following six priority areas: a. Managing population growth; b. Inclusion of vulnerable and marginalized populations; c. Climate change adaptation and resilience; d. Information Management; e. Financing; and f. Capacity strengthening, linkages, and coordination. Priority Area 1: Managing Population Growth Managing population growth is about applying a rights-based approach to making the environment conducive for women and men to decide on the number of children they would like to have. The goal is to reduce population growth rate to levels that are sustainable. This is crucial in ensuring that Malawi achieves its long-term aspiration of being an inclusively wealthy and self-reliant nation, as it will contribute to accelerating the attainment of the country's lowermiddle-income economy status by 2030. The population of Malawi has been growing rapidly due to high fertility. This priority area addresses drivers of rapid population growth, use of modern contraceptive methods especially among the youth, child survival, and early childbearing. Policy Statements a) The Policy will ensure that the fertility decline is accelerated. Strategies: i. Intensify population education campaigns including adopting modern family planning practices of having few children and use of contraception; ii. Identify and implement optimum models for providing quality reproductive health services including modern family planning to both in and out of school youth to reduce unmet need for family planning information and services and teenage pregnancies; and iii. Strengthen implementation of Malawi’s Costed Implementation Plan for Family Planning, FP2030, and ICPD25 commitments. b) The Policy will ensure that child and maternal mortality is reduced. Strategies: i. Support child immunization campaigns; 14 ii. Promote skilled care attendance before, during, and after birth in population messages; and iii. Promote child and maternal nutrition for the special 1,000 days. c) The Policy will ensure that on-set of childbearing is delayed (No children by children). Strategies: i. Eliminate child marriages; ii. Scaling up efforts to reduce teenage pregnancies: iii. Intensify comprehensive sexuality education for in and out of school youth; iv. Keep girls in school for at least twelve years; v. Strengthen implementation of the school re-admission policy; and vi. Identify and implement optimum models for providing quality RH services including modern family planning to both in and out of school youth to reduce unmet need for family planning information and services and teenage pregnancies.	You must respond only using information provided in the prompt. Explain your reasoning using at least three supporting points. CHAPTER THREE: POLICY PRIORITY AREAS The Policy has the following six priority areas: a. Managing population growth; b. Inclusion of vulnerable and marginalized populations; c. Climate change adaptation and resilience; d. Information Management; e. Financing; and f. Capacity strengthening, linkages, and coordination. Priority Area 1: Managing Population Growth Managing population growth is about applying a rights-based approach to making the environment conducive for women and men to decide on the number of children they would like to have. The goal is to reduce population growth rate to levels that are sustainable. This is crucial in ensuring that Malawi achieves its long-term aspiration of being an inclusively wealthy and self-reliant nation, as it will contribute to accelerating the attainment of the country's lowermiddle-income economy status by 2030. The population of Malawi has been growing rapidly due to high fertility. This priority area addresses drivers of rapid population growth, use of modern contraceptive methods especially among the youth, child survival, and early childbearing. Policy Statements a) The Policy will ensure that the fertility decline is accelerated. Strategies: i. Intensify population education campaigns including adopting modern family planning practices of having few children and use of contraception; ii. Identify and implement optimum models for providing quality reproductive health services including modern family planning to both in and out of school youth to reduce unmet need for family planning information and services and teenage pregnancies; and iii. Strengthen implementation of Malawi’s Costed Implementation Plan for Family Planning, FP2030, and ICPD25 commitments. b) The Policy will ensure that child and maternal mortality is reduced. Strategies: i. Support child immunization campaigns; 14 ii. Promote skilled care attendance before, during, and after birth in population messages; and iii. Promote child and maternal nutrition for the special 1,000 days. c) The Policy will ensure that on-set of childbearing is delayed (No children by children). Strategies: i. Eliminate child marriages; ii. Scaling up efforts to reduce teenage pregnancies: iii. Intensify comprehensive sexuality education for in and out of school youth; iv. Keep girls in school for at least twelve years; v. Strengthen implementation of the school re-admission policy; and vi. Identify and implement optimum models for providing quality RH services including modern family planning to both in and out of school youth to reduce unmet need for family planning information and services and teenage pregnancies. Does Malawi support big families?	You must respond only using information provided in the prompt. Explain your reasoning using at least three supporting points. EVIDENCE: CHAPTER THREE: POLICY PRIORITY AREAS The Policy has the following six priority areas: a. Managing population growth; b. Inclusion of vulnerable and marginalized populations; c. Climate change adaptation and resilience; d. Information Management; e. Financing; and f. Capacity strengthening, linkages, and coordination. Priority Area 1: Managing Population Growth Managing population growth is about applying a rights-based approach to making the environment conducive for women and men to decide on the number of children they would like to have. The goal is to reduce population growth rate to levels that are sustainable. This is crucial in ensuring that Malawi achieves its long-term aspiration of being an inclusively wealthy and self-reliant nation, as it will contribute to accelerating the attainment of the country's lowermiddle-income economy status by 2030. The population of Malawi has been growing rapidly due to high fertility. This priority area addresses drivers of rapid population growth, use of modern contraceptive methods especially among the youth, child survival, and early childbearing. Policy Statements a) The Policy will ensure that the fertility decline is accelerated. Strategies: i. Intensify population education campaigns including adopting modern family planning practices of having few children and use of contraception; ii. Identify and implement optimum models for providing quality reproductive health services including modern family planning to both in and out of school youth to reduce unmet need for family planning information and services and teenage pregnancies; and iii. Strengthen implementation of Malawi’s Costed Implementation Plan for Family Planning, FP2030, and ICPD25 commitments. b) The Policy will ensure that child and maternal mortality is reduced. Strategies: i. Support child immunization campaigns; 14 ii. Promote skilled care attendance before, during, and after birth in population messages; and iii. Promote child and maternal nutrition for the special 1,000 days. c) The Policy will ensure that on-set of childbearing is delayed (No children by children). Strategies: i. Eliminate child marriages; ii. Scaling up efforts to reduce teenage pregnancies: iii. Intensify comprehensive sexuality education for in and out of school youth; iv. Keep girls in school for at least twelve years; v. Strengthen implementation of the school re-admission policy; and vi. Identify and implement optimum models for providing quality RH services including modern family planning to both in and out of school youth to reduce unmet need for family planning information and services and teenage pregnancies. USER: Does Malawi support big families? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	19	5	386	null	322
"================ <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."	My son came home from school and told me about one of his classmates who had scary skin. I am not sure what he is referring to, but I suspect it is eczema. My son says that he is afraid of playing with the classmate because he doesn't want to get scaly skin like a lizard. I am not really sure what eczema is, aside from being a skin condition. Please tell me more about it.	Eczema, or atopic dermatitis, is a common chronic skin condition that can lead to recurrent infections and poor quality of life if left untreated. Recognized as the "itch that rashes" due to the rash that results from scratching or rubbing, the hallmark of eczema is dry, itchy skin prone to infections. This activity explores the pathogenesis of eczema, acknowledging the intertwined roles of genetic and environmental factors. Learners will gain valuable insights into recognizing eczema across different age brackets, effective evaluation techniques, proactive management of flare-ups, and preventative measures against recurring infections associated with untreated eczema. The course discussion also highlights the role of interprofessional collaboration in improving outcomes for patients with this condition. Objectives: Identify the pathophysiology of eczema. Evaluate the adverse effects of poorly controlled eczema. Implement appropriate treatment options for eczema. Communicate the importance of improving care coordination among the interprofessional team to improve outcomes for patients with eczema. Eczema, or atopic dermatitis, is the most common form of dermatitis.[1] Many factors, including genetic and environmental factors, are thought to play a part in the pathogenesis of eczema. It is most commonly seen in children but can be seen in adults as well. People with eczema tend to have dry, itchy skin prone to infection. The condition is commonly known as the "itch that rashes" because dry, itchy skin leads to a rash due to scratching or rubbing the skin. The exact etiology of eczema is not entirely understood, but it is believed to be a combination of genetic and environmental factors.[2] Genetic Factors There is a strong genetic component to eczema, with a family history of eczema, asthma, or allergies commonly found in affected individuals. Several genes associated with eczema have been identified, including those involved in the skin barrier function and the immune system. Filaggrin Gene One of the most well-known genes associated with eczema is the filaggrin gene (FLG). This gene provides instructions for making a protein called filaggrin, which is important in maintaining the skin barrier function. Mutations in this gene have been linked to eczema and other skin conditions and are thought to increase susceptibility to environmental irritants and allergens.[3][4] Other Skin Barrier Genes In addition to the filaggrin gene, other genes involved in the skin barrier function have been implicated in the development of eczema. These include genes involved in lipid synthesis and transport, such as the ceramide synthase gene and the ABCA12 gene.[5] Immune-related Genes Several genes involved in the immune response have also been associated with eczema, including genes that regulate T-cells, cytokines, and immunoglobulins. These genes include interleukin (IL)-4, IL-13, IL-31, signal transducer and activator of transduction (STAT)3, and Fc fragment of immunoglobulin (Ig)E receptor Ig (FCER1G). Overall, the genetic factors involved in eczema are complex and likely involve multiple genes and genetic pathways. Although genetic testing is not routinely used to diagnose eczema, understanding the disease's genetic basis can help identify individuals at increased risk and guide treatment approaches. Environmental Factors Environmental factors also play a role in the development of eczema. Patients with eczema have a defect in their skin barrier function, leading to increased water loss and susceptibility to environmental irritants and allergens. Common triggers for eczema flares include exposure to irritants such as detergents, soaps, solvents, and allergens such as dust mites, pet dander, and certain foods. Other factors that can exacerbate eczema symptoms include stress, changes in temperature and humidity, and infections. Immune System Activation In addition to genetic and environmental factors, the immune system is also thought to play a role in the development of eczema. Patients with eczema have an overactive immune response to environmental triggers, leading to inflammation and skin damage. Research shows there is a genetic component to eczema. One common mutation has been observed in FLG, a vital gene for skin cell maturity. This gene is responsible for creating the tough, flat corneocytes that form the outermost protective layer of skin. In a patient with normal skin cells, the corneocytes are tightly packed in an organized manner. A patient with an FLG mutation will have a dysfunctional skin barrier due to the haphazard organization of the skin cells.[7] This dysfunction causes a "leaky" skin barrier, allowing water loss and decreased protection from harmful substances. People with eczema also have reduced numbers of β-defensins in the skin. β-defensins are host defense peptides vital for fighting off certain bacteria, viruses, and fungi. A decrease in these peptides leads to increased colonization and infection, especially with Staphylococcus aureus (S. aureus).	"================ <TEXT PASSAGE> ======= Eczema, or atopic dermatitis, is a common chronic skin condition that can lead to recurrent infections and poor quality of life if left untreated. Recognized as the "itch that rashes" due to the rash that results from scratching or rubbing, the hallmark of eczema is dry, itchy skin prone to infections. This activity explores the pathogenesis of eczema, acknowledging the intertwined roles of genetic and environmental factors. Learners will gain valuable insights into recognizing eczema across different age brackets, effective evaluation techniques, proactive management of flare-ups, and preventative measures against recurring infections associated with untreated eczema. The course discussion also highlights the role of interprofessional collaboration in improving outcomes for patients with this condition. Objectives: Identify the pathophysiology of eczema. Evaluate the adverse effects of poorly controlled eczema. Implement appropriate treatment options for eczema. Communicate the importance of improving care coordination among the interprofessional team to improve outcomes for patients with eczema. Eczema, or atopic dermatitis, is the most common form of dermatitis.[1] Many factors, including genetic and environmental factors, are thought to play a part in the pathogenesis of eczema. It is most commonly seen in children but can be seen in adults as well. People with eczema tend to have dry, itchy skin prone to infection. The condition is commonly known as the "itch that rashes" because dry, itchy skin leads to a rash due to scratching or rubbing the skin. The exact etiology of eczema is not entirely understood, but it is believed to be a combination of genetic and environmental factors.[2] Genetic Factors There is a strong genetic component to eczema, with a family history of eczema, asthma, or allergies commonly found in affected individuals. Several genes associated with eczema have been identified, including those involved in the skin barrier function and the immune system. Filaggrin Gene One of the most well-known genes associated with eczema is the filaggrin gene (FLG). This gene provides instructions for making a protein called filaggrin, which is important in maintaining the skin barrier function. Mutations in this gene have been linked to eczema and other skin conditions and are thought to increase susceptibility to environmental irritants and allergens.[3][4] Other Skin Barrier Genes In addition to the filaggrin gene, other genes involved in the skin barrier function have been implicated in the development of eczema. These include genes involved in lipid synthesis and transport, such as the ceramide synthase gene and the ABCA12 gene.[5] Immune-related Genes Several genes involved in the immune response have also been associated with eczema, including genes that regulate T-cells, cytokines, and immunoglobulins. These genes include interleukin (IL)-4, IL-13, IL-31, signal transducer and activator of transduction (STAT)3, and Fc fragment of immunoglobulin (Ig)E receptor Ig (FCER1G). Overall, the genetic factors involved in eczema are complex and likely involve multiple genes and genetic pathways. Although genetic testing is not routinely used to diagnose eczema, understanding the disease's genetic basis can help identify individuals at increased risk and guide treatment approaches. Environmental Factors Environmental factors also play a role in the development of eczema. Patients with eczema have a defect in their skin barrier function, leading to increased water loss and susceptibility to environmental irritants and allergens. Common triggers for eczema flares include exposure to irritants such as detergents, soaps, solvents, and allergens such as dust mites, pet dander, and certain foods. Other factors that can exacerbate eczema symptoms include stress, changes in temperature and humidity, and infections. Immune System Activation In addition to genetic and environmental factors, the immune system is also thought to play a role in the development of eczema. Patients with eczema have an overactive immune response to environmental triggers, leading to inflammation and skin damage. Research shows there is a genetic component to eczema. One common mutation has been observed in FLG, a vital gene for skin cell maturity. This gene is responsible for creating the tough, flat corneocytes that form the outermost protective layer of skin. In a patient with normal skin cells, the corneocytes are tightly packed in an organized manner. A patient with an FLG mutation will have a dysfunctional skin barrier due to the haphazard organization of the skin cells.[7] This dysfunction causes a "leaky" skin barrier, allowing water loss and decreased protection from harmful substances. People with eczema also have reduced numbers of β-defensins in the skin. β-defensins are host defense peptides vital for fighting off certain bacteria, viruses, and fungi. A decrease in these peptides leads to increased colonization and infection, especially with Staphylococcus aureus (S. aureus). https://www.ncbi.nlm.nih.gov/books/NBK538209/ ================ <QUESTION> ======= My son came home from school and told me about one of his classmates who had scary skin. I am not sure what he is referring to, but I suspect it is eczema. My son says that he is afraid of playing with the classmate because he doesn't want to get scaly skin like a lizard. I am not really sure what eczema is, aside from being a skin condition. Please tell me more about it. ================ <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: Eczema, or atopic dermatitis, is a common chronic skin condition that can lead to recurrent infections and poor quality of life if left untreated. Recognized as the "itch that rashes" due to the rash that results from scratching or rubbing, the hallmark of eczema is dry, itchy skin prone to infections. This activity explores the pathogenesis of eczema, acknowledging the intertwined roles of genetic and environmental factors. Learners will gain valuable insights into recognizing eczema across different age brackets, effective evaluation techniques, proactive management of flare-ups, and preventative measures against recurring infections associated with untreated eczema. The course discussion also highlights the role of interprofessional collaboration in improving outcomes for patients with this condition. Objectives: Identify the pathophysiology of eczema. Evaluate the adverse effects of poorly controlled eczema. Implement appropriate treatment options for eczema. Communicate the importance of improving care coordination among the interprofessional team to improve outcomes for patients with eczema. Eczema, or atopic dermatitis, is the most common form of dermatitis.[1] Many factors, including genetic and environmental factors, are thought to play a part in the pathogenesis of eczema. It is most commonly seen in children but can be seen in adults as well. People with eczema tend to have dry, itchy skin prone to infection. The condition is commonly known as the "itch that rashes" because dry, itchy skin leads to a rash due to scratching or rubbing the skin. The exact etiology of eczema is not entirely understood, but it is believed to be a combination of genetic and environmental factors.[2] Genetic Factors There is a strong genetic component to eczema, with a family history of eczema, asthma, or allergies commonly found in affected individuals. Several genes associated with eczema have been identified, including those involved in the skin barrier function and the immune system. Filaggrin Gene One of the most well-known genes associated with eczema is the filaggrin gene (FLG). This gene provides instructions for making a protein called filaggrin, which is important in maintaining the skin barrier function. Mutations in this gene have been linked to eczema and other skin conditions and are thought to increase susceptibility to environmental irritants and allergens.[3][4] Other Skin Barrier Genes In addition to the filaggrin gene, other genes involved in the skin barrier function have been implicated in the development of eczema. These include genes involved in lipid synthesis and transport, such as the ceramide synthase gene and the ABCA12 gene.[5] Immune-related Genes Several genes involved in the immune response have also been associated with eczema, including genes that regulate T-cells, cytokines, and immunoglobulins. These genes include interleukin (IL)-4, IL-13, IL-31, signal transducer and activator of transduction (STAT)3, and Fc fragment of immunoglobulin (Ig)E receptor Ig (FCER1G). Overall, the genetic factors involved in eczema are complex and likely involve multiple genes and genetic pathways. Although genetic testing is not routinely used to diagnose eczema, understanding the disease's genetic basis can help identify individuals at increased risk and guide treatment approaches. Environmental Factors Environmental factors also play a role in the development of eczema. Patients with eczema have a defect in their skin barrier function, leading to increased water loss and susceptibility to environmental irritants and allergens. Common triggers for eczema flares include exposure to irritants such as detergents, soaps, solvents, and allergens such as dust mites, pet dander, and certain foods. Other factors that can exacerbate eczema symptoms include stress, changes in temperature and humidity, and infections. Immune System Activation In addition to genetic and environmental factors, the immune system is also thought to play a role in the development of eczema. Patients with eczema have an overactive immune response to environmental triggers, leading to inflammation and skin damage. Research shows there is a genetic component to eczema. One common mutation has been observed in FLG, a vital gene for skin cell maturity. This gene is responsible for creating the tough, flat corneocytes that form the outermost protective layer of skin. In a patient with normal skin cells, the corneocytes are tightly packed in an organized manner. A patient with an FLG mutation will have a dysfunctional skin barrier due to the haphazard organization of the skin cells.[7] This dysfunction causes a "leaky" skin barrier, allowing water loss and decreased protection from harmful substances. People with eczema also have reduced numbers of β-defensins in the skin. β-defensins are host defense peptides vital for fighting off certain bacteria, viruses, and fungi. A decrease in these peptides leads to increased colonization and infection, especially with Staphylococcus aureus (S. aureus). USER: My son came home from school and told me about one of his classmates who had scary skin. I am not sure what he is referring to, but I suspect it is eczema. My son says that he is afraid of playing with the classmate because he doesn't want to get scaly skin like a lizard. I am not really sure what eczema is, aside from being a skin condition. Please tell me more about it. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	49	76	749	null	810
Only utilize the information provided to you, and refer to it to respond to any query. Omit any clarifications, that would reach outside the scope of the provided materials. Declare: "I need more provided context", when a User query implies interest in a new field or topic.	Please provide an analysis of the US-Mexico border and how a more efficient border would impact the economy.	Atlantic Council ADRIENNE ARSHT LATIN AMERICA CENTER The Economic Impact of aMore Efficient US-MexicoBorder How Reducing Wait Times at Land Ports of Entry Would Promote Commerce, Resilience, and Job Creation Report Contributors: Alejandro Brugués Rodríguez, John Byrd, Noé Arón Fuentes Flores, David Gaytan, John Gibson, Camila Hernández, Mayra Maldonado, Jason Marczak, Jorge Eduardo Mendoza Cota, Roberto Ransom, and Ignacia Ulloa Atlantic Council ADRIENNE ARSHT LATIN AMERICA CENTER The Atlantic Council’s nonpartisan Adrienne Arsht Latin America Center (AALAC) broadens understanding of regional transformations while demonstrating why Latin America and the Caribbean matter for the world. The center focuses on pressing political, economic, and social issues that will define the region’s trajectory, proposing constructive, results-oriented solutions to inform public sector, business, and multilateral action based on a shared vision for a more prosperous, inclusive, and sustainable future. AALAC – home to the premier Caribbean Initiative – builds consensus for action in advancing innovative policy perspectives within select lines of programing: U.S. policy in the Western Hemisphere; Colombia’s future; Venezuela’s multidimensional crisis; Central American prosperity; US-Mexico ties; China in the Americas; Brazil’s trajectory; Caribbean development; regional economic development and commerce; and energy transitions. Jason Marczak serves as the center’s senior director. This report is written and published in accordance with the Atlantic Council Policy on Intellectual Independence. The authors are solely responsible for its analysis and recommendations. The Atlantic Council and its donors do not determine, nor do they necessarily endorse or advocate for, any of this report’s conclusions. Atlantic Council 1030 15th Street NW, 12th Floor Washington, DC 20005 For more information, please visit www.AtlanticCouncil.org. ISBN-13: 978-1-61977-250-2 September 2022 A joint report by the Atlantic Council’s Adrienne Arsht Latin America Center, the University of Texas at El Paso’s Hunt Institute for Global Competitiveness, and El Colegio de la Frontera Norte. Atlantic Council ADRIENNE ARSHT LATIN AMERICA CENTER The Economic Impact of aMore Efficient US-MexicoBorder How Reducing Wait Times at Land Ports of Entry Would Promote Commerce, Resilience, and Job Creation (The first of a two-part series on the US-Mexico Border) Report Contributors: Alejandro Brugués Rodríguez, John Byrd, Noé Arón Fuentes Flores, David Gaytan, John Gibson, Camila Hernández, Mayra Maldonado, Jason Marczak, Jorge Eduardo Mendoza Cota, Roberto Ransom, and Ignacia Ulloa Table of Contents EXECUTIVE SUMMARY 6 INTRODUCTION 7 WHY INVEST IN THE US-MEXICO BORDER? 8 BORDER WAIT TIMES: A CONTINUED CHALLENGE 9 THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER 11 The United States: Increased border efficiency would strengthen the economy 12 Mexico: The potential economic gains of a more efficient border 15 CONCLUSION 17 METHODOLOGY 18 APPENDICES 19 ACKNOWLEDGMENTS 38 THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER “We know that long wait times at the border can hurt our businesses and economy, especially in my district. Ensuring our ports of entry have sufficient funding to reduce wait times is necessary to keep our economy on track and ensure businesses on both sides of the border succeed.” The Hon. Juan Vargas Representative (D-CA-51) US HOUSE OF REPRESENTATIVES “Strengthened US-Mexico collaboration at our border will unlock significant economic growth, promote supply chain resilience, and boost competitiveness, benefiting Mexican workers and families. These benefits will reverberate far beyond the border, reaching states throughout Mexico. Now is the time to invest in initiatives to create an even more efficient and secure shared border.” H.E. Luz Maria de la Mora Subsecretary of International Commerce, Secretariat of the Economy UNITED MEXICAN STATES “Our border communities rely on efficient and effective infrastructure for work, trade, tourism and other economic exchanges across the US-Mexico border. As the North American region seeks to retain its competitive global advantage, it is more important than ever for these communities to have access to top-notch ports of entry, staffing and technology. With the proper tools for border management, our border cities will be enabled to prosper now and well into the future.” The Hon. Tony Gonzales Representative (R-TX-23) US HOUSE OF REPRESENTATIVES 5 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Executive Summary Improvements in border management and the adoption of new technologies at the US-Mexico border have the potential to enhance security and generate economic benefits for the United States and Mexico through expedited flows of goods and people. Reduced border wait times would lead to more traffic entering the United States from Mexico, both in terms of commercial trucks loaded with goods for US consumers and shoppers ready to buy US goods. This report quantifies the economic impact of this additional commerce and cross-border spending, which would lead to further economic prosperity in the two countries. Research shows that a 10-minute reduction in wait times could lead to an additional $26 million worth of cargo entering the United States each month via commercial vehicles. This translates to more than $312 million in further commerce from Mexico into the United States annually. The extra inventory of finished and intermediate goods would drive down US domestic prices, creating increased economic well-being for US citizens. This report also finds that reducing border wait times by 10 minutes has a positive annual impact of $5.4 million on the US economy due to purchases by additional families and individuals entering the United States from Mexico. While the immediate effect of these purchases is most evident in border communities, economic benefits would spread to the continental United States due to the economic linkages between local economies, with approximately 25 percent of the total impact reaching non-border states. Beyond the $312 million in added commerce from Mexico into the United States, a 10-minute reduction in border wait times would promote the creation of nearly 18,700 direct and indirect jobs in Mexico, increase labor income per sector by an average of $17,474, and simulate growth for various Mexican economic sectors, particularly manufacturing, wholesale trade, and mining. More specifically, a one-minute reduction in border wait times would increase the average production (or output) per sector—for Mexico’s top ten sectors exporting to the United States—by 2 percent. This reduction in border wait times would also boost intermediate sales and aggregate demand in Mexico by 2.4 percent and 1.7 percent, respectively. These findings illustrate the economic benefits of prioritizing investments at the US-Mexico border to reduce commercial and noncommercial wait times. They are understood as the lower range of the potential national-level economic benefits of deepened US-Mexico collaboration to create a more efficient and secure border. A forthcoming second study will build on these findings, disaggregating the economic impact of reduced wait times for US and Mexican states and counties at the border and beyond. Trucks pass through the U.S. border and into the United States from Juarez, Mexico in El Paso, Texas, U.S. June 18, 2018. REUTERS/Mike Blake 6 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Introduction The US-Mexico border is a hub of cultural and commercial exchange, fostering continued growth and collaboration between the United States and Mexico. Stretching over 2,000 miles, it has more than forty-four active ports of entry, with fifteen million US and Mexican citizens residing in border counties. In July 2022 alone, the United States and Mexico traded over $65 billion in goods,1 with more than $53 billion crossing the southern border via trucks and trains.2 Approximately five million US jobs depend on trade with Mexico,3 meaning that one in every twenty-nine workers in the United States has a job created or supported by US-Mexico trade. These jobs are spread throughout the US economy in terms of geography and industries. In Mexico’s automotive sector, US-Mexico trade supports more than one million jobs directly and 4.5 million indirectly.4 In addition to importing and exporting final products, the United States and Mexico jointly produce goods. Cross-border production sharing has contributed to greater economic integration, resilience, and competitiveness while helping to insulate the US and Mexican economies from global competitors. Similarly, US-Mexico trade in services contributes to the commercial relationship, with over $62 billion traded in 2019.5 On July 12, 2022, US President Joseph R. Biden and Mexican President Andrés Manuel López Obrador met in Washington, DC, to discuss how safer and more efficient borders would enhance shared commerce.6 During their meeting, the United States committed to investing $3.4 billion and Mexico $1.5 billion to undertake major projects to modernize land ports of entry on the northern and southern borders. These efforts will create jobs, bolster shared security, and enhance supply chain resilience by promoting legitimate trade and travel. New investments should continue to enhance shared commerce while addressing long-standing efficiency and security challenges, including excessive wait times, inconsistent federal policies, outdated screening technologies, and the illicit flow of weapons, drugs, contraband, and people. Future US-Mexico cooperation should also build on prior efforts to modernize border infrastructure, expedite processing times, and implement joint production programs through accords such as the United States Mexico-Canada Agreement (USMCA). It could also prioritize new information-sharing infrastructure, shared defense strategies, bilateral-processing mechanisms, and expanded trusted traveler programs. The long-term institutionalization of standing working groups like the US-Mexico High-Level Economic Dialogue (HLED) will help the United States and Mexico align priorities and advance shared development goals moving forward—as evidenced through the joint commitments made at the September 12, 2022, HLED meeting.7 This report—the first in a two-part series—shows that US-Mexico cooperation aimed at creating a more efficient, resilient, and secure border will enhance shared commerce and economic well-being through the expedited flow of goods and people. Reduced border wait times would allow more commercial and noncommercial vehicles to enter the United States from Mexico, bolstering cross border trade and spending and stimulating competitiveness, economic integration, and job creation. This report includes national-level findings, while a second report disaggregates results by county and state, showing that investing in the US-Mexico border will pay dividends far beyond the border. 7 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Why Invest in the US-Mexico Border? The United States and Mexico rely on each other to meet their populations’ demand for goods and services. Mexico stands as one of the United States’ largest trading partners in terms of goods, ranking first in 2019 with more than $614 billion in total (two-way) goods traded that year.8 Recent disruptions to cross-border commerce illustrate this interdependence, with important economic implications for populations on both sides of the border. As COVID-19 first raged worldwide, shutting down economies in the spring of 2020, the US-Mexico border was not immune to the global lockdown. Disruptions in cross-border flows of goods and people resulted in unemployment, curtailed retail sales, and decreased revenue for the tourism industry. In Texas alone, the tourism industry lost $1.02 billion over the course of eight months of border closures. In Mexico, agricultural exports decreased 5.9 percent between March and May of 2020, with a 17.9 percent decrease in sugar exports compared to 2019.9 Avocados are another example of US-Mexico economic interdependence. Approximately nine of ten avocados in US supermarkets come from Mexico.10 In 2021 alone, the United States imported more than 1.1 million metric tons of avocados from Mexico, totaling over $2.8 billion. However, a temporary suspension of avocado imports—due to a verbal threat received by a US inspector in Michoacán—led to concerns over shortages and price increases across the United States.11 Fortunately, the eight-day suspension did not have a lasting impact on local economies or spoil the fruit waiting for export. Soon after the suspension was lifted, avocados quickly returned to US supermarkets to satisfy consumer demand. The story of COVID-related commerce disruptions and the avocado example not only illustrate the two countries’ economic interdependence but also the importance of safe and efficient borders. According to US Customs and Border Protection (CBP), the average border-crossing wait time per truck regularly surpasses 125 minutes during regular-to-peak crossing hours.12 Multiplied by the average of 19,617 trucks crossing the border daily, the lost revenue amounts to millions of dollars annually for the United States and Mexico. Cross-border spending by noncommercial entities (families and individuals) also directly impacts the US and Mexican economies. Cities along the southern border of the United States have become attractive commercial poles that draw customers from Mexico up to 75 miles (120 kilometers) away for daily consumption of goods and services. This is partly due to trade mechanisms becoming antiquated under new international trade agreements (originally designed to retain customers in local markets and supply border counties with national products) and the limitations of the Mexican domestic market, which often translates to higher prices and lower quality in goods such as food, clothing, footwear, and household equipment. The United States and Mexico have created a series of tools to expedite border crossings for pedestrians, trains, and commercial and noncommercial vehicles, including Unified Cargo Processing,13 Global Entry, Secure Electronic Network for Travelers Rapid Inspection (SENTRI),14 Customs Trade Partnership Against Terrorism,15 and other trusted traveler programs. However, these mechanisms only serve a small portion of daily border crossers, given high annual fees and other prohibitive eligibility requirements. For example, only 175,000 citizens in the United States and Mexico have become SENTRI card holders.16 Building on these and other programs is essential as US and Mexican leaders work together to tap the full economic potential of our shared border. 8 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Border Wait Times: A Continued Challenge Bottlenecks at land ports of entry along the US-Mexico border present a long-term challenge for economic integration, supply chain resilience, and competitiveness. While international production sharing programs such as the USMCA and the Maquiladora Export Industry17 have promoted mutually beneficial trade, they have contributed to border congestion by increasing the volume of vehicles requiring border inspections. Congestion and associated wait times are compounded by outdated technologies and limited information sharing within and between agencies in Mexico and the United States. Curtailing the illegal flow of weapons, drugs, contraband, and people also requires stringent and time-consuming border inspections that may lead to border delays. As shown in Figure 1, non-expedited cargo (commercial vehicles) entering the United States from Mexico undergoes a multistep inspection process. The first processing step involves examination by Mexican border agents who verify paperwork for outgoing goods, ensuring that tariffs are accurately assigned.18 Once cargo reaches US inspection booths, CBP officers first examine relevant documentation for incoming merchandise and drivers, who are then subject to automated regulation and tariff compliance reviews. At the officers’ discretion, cargo can undergo an additional canine or gamma ray inspection before being cleared for crossing. Noncommercial vehicles entering the United States from Mexico also undergo a multistep inspection process. Depending on the type of border crossing (i.e., land or bridge), vehicles could be required to pay tolls in cash or via electronic toll collection systems. Once completed, vehicles continue to US inspection points, where they can undergo up to two separate inspections. At the primary inspection booth, CBP officials verify travelers’ documentation and inquire about the purpose of their visit to the United States. If the Interagency Border Inspection System finds records of norm violation,20 CBP officers direct the vehicle toward secondary inspection. At the secondary inspection, officers conduct a thorough identity investigation, after which access to the United States is either granted or denied. Figure 1: Inspection Process for Commercial Vehicles at the US-Mexico Border19 1. Mexican Export Lot 2. US Federal Compound 3. State Safety Facility Warehouse / Yard Mexican export documentation verifications and cargo inspection selection Mexican export cargo inspection CBP primary inspection (document inspection) Secondary inspection VACIS, X-Ray, FMCSA `Others Visual vehicle safety inspection Detailed state truck safety inspection Warehouse / Yard Mexico United SOURCE: US Department of Transportation, Federal Highway Administration, “Border-wide Assessment of Intelligent Transportation System (ITS) Technology—Current and Future Concepts,” https://ops.fhwa.dot.gov/publications/fhwahop12015/ch2.htm, 2022. 9 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Trucks wait in a long queue for border customs control to cross into the U.S., in one of the main roads of Tijuana, Mexico, April 18, 2019. REUTERS/Andres Martinez Casares - RC1CE4339C90 Despite the implementation of numerous interventions to enhance the border-user experience, border users consulted while preparing this report expressed concerns about inconsistent federal policies that are not well attuned to their needs.21 For example, outdated technologies at port facilities lead to inaccurate time projections on official agency platforms, making border users turn to social media to better estimate wait and crossing times. Similarly, double inspection processes and unstandardized documentation requirements in different ports of entry generate delays in border crossings, which ultimately increase transport expenses. Finding ways to efficiently process the large volume of commercial and noncommercial vehicles crossing the border while safeguarding national security should remain a priority for the bilateral relationship. This will improve the border-user experience and result in substantial economic gains for both countries. 10 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER The Economic Impact of a More Efficient US-Mexico Border Reduced wait times at the US-Mexico directly impact the US and Mexican economies through increased cross border commerce (commercial vehicles) and spending (noncommercial vehicles). This section quantifies the nationwide dollar value that would result from additional traffic entering the United States from Mexico following a 10-minute reduction in border wait times. The economic impact is estimated for the US and Mexican economies. OUR APPROACH The Atlantic Council’s Adrienne Arsht Latin America Center partnered with the Hunt Institute for Global Competitiveness at the University of Texas at El Paso and El Colegio de la Frontera Norte to produce this two-part study. Findings in this first report result from roundtables, focus groups, and individual consultations carried out virtually across both countries and in-person in Washington, DC; El Paso, Texas; and Tijuana, Mexico; and the analysis of economic data from the United States and Mexico. This study utilizes two economic models; one uses US data, emphasizing the US economy, and another employs Mexican data, focusing on the Mexican economy. As a starting point, both sides of the border were viewed independently to account for discrepancies in data availability and the specific methodologies of local partners and stakeholders. By later harmonizing findings and data, the scope and range of results were extended, ultimately determining the costs and benefits of reducing border wait times for both economies. USEFUL TERMS • Commercial traffic: loaded or unloaded vehicles (usually trucks or trains) that cross the US-Mexico border with the intent to distribute goods produced in the country of origin. • Expenditure: the amount of money spent by noncommercial entities (families and individuals). • Aggregate demand: the total amount of demand for all finished goods and services produced in an economy. • Final good: a product that the final consumer uses or consumes. It does not require any additional processing. • Gross output: the measure of total economic activity in the production of new goods and services during an accounting period. • Labor income: the sum of employee compensation (wages and benefits) and proprietor income. • Intermediate good: a product used to produce a final good. • Intermediate sale: the sale of intermediate goods used in the production of final goods. • Noncommercial traffic: vehicles carrying passengers (tourists, workers, others) that do not transport goods to sell in the destination country. 11 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER The United States: Border Efficiency to Strengthen the Economy By John Byrd, John Gibson, Mayra Maldonado, and Roberto Ransom. University of Texas at El Paso’s Hunt Institute for Global Competitiveness Improved border management and the implementation of new technologies at the US-Mexico border have the potential to enhance border security and expedite legitimate trade and travel, stimulating the US and Mexican economies. A more efficient border would allow more commercial and noncommercial traffic to enter the United States from Mexico, resulting in additional goods for US consumers and businesses and more shoppers buying US goods and services. KEY TAKEAWAYS: A 10-minute reduction in wait times at the US-Mexico border would: • Five-hundred thirty-two additional commercial vehicles loaded with goods entering the United States from Mexico every month would generate an additional commercial intake of nearly $26 million monthly or $312 million annually. The extra inventory resulting from increased imports would reduce US domestic prices, thus promoting economic well-being for US citizens. • Sixty-thousand two-hundred forty additional noncommercial vehicles entering the United States from Mexico every month would generate an additional economic intake of $450,000 monthly, or $5.4 million annually. Border states would absorb approximately 75 percent of this economic impact, and the other 25 percent would reach non-border states in the United States. The Economic Impact of Additional Commercial Crossings In 2021, more than 4.7 million container trucks loaded with over $345.9 million worth of cargo entered the United States from Mexico via the US-Mexico border.22 Research shows that a one minute reduction in commercial wait times would result in 53 additional commercial crossings (see regression analysis in Appendix B). This means that a 10-minute reduction in wait times would result in approximately another 532 container trucks entering the United States every month. These containers may be loaded or unloaded. Therefore, estimating the economic impact of additional commercial crossings would require determining the proportion of loaded containers entering the United States via land ports of entry and the average cargo value of loaded containers. Data from the US Bureau of Transportation shows that approximately 73.1 percent of containers crossing the US-Mexico border are loaded with an average value of $66,798. Table 1 shows a breakdown of the average container value and the number of loaded and unloaded containers crossing the border through individual border counties. 12 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table 1: Proportion of Loaded Containers and Average Container Value (2019) State County Loaded Containers 2019 Unloaded Containers 2019 Loaded + Unloaded Containers Exports 2019 Imports 2019 Total Trade 2019 Average Value per Truck Texas El Paso 610,869 184,426 795,295 $31,717,503,019 $46,613,712,212 $78,331,215,231 $76,307 Texas Hudspeth 0 0 0 $- $- $- $- Texas Presidio 8,418 1,791 10,209 $144,896,195 $200,275,710 $345,171,905 $23,791 Texas Val Verde 59,951 15,651 75,602 $2,068,951,047 $3,082,037,002 $5,150,988,049 $51,409 Texas Maverick 149,732 30,298 180,030 $7,453,868,613 $22,197,870,144 $29,651,738,757 $148,251 Texas Webb 1,711,670 658,639 2,370,309 $95,124,653,587 $135,741,587,991 $230,866,241,578 $79,304 Texas Starr 38,611 17,958 56,569 $92,580,893 $387,724,994 $480,305,887 $10,042 Texas Hidalgo 502,312 213,297 715,609 $13,222,562,811 $23,522,857,942 $36,745,420,753 $46,829 Texas Cameron 153,280 134,796 288,076 $8,910,096,389 $8,930,388,221 $17,840,484,610 $58,262 New Mexico Luna 15,960 794 16,754 $23,980,387 $116,358,933 $140,339,320 $7,291 New Mexico Dona Ana 114,701 19,916 134,617 $14,098,068,953 $16,344,483,518 $30,442,552,471 $142,496 Arizona Yuma 28,342 8,823 37,165 $506,644,995 $875,099,032 $1,381,744,027 $30,876 Arizona Pima 303 12 315 $3,518,870 $1,794,662 $5,313,532 $5,923 Arizona Santa Cruz 293,771 66,136 359,907 $10,369,174,240 $15,633,063,045 $26,002,237,285 $53,215 Arizona Cochise 21,775 8,253 30,028 $802,531,798 $1,153,252,535 $1,955,784,333 $52,962 California San Diego 798,230 258,912 1,057,142 $17,279,207,288 $32,480,486,882 $49,759,694,170 $40,691 California Imperial 258,227 134,805 393,032 $7,023,568,716 $11,087,270,453 $18,110,839,169 $42,936 Total US Border 4,766,152 1,754,507 6,520,659 $208,841,807,801 $318,368,263,276 $527,210,071,077 Average $66,798 SOURCE: The Hunt Institute for Global Competitiveness and the COLEF using data from the Department of Transportation and the US Census Bureau. Based on these findings, a 10-minute reduction in commercial wait times would allow $26 million23 in additional cargo value to enter the United States monthly or $312 million annually. This added commerce from Mexico into the United States consists of various finished and intermediate goods demanded by US consumers and businesses. While it may be argued that additional consumer goods entering the United States via the southern border would result in fewer jobs in the United States, the extra inventory generated by these other imports would also drive down domestic prices. Furthermore, the inflow of intermediate goods serves as vital inputs that support US businesses. As such, more data and analysis are required to determine which of these offsetting effects dominate. The Economic Impact of Additional Noncommercial Crossings24 Improvements in border management tools and practices could also expedite the flow of noncommercial crossings, with positive repercussions for the US economy due to additional cross border spending. In 2021, nearly 126 million people entered the United States from Mexico to purchase goods and services from US businesses. As shown in Table 2, these purchases generated an economic impact of $12.3 billion for the US economy.25 While the four US border states—Arizona, California, New Mexico, and Texas—absorb 75 percent of this impact, approximately 25 percent 13 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table 2: Economic Impact of Cross-Border Spending in the United States (2022) Impact Employment Labor Income Value Added Output 1 - Direct 2 - Indirect 3 - Induced 60,619.16 $1,812,022,814.56 $2,765,047,740.91 $5,036,142,293.41 21,166.07 $1,234,825,927.30 $1,980,607,178.46 $4,118,866,436.04 18,648.05 $977,441,701.68 $1,771,486,445.19 $3,177,688,817.94 100,433.29 $4,024,290,443.54 $6,517,141,364.56 $12,332,697,547.38 SOURCE: The Hunt Institute for Global Competitiveness and the COLEF, using IMPLAN. bleeds directly into non-border states. This means that spending by shoppers from Mexico in US border states has an economic impact of $3.1 billion in the other forty-six US states. Research finds that a 10-minute reduction in wait times at the US-Mexico border would result in an average of approximately 5,020 additional noncommercial crossings every month, or 60,240 every year (see regression results in Appendix B). Determining the economic impact of these additional crossings requires data on the spending patterns of noncommercial crossers and a model to assess the economic impact of this spending. Appendix C provides technical details on how the data and model were used to calculate impact. Research shows that a 10-minute reduction in noncommercial wait times at the US-Mexico border would lead to a $450,000 positive economic impact on the US economy every month. Over the course of one year, this would add up to a monetary intake of $5.4 million. The top three industries that would most benefit from additional cross-border spending is concentrated in areas where tourists or temporary visitors are likely to spend money, particularly retail, full service restaurants, and general merchandise industries. For further information on sector-specific impacts, see Appendix C. Trucks wait in a queue for border customs control, to cross into the United States, at the Zaragoza-Ysleta border crossing bridge in Ciudad Juarez, Mexico April 30, 2020. REUTERS/Jose Luis Gonzalez 14 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Mexico: The Potential Economic Gains of Border Efficiency By David Gaytan, Noé Arón Fuentes Flores, Alejandro Brugués Rodríguez, and Jorge Eduardo Mendoza Cota. El Colegio de la Frontera Norte KEY TAKEAWAYS: A one-minute reduction in wait times at the US-Mexico border would: • Boost Mexican exports to the United States, increasing sectoral output by an average of 2 percent, intermediate sales by an average of 2.4 percent, and aggregate demand by an average of 1.7 percent. Sectors benefiting the most from reduced commercial wait times are those for which production is largely driven by US demand for export goods such as mining, manufacturing, wholesale trade, and agriculture. A 10-minute reduction in wait times at the US-Mexico border would: • Create nearly 18,700 additional direct and indirect Mexican jobs. These posts would be largely concentrated in financial services; wholesale trade; sports, cultural, and other recreational services; and professional, scientific, and technical services. • Lead to an overall increase of $174,474 in labor income. Expediting the flow of commercial traffic from Mexico into the United States would boost cross-border commerce, which impacts aggregate demand in Mexico, causing a change in total gross output and intermediate sales.26 These effects can be disaggregated by sector in the Mexican economy. Macroeconomic Impact of Additional Commercial Crossings Determining the sectoral economic impact of a more efficient US-Mexico border requires understanding the relationship between Mexico’s exports per sector and US demand for export goods. The United States stands as Mexico’s largest export market, with approximately 80 percent of Mexican exports destined for the United States.27 Nearly 100 percent of these exports are concentrated in ten sectors,28 accounting for $349 billion in 2018 and $358 billion in 2019 (for more information, see Appendix F).29 Therefore, this study only considers Mexico’s top-ten sectors in terms of exports to the United States. Within this group, the manufacturing and maquiladora export industries are particularly important, producing more than 60 percent of Mexico’s total exports to the United States. Today, Mexico stands as the top US supplier of motor vehicles and motor vehicle parts.30 Findings show that, on average, Mexican exports to the United States drive 38 percent of Mexican production (or output) per sector (for a detailed breakdown, see Appendix F). For mining, manufacturing, wholesale trade, and agriculture, exports to the United States drive more than 50 percent of total gross output. These four sectors alone are responsible for 84.4 percent of the total dollar value generated from exports to the United States, accounting for $664.26 billion out of the total $787.16 billion in total production. A significant portion of Mexican exports enters the United States via land ports across the US-Mexico border. An average of twenty-eight commercial vehicles with export goods arrive at the border every hour, with the average truck taking approximately 20 minutes to cross the border (for more information, see Appendix D3). Reducing wait times would boost Mexican exports by allowing additional commercial crossings into the United States. This would strengthen Mexican supply chains by stimulating the exchange of intermediate and final goods between sectors in response to the increased demand for export goods. Given that approximately 73.1 percent of containers crossing the US-Mexico border are loaded with an average value of $66,798,31 a one-minute reduction in commercial wait times would increase 15 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER sectoral output (total gross output) by an average of 2 percent. This output growth would be driven by a 1.7 percent increase in average demand per sector, occurring as a result of additional Mexican exports entering the United States. Intermediate sales (the sectoral exchange of intermediate goods for the production of additional export goods) would grow by an average of 2.4 percent per sector. Appendix D includes a detailed description of the two models used in the analysis, a queuing and input-output model. As Figure 2 shows, the benefits of increased commercial crossings into the United States are unequally distributed across sectors of the Mexican economy. The mining, manufacturing, and wholesale trade sectors experience the highest growth rates in production, at 3.62 percent, 3.62 percent, and 3.33 percent, respectively. These three sectors also have the largest increase in aggregate demand, growing at 3.88 percent, 5.20 percent, and 3.63 percent, respectively. Regarding intermediate sales, the agricultural and mining sectors have growth rates higher than 3 percent. Appendix F has a detailed breakdown of nominal and percentage growth in production (total gross output), intermediate sales, and aggregate demand following a one-minute reduction in border wait times. Economic Impact on Employment and Labor Income of Additional Commercial Crossings Moreover, this study finds that a 10-minute reduction in border wait times would promote the creation of nearly 18,700 indirect and direct jobs in Mexico over the course of one year, with 5,505 new positions opening in financial and insurance services, 3,684 in mass media information, 3,216 in wholesale trade, and 2,448 in professional, scientific, and technical posts. The loss in labor is far smaller, with an estimated 793 jobs lost in manufacturing and 210 in the transportation, postage, and warehousing sectors. (For detailed analysis, see Appendix G). A ten-minute reduction in commercial wait times would also result in a $174,474 increase in labor income. When disaggregated by sector, labor income growth is higher in the wholesale trade, financial and insurance services, information services, and mining sectors. Interestingly, this change would lead to more equitable distribution of labor income across Mexican economic sectors. However, the variation is driven mainly by increased production by sector rather than overall productivity. (For more information, see Appendix G). Figure 2: Growth of Total Gross Output, Aggregate Demand, and Intermediate Sales Total Production Growth Aggregate Demand Growth Intermediate Sales GrowthSOURCE: In-house prepared graph based on estimates for 2018 data, obtained from the National Institute of Statistics and Geography, 2022. 16 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Conclusion Trucks wait in a long queue for border customs control to cross into the United States at the World Trade Bridge in Nuevo Laredo, Mexico April 2, 2019. REUTERS/Daniel Becerril A more efficient US-Mexico border would expedite legitimate trade and travel, enhancing cross-border commerce and benefiting the US and Mexican economies. Streamlined border crossings could be achieved through improvements in border management practices and the adoption of new technologies. These efforts would also bolster shared security between the United States and Mexico. This report focused on the economic impact of expediting commercial and noncommercial crossings from Mexico into the United States. Reduced border wait times would increase the supply of goods and services for US consumers and stimulate spending in the United States while boosting Mexican exports into the United States. This would lead to an increasingly competitive, economically integrated, and resilient bilateral relationship. In the United States, a 10-minute reduction in border wait times would facilitate the crossing of 532 additional loaded trucks every month, generating an added commercial intake of nearly $26 million per month. In one year, the economic impact on the US economy would be $312 million. Similarly, it would allow 60,240 additional noncommercial vehicles to enter the United States every month, generating an extra economic intake of $450,000 monthly, or $5.4 million annually. The benefits of increased cross-border commerce and spending would extend throughout the United States due to the economic linkages between local economies. For Mexico’s top ten export sectors to the United States, a one minute reduction in commercial wait times would, on average, increase production (total gross output) by 2 percent, intermediate sales by 2.4 percent, and aggregate demand by 1.7 percent. Results show the mining, manufacturing, wholesale trade, and agricultural sectors would benefit the most from additional commerce from Mexico into the United States. Historically, more than 50 percent of production in these sectors has been driven by US demand for export goods. Expediting the flow of commercial vehicles from Mexico into the United States by ten minutes would increase labor income by $174,474 and promote the creation of nearly 18,700 additional direct and indirect jobs in Mexico, particularly in financial services; mass media information; wholesale trade; and professional, scientific, and technical services. These numbers illustrate the lower-bound economic gains that would result from reduced wait times at the US-Mexico border, stemming from potential improvements in border management practices and tools. They emphasize the economic interdependence of the United States and Mexico, outlining how a further coordinated, binational approach to the border would benefit both countries. A subsequent study will disaggregate national-level findings and thus determine the impact of a more efficient and secure US-Mexico border at the state and county level in the United States and Mexico. 17 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Methodology US-focused analysis The Hunt Institute for Global Competitiveness used a two-step process to calculate the economic impact of reducing border wait times for commercial and noncommercial crossings. First, regression analysis was employed to determine the relationship between average wait times (in minutes) and the average number of crossings (commercial and noncommercial) at major US-Mexico land ports of entry. Additional factors impacting this relationship, such as employment and crime on both sides of the border, the number of lanes in operation, and total expenditures made by the US Department of Homeland Security (DHS), were considered. The analysis used data from various sources, including CBP, the US Department of Transportation’s Bureau of Transportation Statistics, the US Department of Labor’s Bureau of Labor Statistics, Instituto Nacional de Estadística y Geografía (INEGI, or National Institute of Statistics and Geography), and the Instituto Mexicano de Seguro Social (Mexican Institute of Social Security). To account for disruptions in border traffic patterns stemming from COVID-19 and its accompanying policy changes, the study captures data between April 2016 and December 2019, before the pandemic’s onset. The second step in the analysis was quantifying the economic impact of additional crossings resulting from reduced wait times. Because of the different types of data available for commercial and noncommercial crossings; this study used various methods to quantify their effects. For commercial crossings, the proportion of loaded container crossings and the average value per container— obtained from the US Department of Transportation—were used to determine the dollar value associated with increased container crossings. For noncommercial crossings, survey data from the City of El Paso’s International Bridges Department on travel and spending patterns were used to model the economic impact of spending by additional noncommercial crossers. Appendices A through C include more technical information and a detailed, step by-step explanation of the analysis. Mexico-focused analysis El Colegio de la Frontera Norte used a three-step process and two economic models to determine the economic impact of reduced border wait times for commercial vehicles. The analysis used data from the US Bureau of Transportation Statistics, CBP, the North American Industry Classification System (NAICS), Mexico’s INEGI, Automated Census Information System (ACIS), and Servicio de Administración Tributaria (SAT, or Tax Administration Service). The first step was to estimate the average inspection rate of commercial vehicles at US-Mexico border land ports of entry (see Appendix D3 for detailed analysis). Then, a queuing model was used to determine how reduced wait times affect Mexican exports to the United States. Finally, an input-output model was implemented to establish how changes in exports affect production (total gross output), intermediate sales, and aggregate demand for Mexico’s top ten sectors in terms of exports to the United States. Appendix D provides a detailed, technical description of the queueing and input output models, while Appendix F includes analysis results. 18 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendices The following Appendices provide additional details on the economic analysis summarized in the main report. Given its technical nature, this section can be skipped by more casual readers. Appendices A, B, and C explain the US-focused analysis by the Hunt Institute for Global Competitiveness and Appendices D, E, F, and G expand on the Mexico-focused analysis by El Colegio de la Frontera Norte. US-FOCUSED ANALYSIS APPENDIX A 20 Provides a detailed description of the data used in the regression analysis. APPENDIX B 24 Outlines the regression model used to estimate the relationship between border wait times and commercial and noncommercial crossings. APPENDIX C 25 Gives an overview of IMPLAN and how it was used to measure the economic impact of noncommercial crossings. MEXICO-FOCUSED ANALYSIS APPENDIX D 28 Provides more details on the input-output and queuing models. APPENDIX E 31 Describes the data used in the analysis. APPENDIX F 32 Explains the economic impact analysis with and without reduced border wait times. APPENDIX G 36 Describes the analysis of economic impact on employment and labor income. 19 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX A: DATA USED FOR THE FIXED EFFECTS MODEL While report results are presented at the national level, the analysis by the Hunt Institute for Global Competitiveness is built from county level data focusing on major US-Mexico land ports of entry. Map 1 shows the counties on the US-Mexico border for which data was collected and analyzed. These counties have one or more land ports of entry. Map 2 presents CBP sectors and selected counties’ ports of entry within each sector. Map 1. US Border Counties on the US-Mexico Border SOURCE: The Hunt Institute for Global Competitiveness and El Colegio de la Frontera Norte (COLEF). 20 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Map 2. CBP Sectors Along the US-Mexico Border SOURCE: The Hunt Institute for Global Competitiveness and COLEF using data from CBP. Table A1 lists every US county that touches the US-Mexico border. The list includes the name of every port of entry within that county, the names of the corresponding Mexican counties, and the CBP sector that contains that county. 21 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table A1: US-Mexico Border States, Counties, Cities, Ports of Entry, Mexican Sister Cities, and CBP Sectors State County City PoE Sister City CBP Sector California Arizona New Mexico Texas San Diego San Ysidro San Ysidro Tijuana, Baja California San Diego Sector, California Otay Mesa Otay Mesa - Commercial Otay Mesa - Passenger Otay Mesa - Pedestrian Cross Border Express Tecate Tecate Imperial Calexico Calexico - East Mexicali, Baja California El Centro Sector, California Calexico - West Andrade Andrade Yuma San Luis San Luis - San Luis I San Luis Rio Colorado, Sonora Yuma Sector, Arizona San Luis - San Luis II Pima Lukeville Lukeville Puerto Peñasco, Sonora Tucson Sector, Arizona Sasabe Sasabe Sáric, Sonora Santa Cruz Nobales Nogales - Deconcini Nogales, Sonora Nogales - Mariposa Nogales - Morley Gate Cochise Naco Naco Naco, Sonora Douglas Douglas (Raul Hector Castro) Agua Prieta, Sonora Luna Columbus Columbus Asencion, Chihuahua El Paso Sector, New Mexico Doña Ana Santa Teresa Santa Teresa - Santa Teresa Port of Entry Ciudad Juarez, Chihuahua El Paso El Paso El Paso - Bridge of the Americas (BOTA) Ciudad Juarez, Chihuahua El Paso Sector, Texas El Paso - Paso del Norte (PDN) El Paso - Stanton DCL El Paso - Ysleta Hudspeth Fort Hancock Fort Hancock - Fort Hancock El Paso Fabens Fabens - Tornillo Guadalupe, Chihuahua Presidio Presidio Presidio Ojinaga, Chihuahua Big Bend Sector, Texas Val Verde Del Rio Del Rio Acuña, Coahuila Del Rio Sector, Texas Maverick Eagle Pass Eagle Pass - Bridge I Piedras Negras, Coahuila Eagle Pass - Bridge II Webb Laredo Laredo - Bridge I Nuevo Laredo, Tamaulipas Laredo Sector, Texas Laredo - Bridge II Laredo - Colombia Solidarity Laredo - World Trade Bridge Starr Roma Roma Ciudad Miguel Aleman, Tamaulipas Rio Grande Rio Grande City Camargo, Tamaulipas Rio Grande Valley Sector Hidalgo County Hidalgo/ Pharr Hidalgo/Pharr - Anzalduas International Bridge Reynosa, Tamaulipas Hidalgo/Pharr - Hidalgo Hidalgo/Pharr - PharrProgreso - Donna International Bridge Hidalgo Progreso Progreso - Donna International Bridge Rio Bravo, Tamaulipas Progreso - Progreso International Bridge Cameron Brownsville Brownsville - B&M Matamoros, Coahuila Brownsville - Gateway Brownsville - Los Indios Brownsville - Veterans International SOURCE: The Hunt Institute for Global Competitiveness and El Colegio de la Frontera Norte (COLEF) using data from CBP. 22 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Running the necessary regressions to determine the impact of border wait times on border crossings requires data on several variables in various geographies. The data gathered for the regression analysis includes: 1. Average wait times: Border wait times at ports of entry were obtained from CBP. The research team used this data to estimate the monthly average border wait time (in minutes) for every land port of entry. This data was available for commercial vehicles, personal vehicles, and pedestrian modes of crossing, but not for rail crossings.32 Commercial vehicle data for the Hudspeth port of entry were unavailable for this variable.33 2. Total number of crossings per month: Data was captured from the US Department of Transportation’s Bureau of Transportation Statistics for each port of entry on the US-Mexico border and mode of crossing (commercial vehicles, noncommercial vehicles, and pedestrian crossings). The analysis uses these data to estimate the total number of crossings per city and county. The data for the Fort Hancock port of entry was unavailable for this variable. 3. Number of operational lanes per month: The total number of operating lanes per hour per port of entry was taken from the CBP for every port of entry. This analysis used the point of entry level data to estimate the number of operational lanes by city and county. The research team estimated an hourly average for every port of entry, using it to estimate a monthly average of the number of lanes in operation per port of entry. The commercial vehicles data for the Eagle Pass port of entry were not available for this variable. 4. Total number of existing lanes: The total number of existing lanes for every port of entry was captured from CBP. Commercial vehicle data for the Fort Hancock port of entry were unavailable for this variable. 5. Total employment (United States): The monthly data of total non-farm employment information for each US county on the US-Mexico border with ports of entry was obtained from the US Department of Labor’s Bureau of Labor Statistics. 6. Total employment (Mexico): The monthly data on total non-farm employment for each of the Mexican counties on the US-Mexico border with a port of entry was acquired from the Instituto Mexicano del Seguro Social (IMSS or Mexico’s Institute of Social Security). 7. Illegal Apprehensions: CBP provided its complete monthly number of illegal apprehensions for every sector within the southern border. See Map 2 for the boundaries of each CBP sector. This variable serves as a measure of crime in the United States. 8. Homicide rate: The total number of homicides per county was obtained for every northern Mexican municipality from the Secretariado Ejecutivo del Sistema Nacional de Seguridad Publica (Mexico’s Executive Secretary of the National Public Security System), the Mexican agency that compiles the total number of homicides per county. Mexican population data is available from two Mexican agencies, the Instituto Nacional de Estadística y Geografía (INEGI or the National Institute of Statistics and Geography) and the Consejo Nacional de Población (CONAPO or the National Council on Population). This variable serves as a measure of crime in Mexico. 9. Federal Expenditures (United States): Federal costs data were obtained for the following federal agencies: CBP, US Coast Guard, Transportation Security Administration, Federal Law Enforcement Training Center, and US Immigration and Customs Enforcement. These expenses were gathered for the following counties: San Diego and Imperial in California; Yuma, Pima, Santa Cruz, and Cochise in Arizona; Luna and Doña Ana in New Mexico; and El Paso, Presidio, Val Verde, Maverick, Webb, Starr, Hidalgo, and Cameron in Texas. 10. Trade: The data obtained from the US Trade Census consists of the value of the total imports and exports that cross the US-Mexico border ports of entry every month. 23 ATLANTIC COUNCIL APPENDIX B THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX B: FIXED EFFECTS MODEL Calculating the economic impact of a more efficient and secure border, requires understanding the relationship between wait times and the number of border crossings. The data across counties shows a low yet positive correlation between noncommercial crossings and wait times, suggesting that increased wait times are associated with more border crossings.34 This counterintuitive finding is explained by the fact that increased border usage (or border congestion) results in both longer wait times and more crossings. Therefore, to determine the underlying relationship between border wait time and crossings, the research team used an econometric model to control for other factors that may influence border crossings. The following equation is estimated by fixed effects using monthly county-level data from April 2016 through December 2019.35 crossit = β1waitit + β2Xit+ i+uit ,t = 1,2, ..., T In the estimation equation, crossit and waitit denote the number of crossings (either commercial or noncommercial) and average wait times in county i at time t, respectively. All additional time-varying explanatory variables are included in Xit, while i denotes the time constant fixed effect for county i and uit denotes the error term.36 The additional controls in Xit account for other factors influencing crossings and include a measure of employment in the United States and Mexico, a measure of crime in both countries, the number (or proportion) of lanes in operation, total expenditures by DHS, and a measure of trade (included in the commercial regression only). The left panel of Table B1 provides regression results for commercial crossings, while the right panel shows results for noncommercial crossings. The coefficient estimate on wait times is of primary interest, which is negative and statistically significant in both regressions. Specifically, the analysis found that a one-minute reduction in wait times results in 53 additional commercial crossings and 502 noncommercial crossings on average per month. The coefficient on wait times in the commercial crossing regression is statistically significant at 10 percent. Each additional commercial crossing represents another cargo container (loaded or unloaded) crossing into the United States via a land port of entry. The coefficient on wait times in the noncommercial crossings regression is statistically significant at 5 percent. Each additional noncommercial crossing represents a personal vehicle crossing into the United States via a land port of entry. Regression results suggest an inverse relationship between wait times and commercial and noncommercial border crossings. Including additional time-varying controls and time-constant fixed effects helped to reverse the counterintuitive finding of a positive correlation reported above. As such, Table B1 describes the underlying relationship between border wait times and border crossings. These findings can be used to determine how improved border management techniques or the adoption of new technologies affect commercial and noncommercial border crossings. Table B1: Fixed Effects Regression Results Regression Results Commercial Crossings Noncommercial Crossings Wait times -53.23* -502.05 (30.34) (227.18) Employment in US 0.03 0.23 (0.05) (0.41) Employment in Mexico -0.01 0.05 (0.02) (0.17) Crime in US -0.03 -1.16* (0.04) (0.43) Crime in Mexico -17.60* -30.00 (5.56) (98.12) Lanes operational 487.29 314031.50* (1998.54) (68954.24) DHS Expenditures -0.002 0.01 (0.001) (0.01) Trade 8.92E-06* - (5.09E-07) - Constant 8307.01 268168.40* (6615.80) (48439.59) Sample Size 554 585 R^2 0.95 0.76 SOURCE: The Hunt Institute for Global Competitiveness and the COLEF, using data from the US Department of Transportation. NOTE: The standard error is in parentheses. Statistically significant at 1 percent. Statistically significant at 5 percent. Statistically significant at 10 percent. 24 ATLANTIC COUNCIL APPENDIX C THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX C: ECONOMIC IMPACT ANALYSIS OF BORDER CROSSINGS The regression results presented in Appendix B established a link between border wait times and commercial and noncommercial crossings. This serves as the first step in understanding the economic impact of reduced border wait times. Additional data is needed to determine the economic impact of reductions in border wait times. The following subsections explain the steps taken to produce the economic impact results described in the main text. Appendix C1: Economic Impact of Commercial Crossings The regression results described in Appendix B indicate that a one-minute reduction in average commercial wait times results in approximately fifty-three additional container crossings per month. Data from the US Department of Transportation’s Bureau of Transportation Statistics were used to estimate that approximately 73.1 percent of these containers would be loaded with an average value of $66,798 (for a detailed breakdown of the proportion of loaded containers crossing the US-Mexico border and their average cargo value, see table 1 on page 13). This means that a 10-minute reduction in wait times would result in 532 additional container crossings, of which 388 would be loaded with $25,879,549 in cargo value. Appendix C2: Economic Impact of Noncommercial Crossings Individuals crossing from Mexico into the United States make purchases on the US borders and in states, contributing to local economies. Due to underlying economic linkages, this spending has an amplified national impact. To estimate this impact, the research team used IMPLAN—a regional economic impact software—, data on expenditure patterns, and the average number of border crossings aggregated to the county level. Below is an overview of the data and model used to estimate the economic impact of the expenditures that result from these noncommercial border crossings. A 2019 study by the City of El Paso International Bridges Department quantifies the social and economic cross-border activities from vehicle and pedestrian crossings through the El Paso–Ciudad Juárez port of entry. The study consisted of two surveys. First, a short questionnaire administered to US-Mexico border crossers between October 1 and December 31, 2019. Residents who indicated Mexico as their primary place of residence received an entry survey, while those indicating the United States as their primary place of residence received an exit survey. The entry survey captured the planned activities and expenditures of those traveling to El Paso from Ciudad Juárez, while the exit survey captured the activities and spending already made by those traveling to Ciudad Juárez from El Paso. 25 ATLANTIC COUNCIL APPENDIX C THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Survey respondents were asked questions related to four categories: • Demographics • Reasons for crossing • Anticipated spending (including the area of spending) • Trip characteristics This report focused on survey responses related to the intended destination (El Paso or other) and expected spending across various categories. The survey results indicate that approximately 80 percent of individuals crossing the border (by vehicle and as pedestrians) remained in El Paso, while 20 percent continued to another location. Of the 80 percent who stayed in El Paso, approximately 64 percent of those who crossed by vehicle and 47 percent who crossed as pedestrians reported positive expected expenditures. The survey data breaks down the dollar amount individuals expected to spend within twenty categories.37 This information was used to calculate the average expenditure per crosser, for both vehicle and pedestrian crossings. These expenditures were then scaled by the total number of vehicle and pedestrian crossings in 2019 (after scaling by the proportion of crossers who remained in El Paso and reported spending money) to determine the average expenditure of crossings in 2019 for El Paso County. To establish the economic impact of these expenditures at the national level, the average expenditures by crossers in 2019 were computed for the following border counties: • Texas: Presidio, Val Verde, Maverick, Webb, Starr, Hidalgo, and Cameron • New Mexico: Luna and Doña Ana • Arizona: Yuma, Pima, Santa Cruz, and Cochise • California: San Diego and Imperial Unfortunately, detailed expenditure data were unavailable for the other border counties. However, the El Paso survey was used with the assumption that spending patterns across the twenty categories do not change across counties. First, the average expenditures per crosser for each category was recovered from the El Paso survey. These expenditures were then scaled up or down based on the average household income in the neighboring Mexican state relative to the average household income in Chihuahua (the Mexican state neighboring El Paso). Once this income adjustment was made, the average 2019 expenditures were scaled by the number of vehicle and pedestrian crossings in 2019 for each border county listed above. This exercise reveals the total spending in the twenty categories for each of the sixteen border counties considered in the analysis.38 These findings were used as inputs into IMPLAN to estimate the economic impact of expenditures by individuals crossing the US-Mexico border. First, the twenty expenditure categories from the survey were mapped into comparable IMPLAN industries. Then, industry output (spending) was reduced in these industries for each of the sixteen counties. Twenty adverse output (spending) events were modeled separately in the sixteen counties for a total of 320 events. The rest of the United States was then built up, county-by county for Texas, New Mexico, Arizona, and California; and state-by state for the non-border states. Finally, the national-level analysis was run using IMPLAN’s multiregion input-output feature, allowing for additional indirect linkages between regions within the analysis. Tables C2.1 and C2.2 present the main findings. 26 ATLANTIC COUNCIL APPENDIX C THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table C2.1: Economic Impact of Removing Cross-Border Spending in the United States (2022) Impact Employment Labor Income Value Added Output 1 - Direct 2 - Indirect 3 - Induced -60,619.16 -$1,812,022,814.56 -$2,765,047,740.91 -$5,036,142,293.41 -21,166.07 -$1,234,825,927.30 -$1,980,607,178.46 -$4,118,866,436.04 -18,648.05 -$977,441,701.68 -$1,771,486,445.19 -$3,177,688,817.94 -100,433.29 -$4,024,290,443.54 -$6,517,141,364.56 -$12,332,697,547.38 Source: The Hunt Institute for Global Competitiveness and the COLEF, using IMPLAN. As shown on Table C2.1, removing cross-border spending by noncommercial crossers results in approximately 100,433 fewer jobs in the United States. Approximately 60 percent of this job loss is directly caused by reduced expenditure. The remaining 40 percent is due to indirect and induced effects. Removing cross border spending would also result in a loss of $12,332,697,547 in economic output. Approximately 41 percent of this output loss is explained by the direct effects of reducing expenditures and 59 percent by indirect or induced effects. Table C2.2 includes the top five most impacted industries in terms of output lost due to the reduction in cross-border spending by noncommercial crossers. As expected, these industries are concentrated in areas where tourists or temporary visitors would likely spend money. The three sectors with the largest output loss include retail, full-service restaurants, and general merchandise. As such, the entire output loss within these industries was due to sectoral linkages with other areas experiencing direct impacts. IMPLAN results in Table C2 can be combined with the regression results in Appendix B to determine the economic impact of reducing noncommercial border wait times. The research team divided the total output loss resulting from eliminating noncommercial crossings by the total number of crossers in 2019, 87,812,443.39 This yields a value of $140.44 which can be interpreted as the output loss associated with losing one noncommercial crosser or the output gain associated with one additional noncommercial crosser. Table C2.2: Top Five Industries with Reductions in Economic Output from Removing Cross-Border Spending in the United States (2022) Impact 1 - Direct 2 - Indirect 3 - InducedImpact output Industry display Impact output Impact output Impact output Retail: Clothing and ccessories -$2,161,062,814.49 -$707,698.49 -$23,321,554.17 -$2,185,092,067.16 Other real estate services $0.00 -$740,224,149.66 -$130,392,264.37 -$870,616,414.03 Full service restaurants -$713,075,639.37 -$28,572,142.09 -$65,051,510.06 -$806,699,291.52 General merchandise -$575,957,329.13 -$2,040,513.78 -$36,955,115.99 -$614,952,958.90 Management $0.00 -$397,735,328.22 -$56,187,767.71 -$453,923,095.93 1 2 3 4 5 Source: The Hunt Institute for Global Competitiveness and the COLEF, using IMPLAN. 27 ATLANTIC COUNCIL APPENDIX D THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX D: DESCRIPTION OF THE INPUT-OUTPUT AND QUEUING MODELS Appendix D1: The queueing model This study uses a queuing model to evaluate how wait times for commercial vehicles at the US-Mexico border affect Mexican exports to the United States. A queueing model mathematically describes a queuing system, making specific assumptions about the probabilistic nature of the number and type of servers (commercial vehicles), the arrival and service processes (border processing rates), and the queue discipline and organization. For this study, this can be described as: E'j,t = E'j,0- ∆ %(λ-μ)αj ∑ E'j,0 (1) Where; E'j,t = commercial vehicles processed per hour at t ≥1. E'j,0 = commercial vehicles processed per hour at t=0. λ = the average number of commercial vehicles arriving per hour.40 μ = the average number of commercial vehicles dispatched per hour.41 α = the share of sectoral exports in total exports per hour (E'j,0 / ∑ E'j,0). ∑ E'j,0 = the total number of commercial vehicles per hour in the economy. The E'j,0 vector also serve as a measure of Mexican exports, given that commercial vehicles entering the United States are loaded with Mexican goods. In equation (1), the assigned volume is the number of commercial vehicles arriving at a border checkpoint every hour (λ), while the volume processed is the processing capacity of the checkpoint per hour (μ). To conduct the queuing analysis, these two variables must be known beforehand. Appendix D3 shows how they were defined. Besides the variables λ and μ, the queuing model considers other key variables, including the value of exports transported by commercial vehicles and the number of lanes in operation. The former was determined using data from the US Department of Transportation’s Bureau of Transportation Statistics (see Appendix C1), and the latter with data from CBP. Additionally, this study considers the system in its steadystate of operation, i.e., during time intervals when λ and μ behave normally. This means that anomalous states of operation are removed from the analysis (such as the first 30 minutes in the workday when personnel perform preparatory activities). As equation (1) shows, when the volume of commercial vehicles in the system is processed immediately [(λ-μ) = 0], there would be no queues. As a result, wait times would be insignificant, and the value of Mexican exports entering the United States in commercial vehicles would be E'j,0. However, when the assigned volume of commercial vehicles is greater than the volume of vehicles processed [(λ-μ) > 0], a queue forms, leading to increased wait times and reducing the number of commercial vehicles crossing the border with Mexican export goods (reducing E'j,t). This calculation produces approximate wait times, which are sufficiently accurate to understand the overall distribution of traffic between land ports of entry across the US-Mexico border. Once approximate wait times are established, it is important to verify the model’s validity. Using a chi-square goodness of fit test, the observed distribution of the variables λ and μ is compared with their theoretical distribution, demonstrating the degree of adjustment between the sample (the average service rate for one checkpoint) and the population (the average service rate for all checkpoints across the US-Mexico border). This hypothesis test concludes, with a certain degree of statistical significance, that the sample in this study is representative of the full population. 28 ATLANTIC COUNCIL APPENDIX D THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix D2: Intersectoral input-output model Input-output models are a form of macroeconomic analysis based on the interdependencies (the flow of goods and services) between different economic sectors. They are commonly used to estimate the impacts of positive or negative economic shocks and their ripple effects throughout an economy. This study uses an input-output model to determine how increased Mexican exports stemming from reduced border wait times (previously established using a queuing model; see Appendix D1) affect aggregate demand in Mexico (calculated as aggregate demand = C + I + G + Nx, where: C = consumer spending; I = private investment and corporate spending; G = government spending; and Nx = net exports (exports minus imports). Economic sectors respond to increases in aggregate demand directly by supplying final goods (increasing output) or indirectly by producing intermediate goods for sectors that respond directly (increasing intermediate sales). Therefore, findings are then used to calculate the impact on total gross output and intermediate sales across sectors of the Mexican economy. Equation (2) estimates the impact of increased demand for Mexican exports on output per sector: Xj,0= (I-A)-1Yj,0 (2) Where: Xj,0 = the total gross output vector per sector at t=0. (I-A)-1 = the Leontief inverse (or the matrix of indirect and direct multipliers). In which I = identity matrix and A = technical coefficient matrix. Yj,0 = the aggregate demand vector per sector at t=0. Therefore, equation (2) could be re-written as: Xj,0= (I-A)-1E'j,0 (3) Where: E'j,0 = the exports vector per sector at t=0. As discussed in Appendix D1, E'j,0 can be interpreted as “commercial vehicles processed by the customs system every hour” and equation (3) expressed as: Xj,t = (I-A)-1E'j,t (4) Where E'j,0 = commercial vehicles processed per hour at t ≥ 1. This interpretation makes two assumptions: (a) that the system operates at full capacity and (b) that the volume of commercial vehicles in the system is processed immediately [(λ-μ) = 0], resulting in no wait times (see Appendix D1). In other words, the input-output model is static. However, this is not always the case, given that commercial vehicle arrivals and departures to and from border checkpoints do not happen at fixed intervals (they are uncertain). Therefore, by incorporating specific trajectories describing the behavior of E'j,t (changes to the number of commercial vehicles processed by customs checkpoints due to reduced wait times), the static input output model can be used to estimate the impact of increased Mexican exports on total gross output per sector. This is calculated with the equation: Lj,t = ∑ [Xj,t+Xj,0] (5) Where: Lj,t = the impact on total gross output. Xj,0 = the total gross output vector per sector at t=0 (before reduced wait times and no changes to E'j,0). Xj,t = the total gross output vector per sector at t ≥1 (after reduced wait times and changes to E'j,t). j = 1- n sectors. 29 ATLANTIC COUNCIL APPENDIX D THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix D3: Establishing the assigned volume and processing rate of commercial vehicles Estimating the average processing capacity of a port of entry requires data on the volume of commercial vehicles serviced and the number of lanes, hours, and days in operation for that port of entry. For land ports of entry across the US-Mexico border, these data were obtained from the Bureau of Transportation Statistics’ Border Crossing Data.42 Table D3 shows data for the Otay Mesa port of entry in Baja, California, the third-busiest on the US-Mexico border.43 The Otay Mesa example helps to illustrate how processing capacity was calculated for other ports of entry as part of this study. On average, one lane in the Otay Mesa port of entry operates 65 hours per week. Together, its ten lanes would operate 650 hours per week, meaning that, together, the lanes of the Otay Mesa port of entry operate for approximately 33,800 hours in one year (52 weeks). Given that 962,577 commercial vehicles are serviced per year, a total of 18,511 trucks would cross the border weekly. For one lane, this translates to 1,851 trucks per week, 370 per day, and 28.5 per hour. Having established the number of commercial vehicles serviced per hour (28.5 vehicles), an M/M/1 queue was simulated (see Appendix D1) to estimate the average processing capacity (μ), showing that border wait times for commercial vehicles are approximately 21.5 minutes.44 Enhanced border management practices and the implementation of new technologies would improve the processing capacity of ports of entry, reduce commercial wait times, and allow more Mexican exports to enter the United States. This would boost total gross output, aggregate demand, and intermediated sales across various sectors in the Mexican economy, as well as employment and labor income (see Appendices F and G for input-output analysis results). Table D3: Data for the Otay Mesa Port of Entry Item Value Total number of commercial vehicles serviced per year Hours in operation per day Days in operation per week Maximum number of lanes in operation 962,577 13 5 10 FUENTE: Cálculos propios con base en Información procedente de <https://bwt.cbp.gov/> y <Border Crossing/Entry Data - Bureau of Transportation Statistics 30 ATLANTIC COUNCIL APPENDIX E THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX E: DATA USED FOR THE ANALYSIS This study relied on the North American Industry Classification System (NAICS) and the Sistema Automatizado de Información Censal (ACIS or Automated Census Information System) to further understand Mexico’s productive sector and commercial relationship with the United States. It also used data from the Instituto Nacional de Estadística y Geografía (INEGI or the National Institute of Statistics and Geography). The NAICS, jointly developed by the US Economic Classification Policy Committee, INEGI, and Statistics Canada, classifies North American business statistics, allowing for a high level of comparability between economic activities in the United States, Mexico, and Canada. The sectors shown in Table E1, classified by NAICS in 2018, were used for this study. The INEGI used data from economic censuses in Mexico, systematized in the ACIS,45 to produce an input-output matrix46 for the Mexican economy in 2013. It then used a RAS method to estimate a matrix for 2018.47 The 2018 matrix was used as part of this study to determine the top ten Mexican sectors exporting to the United States, which were later used in the intersectoral input output analysis described in Appendix D2. Results on the economic impact of reduced border wait times on sectoral output, aggregate demand, and intermediate sales appear in Appendix F2. Additionally, the 2018 input-output matrix and vectors for employment and labor income in Mexico were used to estimate how reduced commercial wait times affect employment and labor income, as shown in Appendix G. The vectors were calculated using data from the ACIS. Table E: Sectoral Classification of the North American Industry Classification System (NAICS) (2018) NAICS Code Sector 11 Agriculture, animal breeding and exploitation, forestry, fishing and hunting 21 Mining 22 Electric power generation, transmission and diffusion, water and gas supply through pipelines to final consumers 23 Construction 31-33 Manufacturing industries 43 Wholesale trade 46 Retail trade 48-49 Transportation, postage, and warehousing 51 Mass media information 52 Financial and insurance services 53 Real estate and rental services of personal and intangible property 54 Professional, scientific, and technical services 55 Corporate 56 Business support services and waste and residue management and remediation services 61 Educational services 62 Health and social welfare services 71 Cultural, sports, and other recreational services 72 Temporary accommodation services and food and beverage preparation services 81 Other services, except government activities. 93 Legislative, governmental, law enforcement, and international and extraterritorial organization activities SOURCE: The Colegio de la Frontera Norte using the 2018 sectoral classification of the NAICS 31 ATLANTIC COUNCIL APPENDIX F THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX F: ECONOMIC IMPACT ANALYSIS OF BORDER CROSSINGS This study first established a baseline of Mexican exports to the United States without reduced wait times, which allowed for the determination of the top ten sectors exporting to the United States and the effect that exports have on sectoral output in Mexico. Then, an analysis with reduced border wait times was conducted, and baseline results were compared with new findings to determine the relative and absolute variation in sectoral output, aggregate demand, and intermediate sales stemming from reduced wait times. The values in all Appendix F tables appear in 2018 US dollars, using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results have yet to be adjusted to 2022 values, using inflation and consumer price index (CPI) historical data from the United States. Appendix F1: Analysis without reduced border wait times Assessing the economic impact of a one-minute reduction in border wait times requires understanding the US-Mexico commercial relationship and how it drives sectoral output in Mexico. As shown in Figure F1, ten sectors produced 99.86 percent of total Mexican exports to the United States in 2018. Therefore, this study considers these ten sectors. Figure F1: Top Ten Mexican Sectors in Terms of Exports to the United States (2018) • 31-33 - Manufacturing 0.82% • 43 - Wholesale trade • 21 - Mining • 48-49 - Transportation, postage, and warehousing • 46 - Retail trade • 11 - Agriculture, animal breeding and exploitation, forestry, fishing, and hunting • 52 - Financial and insurance services • 22 - Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers • 51 - Mass media information • 54 - Professional, scientific, and technical services SOURCE: In-house, prepared using 2018 using data obtained from INEGI (2022). 1.92% 3.97% 6.30% 6.81% 16.80% 0.05% 0.05% 0.02% 63.24% 32 ATLANTIC COUNCIL APPENDIX F THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER The input-output analysis was employed to estimate the baseline output per sector driven by Mexican exports to the United States, using equation (3) in Appendix D2 [Xj,0 = (I-A)-1E'j,0]. Table F1 includes results in relative and absolute terms, showing that, on average, Mexican exports to the United States drive 38 percent of total gross output per sector in Mexico. Table F1: Total Gross Output (TGO) Driven by Mexican Exports to the United States (2018)48 NAICS classification code Sector Total Percentage 21 Mining 976,753.75 68.91% 31-33 Manufacturing 9,992,494.79 68.79% 43 Wholesale trade 1,724,997.69 63.26% 11 Agriculture, animal breeding and exploitation, forestry, fishing, and hunting 630,344.07 50.86% 22 Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers 234,304.63 31.91% 48-49 Transportation, postage, and warehousing 682,499.14 27.21% 54 Professional, scientific, and technical services 155,642.26 26.37% 46 Retail trade 477,034.24 17.72% 52 Financial and insurance services 185,136.92 13.40% 51 Mass media information 79,296.98 12.22% Total 15,138,504.47 380.65% Average 1,513,850.45 38.07% SOURCE: In-house, prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 33 ATLANTIC COUNCIL APPENDIX F THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix F2: Analysis with reduced wait times A second input-output analysis was performed to determine how the positive economic shock (increased Mexican exports caused by reduced border wait times) affected total gross production per sector (Xj,t). This is estimated using equation (4) in Appendix D2 [Xj,t= (I-A)-1E'j,t], where E'j,t is the exports vector and j the number of sectors. Given the interdependencies between sectors, the economic impact of reduced border wait times spreads throughout productive sectors in the Mexican economy. Therefore, results show the average percentage increase in output, aggregate demand, and final sales per sector driven by additional Mexican exports to the United States (caused by a one-minute reduction in border wait times). Table F2.1 shows findings in terms of total gross output, while Tables F2.2 and F2.3 include results for aggregate demand and intermediate sales, respectively. NAICS Table F2.1: Growth in Total Gross Output (TGO)49 Total Gross Output Classification Sectors code Absolute (TGO) Change driven by Mexican exports Percentage increase 11 Agriculture, animal breeding and exploitation, forestry, fishing, and hunting 61,870,394,408.39 63,525,716,328.93 2.68% 21 Mining 70,768,853,919.12 73,333,868,768.35 3.62% 22 Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers 36,661,826,110.83 37,277,124,334.51 1.68% 31-33 Manufacturing industries 725,175,223,165.25 751,416,123,114.45 3.62% 43 Wholesale trade 136,148,265,851.22 140,678,214,854.59 3.33% 46 Retail trade 134,388,874,388.42 135,641,595,360.59 0.93% 48-49 Transportation, postage, and warehousing 125,222,060,808.79 127,014,345,127.69 1.43% 51 Mass media information 32,404,278,182.73 32,612,516,876.33 0.64% 52 Financial and insurance services 68,962,248,726.91 69,448,429,551.32 0.70% 54 Professional, scientific, and technical services 29,468,317,923.12 29,877,043,990.12 1.39% Average 142,107,034,348.48 146,082,497,830.69 2.00% SOURCE: In-house, prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 34 ATLANTIC COUNCIL APPENDIX F NAICS THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table F2.2: Growth in intermediate sales50 Intermediate Sales Classification Sectors code Absolute intermediate sales Change driven by Mexican exports Percentage increase 11 Agriculture, animal breeding and exploitation, forestry, fishing, and hunting 37,715,987,831.23 39,017,404,257.82 3.45% 21 Mining 38,319,742,304.75 39,627,221,214.17 3.41% 22 Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers 26,093,440,432.45 26,698,820,186.23 2.32% 31-33 Manufacturing industries 500,578,423,695.96 515,136,851,491.74 2.91% 43 Wholesale trade 50,588,439,711.28 52,014,146,106.25 2.82% 46 Retail trade 20,372,948,351.47 20,891,889,251.96 2.55% 48-49 Transportation, postage, and warehousing 27,507,131,659.31 28,135,165,832.62 2.28% 51 Mass media information 14,218,572,797.10 14,418,468,679.28 1.41% 52 Financial and insurance services 23,171,318,014.63 23,506,746,665.51 1.45% 54 Professional, scientific, and technical services 27,550,006,467.55 27,955,133,873.68 1.47% Average 76,611,601,126.57 78,740,184,755.93 2.41% SOURCE: In-house, prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). Table F2.3: Growth in final demand51 NAICS Classification Sectors Final demand code Absolute aggregate demand Change driven by Mexican exports Percentage increase 11 Agriculture, animal breeding and exploitation, forestry, fishing, and hunting 24,154,406,577.15 24,508,312,071.11 1.47% 21 Mining 32,449,111,614.37 33,706,647,554.19 3.88% 22 Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers 10,568,385,678.38 10,578,304,148.28 0.09% 31-33 Manufacturing industries 224,596,799,469.30 236,279,271,622.71 5.20% 43 Wholesale trade 85,559,826,139.94 88,664,068,748.35 3.63% 46 Retail trade 114,015,926,036.95 114,749,706,108.63 0.64% 48-49 Transportation, postage, and warehousing 97,714,929,149.48 98,879,179,295.07 1.19% 51 Mass media information 18,185,705,385.62 18,194,048,197.05 0.05% 52 Financial and insurance services 45,790,930,712.28 45,941,682,885.81 0.33% 54 Professional, scientific, and technical services 1,918,311,455.57 1,921,910,116.43 0.19% Average 65,495,433,221.90 67,342,313,074.76 1.67% SOURCE: In-house, prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 35 ATLANTIC COUNCIL APPENDIX G THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX G: ECONOMIC IMPACT ON EMPLOYMENT AND LABOR INCOME Appendix G1: Employment The effect of a 10-minute reduction in commercial wait times on direct employment in Mexico was estimated using the multiplier: l= LT [diag(X)-1] (6) Where: l = the direct employment coefficient LT = the employment generated per sector52 [diag(X)-1] = the diagonal matrix of total gross output (obtained via the input-output model) To assess the impact on direct and indirect employment, the direct employment coefficient (l) is multiplied by the Leontief inverse: MED-1 = l[(I-A)-1] (7) Table G1 shows the original jobs per sector and the new jobs created as a result of increased exports following a 10-minute reduction in commercial wait times. It also includes the difference between these two values and the relative increase and net variation in employment. Results show that 18,697 jobs would be created in one year. NAICS Classification code Table G1: Impact on Direct and Indirect Employment of a More Efficient US-Mexico Border Sectores Original New Difference Relative Increase Net Variation 11 Agriculture, animal breeding and ex ploitation, forestry, fishing, and hunting 5.9 6.6 0.7 0.3% 748.2 21 Mining 5.9 8.1 2.2 1.2% 2,220.1 22 Electric power generation, transmis sion and diffusion, and water and gas supply through pipelines to final consumers 7.4 7.5 0.1 0.1% 129.3 31-33 Manufacturing industries 13.6 12.8 -0.8 0.0% -793.1 43 Wholesale trade 8.4 11.6 3.2 0.2% 3,216.0 46 Retail trade 24.7 26.4 1.7 0.0% 1,748.8 48-49 Transportation, postage, and ware housing 10.3 10.1 -0.2 0.0% -210.3 51 Mass media information 12.0 15.7 3.7 1.0% 3,684.5 52 Financial and insurance services 10.1 15.6 5.5 0.8% 5,505.5 54 Professional, scientific, and technical services 18.6 21 2.4 0.3% 2,448.6 Total 116.9 135.4 18.5 3.9% 1,8697.6 Average 11.7 13.5 1.9 0.4% 1,869.8 SOURCE: In-house prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 36 ATLANTIC COUNCIL APPENDIX G THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix G2: Labor income The effect of a 10-minute reduction in commercial wait times on labor income in Mexico was estimated using a two-step process. First, the labor income coefficient was determined with the equation: r= RemT [diag(X)-1] (8) Where: r = the labor income coefficient RemT = the labor income per sector 53 [diag(X)-1] = the diagonal matrix of total gross output Second, the labor income coefficient (r) was multiplied by the Leontief inverse: MRemD-1 =r[(I-A)-1] (9) Table G2 shows the direct and indirect effects on labor income of increased Mexican exports to the United States stemming reductions in commercial wait times. It includes labor income per sector before reduced wait times (original), labor income after reduced wait times (new), the difference between these two values, and the relative increase and net variation in labor income. Results show that, overall, labor income would increase by $17,474 with a one-minute reduction in border wait times or $174,474 with a ten minute reduction. NAICS Table G2: Impact on Labor Income of a More Efficient US-Mexico Border One-minute 10-minute Relative Classification code Sector Original New Difference reduction in wait times reduction in wait times weight Agriculture, animal breeding and exploita tion, forestry, fishing, and hunting 0.04 0.05 0.01 $ 324.72 $3,247.21 Mining 0.10 0.15 0.05 $ 2,643.81 $26,438.14 Electric power genera tion, transmission and diffusion, and water and gas supply through pipe lines to final consumers 0.08 0.09 0.01 $ 711.73 $7,117.31 Manufacturing industries 0.14 0.15 0.01 $ 467.19 $4,671.91 Wholesale trade 0.08 0.16 0.08 $ 3,852.29 $38,522.90 Retail trade 0.09 0.13 0.04 $ 1,766.03 $17,660.32 Transportation, postage, and warehousing 0.10 0.10 0.00 $ (89.37) $(893.65) Mass media information 0.17 0.23 0.06 $ 2,895.81 $28,958.10 Financial and insurance services 0.16 0.23 0.07 $ 3,574.24 $35,742.39 Professional, scientific, and technical services 0.14 0.17 0.03 $ 1,327.86 $13,278.59 Total $ 17,474.32 $174,743.23 111.9% 21 15.1% 224.1% 31-33 2.7% 43 22.0% 46 10.1% 48-49 -0.5% 51 16.6% 52 20.5% 54 7.6% Average $ 1,747.43 $17,474.32 SOURCE: In-house prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 37 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Acknowledgments This report was informed by roundtables, focus groups, and consultations carried out in the United States and Mexico and the analysis of economic data. We thank the many individuals and institutions who participated in project activities and research efforts. It was a true pleasure to work with our partners at the University of Texas at El Paso’s (UTEP’s) Hunt Institute for Global Competitiveness and Colegio de la Frontera Norte (COLEF). We are deeply grateful to the Adrienne Arsht Latin America Center (AALAC) team, who worked tirelessly to produce this report, particularly to Camila Hernández and Ignacia Ulloa, who provided invaluable writing and editorial support. Thank you to Jason Marczak, senior director for AALAC, and Maria Fernanda Bozmoski, deputy director for programs, for their guidance and editorial support. We thank AALAC Non-Resident Fellow Bosco Martí and the Global Nexus team, specifically Ruben Olmos, Ana Margarita Martínez, and Alejandro Vales, for providing crucial expertise and contributions. Our gratitude extends to Rhonda Shore for her diligent editorial work and to Donald Partyka and Anais Gonzalez for their exceptional design skills. Most importantly, we thank the US Department of State’s Bureau for International Narcotics and Law Enforcement Affairs for giving the Atlantic Council, UTEP, and COLEF the opportunity to produce this report in service of daily border users and strengthening the US and Mexican economies. 38 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Endnotes 1 Government of the United States, “Trade in Goods with Mexico,” US Census Bureau, accessed August 16, 2022, https://www.census.gov/foreign-trade/balance/c2010.html; and Government of the United States, “Monthly U.S. International Trade in Goods and Services, June 2022,” US Census Bureau and US Department of Commerce, August 4, 2022, https://www.census.gov/foreign-trade/Press-Release/current_press_release/ft900.pdf. 2 Government of the United States, “Overview of US- North American Freight by Port, Commodity Group, and Mode - Value (in Millions),” US Department of Transportation, accessed August 16, 2022, https://explore.dot.gov/views/Dashboard_PortbyCommodity/Overview?%3Aembed=y&%3Aiid=1&%3AisGuestRedirectFromVizportal=y. 3 Government of Mexico, “US-Mexico Trade Relation,” Embassy of Mexico to the United States of America, Section of Economic Affairs, February 2022, https://embamex.sre.gob.mx/eua/images/stories/economicos/2022/documents/US-MX_Trade_Website_02-2022.pdf. 4 Government of Mexico, Secretariat of Foreign Affairs, Embassy of Mexico to the United States of America, Office of Political Affairs. Information acquired September 8, 2022. 5 Government of the United States, “Mexico: US-Mexico Trade Facts,” Office of the US Trade Representative, accessed August 14, 2022, https://ustr.gov/countries-regions/americas/mexico. 6 Joint Statement by President Biden and President Lopez Obrador, The White House, July 12, 2022, https://www.whitehouse.gov/briefing-room/statements-releases/2022/07/12/president-biden-and-president-lopez-obrador-joint-statement/. 7 The US-Mexico High-Level Economic Dialogue is an opportunity for Mexico and the United States to advance strategic economic and commercial priorities to foster economic development and growth, job creation, and global competitiveness and reduce poverty and inequality. 8 Government of the United States, “Mexico: US-Mexico Trade Facts,” US Trade Representative, accessed August 16, 2022, https://ustr.gov/countries-regions/americas/mexico. 9 Zahniser, Stephen. “COVID-19 Working Paper: U.S.-Mexico Agricultural Trade in 2020,” United States Department of Agriculture, Economic Research Service. January, 2022. 10 Michoacán, Mexico, exports approximately 80 percent of its avocado supply directly to the United States. Government of the United States, “Fresh Avocado Imports from Mexico Resume,” Animal and Plant Inspection Service, United States Department of Agriculture, accessed August 20, 2022. https://www.aphis.usda.gov/aphis/newsroom/stakeholder-info/sa_by_date/sa-2022/avocado-imports-mexico. 11 Ibid 12 Government of the United States, “Hourly Wait Times Trends vs Current,” Customs and Border Protection, accessed August 17, 2022, https://bwt.cbp.gov/details/09250401/POV. 13 Unified Cargo Processing is a program for joint inspection of northbound cargo via free and secure trade lanes. John Davis, “U.S. and Mexico United in Cargo Processing,” US Customs and Border Protection, last modified January 4, 2022, https://www.cbp.gov/frontline/cargo-processing.. 14 Global Entry and the Secure Electronic Network for Travelers Rapid Inspection are risk-based programs that allow expedited clearance for pre-approved, low-risk travelers upon arrival in the United States. Government of the United States, “Global Entry: Trusted Traveler Program Enrollment,” US Customs and Border Protection, last modified September 6, 2022, https://www.cbp.gov/travel/trusted-traveler-programs/global-entry; and Government of the United States, “Secure Electronic Network for Travelers Rapid Inspection,” US Customs and Border Protection, last modified January 4, 2022, https://www.cbp.gov/travel/trusted-traveler-programs/sentri. 15 The Customs Trade Partnership Against Terrorism is a voluntary supply chain security partnership used by the public and private sectors. Government of the United States, “CTPAT: Customs Trade Partnership Against Terrorism,” US Customs and Border Protection, last modified August 29, 2022, https://www.cbp.gov/border-security/ports-entry/cargo-security/CTPAT. 16 “SENTRI Program Requirements,” Immigration Passport Visa Service, accessed August 17, 2022, http://immigrationpassportvisa.com/travel/sentri-pass program-requirements/#:~:text=Over%20175%2C000%20US%20citizens%20and%20Mexican%20citizens%20have%20become%20card%20holders. 17 The Maquiladora Export Industry is a conglomerate of intermediate-good manufacturing companies. 18 According to the North American Industry Classification System (NAICS), a classification scheme for Mexican productive activities that dates to 1993 and collects information on businesses, households, and individuals. In the development of this study, the consortium also referred to the Automated Census Information System (ACIS), which allowed for adjustments and specifications of data. For additional information on NAICS and ACIS, see Appendix G. 19 Vehicle and Cargo Inspection System (VACIS) and Federal Motor Carrier Safety Administration (FMCSA). 20 The Interagency Border Inspection System is a computer-based system that provides law enforcement access to drivers’ criminal records and other information used to screen vehicles crossing the border. 21 Border users were consulted during roundtables hosted by the Atlantic Council. The first took place on May 10, 2022, in El Paso, Texas, in collaboration with the Hunt Institute for Global Competitiveness at the University of Texas at El Paso. The second occurred on July 12, 2022, in Tijuana, Mexico, in collaboration with El Colegio de la Frontera Norte. 22 According to research by the Hunt Institute for Global Competitiveness, 4,720,967 container trucks crossed the border in 2021. 23 A 10-minute reduction in commercial wait times would allow $25,879,549 million, specifically in additional cargo value, to enter the United States monthly. See Appendix C1 for more information. 24 This section focuses on crossings by individuals and families in noncommercial vehicles alone. Migrant caravans at the US-Mexico border disrupted standard pedestrian crossing patterns during the sample period, preventing the analysis of pedestrian traffic using the regression model described in Appendix B. Further research is needed to estimate the economic impact of additional pedestrian crossings following a reduction in border wait times. 25 Per Table 2, these purchases generated an economic impact of $12,332,697,547 for the US economy. The economic impact of cross-border spending was determined by mapping out expenditure categories and running INPLAN’s multi-region input-output feature. 26 Given the nature of available data for the input-output analysis (macroeconomic data from Mexico’s National Institute of Statistics and Geography (INEGI), which captures the commercial relationship between the United States and Mexico), this section exclusively focuses on commercial crossings from Mexico into the United States. The economic impact for Mexican families and workers was estimated by considering how changes in the US-Mexico commercial relationship affect employment and labor income. 27 Government of the United States, “U.S.-Mexico Trade Relations,” Congressional Research Service, updated April 25, 2021, https://sgp.fas.org/crs/row/IF11175.pdf. 28 The ten sectors are mining; manufacturing; wholesale trade; agriculture, animal breeding and exploitation, forestry, fishing, and hunting; electric power generation, transmission and diffusion, and water and gas supply; transportation, postage, and warehousing; professional, scientific, and technical services; retail trade; financial and insurance services; and mass media information. 29 “U.S.-Mexico Trade Relations,” Congressional Research Service. https://sgp.fas.org/crs/row/IF11175.pdf 30 “México supera a Japón y lidera por primera vez envíos de autos a Estados Unidos” (“Mexico surpasses Japan and leads car shipments to the United States for the first time”), El Economista, September 5, 2022, https://dfsud.com/america/mexico-supera-a-japon-y-lidera-por-primera-vez-envios-de-autos-a-estados. 31 See Appendix C1. 32 As described in the report, the regression analysis did not include pedestrian crossings due to the impact of migrant caravans during the period under study. 39 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER 33 Missing data was excluded from averages. 34 The correlation between wait times and crossings is 0.2977. This is likely because congestion at the border may result in both increased wait times and a higher number of crossings. 35 The sample ends prior to 2020 to avoid disruptions in border crossings due to COVID-19. See Appendix A for a detailed description of the data. 36 The fixed effect, i, accounts for time-constant heterogeneity between counties in the analysis. Estimating the regression equation by fixed effects removes this time-constant heterogeneity, effectively controlling for the immutable differences between counties. 37 Spending categories include clothing, general merchandise, auto parts, groceries, electronics, restaurants, gas, sports and music, building, furniture, personal care services, fast food, health, business and other professional services, amusement and recreation, accommodation, bar, theater, transportation and parking, and other products. 38 The sixteen counties used in the analysis were El Paso, Presidio, Val Verde, Maverick, Webb, Starr, Hidalgo, Cameron, Luna, Dona Ana, Yuma, Pima, Santa Cruz, Cochise, San Diego, and Imperial. 39 The total number of crossers was determined using data from the Bureau of Transportation Statistics. 40 This could also be the average arrival rate. 41 This could also be the average service rate. 42 Government of the United States, “Bureau of Transportation Statistics: Border Crossing/Entry Data,” US Department of Transportation, accessed August 18, 2022, https://www.bts.gov/browse-statistical-products-and-data/border-crossing-data/border-crossingentry-data#:~:text=Border%20 crossing%20data%20are%20collected,comparable%20data%20on%20outbound%20crossings.. 43 Scott Mall, “FreightWaves Classics: Otay Mesa Land Port is third-busiest on U.S.-Mexico border,” Freightwaves, May 12, 2021, https://www.freightwaves.com/news/freightwaves-classics-otay-mesa-land-port-is-third-busiest-on-us-mexico-border. 44 Ports of entry with extremely atypical wait times (anomalies) were disregarded in this paper’s analysis. 45 The ACIS systematizes information from Mexico’s four most recent economic censuses, which occurred in 2019, 2014, 2009, and 2004. 46 An input-output matrix represents national or regional economic accounting that records how industries trade with one another and produce for consumption and investments. 47 The RAS method is an interactive method for data reconciliation. It scales an input-output table bi-proportionally to achieve consistency between given row and column sums. For a detailed description of the methodology used by INEGI, see “Matrices de Contabilidad Social de México: Fuentes y metodología,” INEGI, accessed August 18, 2022, https://inegi.org.mx/contenidos/investigacion/mcsm/doc/fuente_y_metodologia.pdf. 48 Originally in 2018 Mexican pesos and converted to US dollars using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results are in 2018 values. 49 Originally in 2018 Mexican pesos and converted to US dollars using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results are in 2018 values. 50 Originally in 2018 Mexican pesos and converted to US dollars using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results are in 2018 values. 51 Originally in 2018 Mexican pesos and converted to US dollars using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results are in 2018 values. 52 Total employment per sector was obtained from INEGI, using 2018 data. 53 Total labor income per sector was obtained from INEGI, using 2018 data in Mexican pesos (millions). 40 ATLANTIC COUNCIL CHAIRMAN John F.W. Rogers EXECUTIVE CHAIRMAN EMERITUS James L. Jones PRESIDENT ANDCEO Frederick Kempe EXECUTIVE VICE CHAIRS Adrienne Arsht Stephen J. Hadley VICE CHAIRS Robert J. Abernethy C. Boyden Gray Alexander V. Mirtchev TREASURER George Lund DIRECTORS Todd Achilles Timothy D. Adams Michael Andersson David D. Aufhauser Barbara Barrett Colleen Bell Stephen Biegun Linden P. Blue Adam Boehler John Bonsell Philip M. Breedlove Myron Brilliant Esther Brimmer Richard R. Burt Teresa Carlson James E. Cartwright John E. Chapoton Ahmed Charai Melanie Chen Michael Chertoff George Chopivsky Wesley K. Clark Helima Croft Ankit N. Desai Dario Deste Paula J. Dobriansky Joseph F. Dunford, Jr. Richard Edelman Thomas J. Egan, Jr. Stuart E. Eizenstat Mark T. Esper Michael Fisch Alan H. Fleischmann Jendayi E. Frazer Meg Gentle Thomas H. Glocer John B. Goodman Sherri W. Goodman Jarosław Grzesiak Murathan Günal Frank Haun Michael V. Hayden Tim Holt Karl V. Hopkins Kay Bailey Hutchison Ian Ihnatowycz Mark Isakowitz Wolfgang F. Ischinger Deborah Lee James Joia M. Johnson Safi Kalo Andre Kelleners Brian L. Kelly Henry A. Kissinger John E. Klein C. Jeffrey Knittel Joseph Konzelmann Franklin D. Kramer Laura Lane Almar Latour Yann Le Pallec Jan M. Lodal Douglas Lute Jane Holl Lute William J. Lynn Mark Machin Umer Mansha Marco Margheri Michael Margolis Chris Marlin William Marron Christian Marrone Gerardo Mato Timothy McBride Erin McGrain John M. McHugh Judith A. Miller Dariusz Mioduski Michael J. Morell Richard Morningstar Georgette Mosbacher Majida Mourad Dambisa F. Moyo Virginia A. Mulberger Mary Claire Murphy Edward J. Newberry Franco Nuschese Joseph S. Nye Ahmet M.Ören Sally A. Painter Ana I. Palacio Kostas Pantazopoulos Alan Pellegrini David H. Petraeus Lisa Pollina Daniel B. Poneman Dina H. Powell dddMcCormick Michael Punke Ashraf Qazi Thomas J. Ridge Gary Rieschel Lawrence Di Rita Michael J. Rogers Charles O. Rossotti Harry Sachinis C. Michael Scaparrotti Ivan A. Schlager Rajiv Shah Gregg Sherrill Jeff Shockey Ali Jehangir Siddiqui Kris Singh Walter Slocombe Christopher Smith Clifford M. Sobel James G. Stavridis Michael S. Steele Richard J.A. Steele Mary Streett Gil Tenzer Frances M. Townsend Clyde C. Tuggle Melanne Verveer Charles F. Wald Michael F. Walsh Ronald Weiser Al Williams Maciej Witucki Neal S. Wolin Jenny Wood Guang Yang Mary C. Yates Dov S. Zakheim HONORARY DIRECTORS James A. Baker, III Ashton B. Carter Robert M. Gates James N. Mattis Michael G. Mullen Leon E. Panetta William J. Perry Condoleezza Rice Horst Teltschik William H. 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Declare: "I need more provided context", when a User query implies interest in a new field or topic. Please provide an analysis of the US-Mexico border and how a more efficient border would impact the economy. Atlantic Council ADRIENNE ARSHT LATIN AMERICA CENTER The Economic Impact of aMore Efficient US-MexicoBorder How Reducing Wait Times at Land Ports of Entry Would Promote Commerce, Resilience, and Job Creation Report Contributors: Alejandro Brugués Rodríguez, John Byrd, Noé Arón Fuentes Flores, David Gaytan, John Gibson, Camila Hernández, Mayra Maldonado, Jason Marczak, Jorge Eduardo Mendoza Cota, Roberto Ransom, and Ignacia Ulloa Atlantic Council ADRIENNE ARSHT LATIN AMERICA CENTER The Atlantic Council’s nonpartisan Adrienne Arsht Latin America Center (AALAC) broadens understanding of regional transformations while demonstrating why Latin America and the Caribbean matter for the world. The center focuses on pressing political, economic, and social issues that will define the region’s trajectory, proposing constructive, results-oriented solutions to inform public sector, business, and multilateral action based on a shared vision for a more prosperous, inclusive, and sustainable future. AALAC – home to the premier Caribbean Initiative – builds consensus for action in advancing innovative policy perspectives within select lines of programing: U.S. policy in the Western Hemisphere; Colombia’s future; Venezuela’s multidimensional crisis; Central American prosperity; US-Mexico ties; China in the Americas; Brazil’s trajectory; Caribbean development; regional economic development and commerce; and energy transitions. Jason Marczak serves as the center’s senior director. This report is written and published in accordance with the Atlantic Council Policy on Intellectual Independence. The authors are solely responsible for its analysis and recommendations. The Atlantic Council and its donors do not determine, nor do they necessarily endorse or advocate for, any of this report’s conclusions. Atlantic Council 1030 15th Street NW, 12th Floor Washington, DC 20005 For more information, please visit www.AtlanticCouncil.org. ISBN-13: 978-1-61977-250-2 September 2022 A joint report by the Atlantic Council’s Adrienne Arsht Latin America Center, the University of Texas at El Paso’s Hunt Institute for Global Competitiveness, and El Colegio de la Frontera Norte. Atlantic Council ADRIENNE ARSHT LATIN AMERICA CENTER The Economic Impact of aMore Efficient US-MexicoBorder How Reducing Wait Times at Land Ports of Entry Would Promote Commerce, Resilience, and Job Creation (The first of a two-part series on the US-Mexico Border) Report Contributors: Alejandro Brugués Rodríguez, John Byrd, Noé Arón Fuentes Flores, David Gaytan, John Gibson, Camila Hernández, Mayra Maldonado, Jason Marczak, Jorge Eduardo Mendoza Cota, Roberto Ransom, and Ignacia Ulloa Table of Contents EXECUTIVE SUMMARY 6 INTRODUCTION 7 WHY INVEST IN THE US-MEXICO BORDER? 8 BORDER WAIT TIMES: A CONTINUED CHALLENGE 9 THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER 11 The United States: Increased border efficiency would strengthen the economy 12 Mexico: The potential economic gains of a more efficient border 15 CONCLUSION 17 METHODOLOGY 18 APPENDICES 19 ACKNOWLEDGMENTS 38 THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER “We know that long wait times at the border can hurt our businesses and economy, especially in my district. Ensuring our ports of entry have sufficient funding to reduce wait times is necessary to keep our economy on track and ensure businesses on both sides of the border succeed.” The Hon. Juan Vargas Representative (D-CA-51) US HOUSE OF REPRESENTATIVES “Strengthened US-Mexico collaboration at our border will unlock significant economic growth, promote supply chain resilience, and boost competitiveness, benefiting Mexican workers and families. These benefits will reverberate far beyond the border, reaching states throughout Mexico. Now is the time to invest in initiatives to create an even more efficient and secure shared border.” H.E. Luz Maria de la Mora Subsecretary of International Commerce, Secretariat of the Economy UNITED MEXICAN STATES “Our border communities rely on efficient and effective infrastructure for work, trade, tourism and other economic exchanges across the US-Mexico border. As the North American region seeks to retain its competitive global advantage, it is more important than ever for these communities to have access to top-notch ports of entry, staffing and technology. With the proper tools for border management, our border cities will be enabled to prosper now and well into the future.” The Hon. Tony Gonzales Representative (R-TX-23) US HOUSE OF REPRESENTATIVES 5 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Executive Summary Improvements in border management and the adoption of new technologies at the US-Mexico border have the potential to enhance security and generate economic benefits for the United States and Mexico through expedited flows of goods and people. Reduced border wait times would lead to more traffic entering the United States from Mexico, both in terms of commercial trucks loaded with goods for US consumers and shoppers ready to buy US goods. This report quantifies the economic impact of this additional commerce and cross-border spending, which would lead to further economic prosperity in the two countries. Research shows that a 10-minute reduction in wait times could lead to an additional $26 million worth of cargo entering the United States each month via commercial vehicles. This translates to more than $312 million in further commerce from Mexico into the United States annually. The extra inventory of finished and intermediate goods would drive down US domestic prices, creating increased economic well-being for US citizens. This report also finds that reducing border wait times by 10 minutes has a positive annual impact of $5.4 million on the US economy due to purchases by additional families and individuals entering the United States from Mexico. While the immediate effect of these purchases is most evident in border communities, economic benefits would spread to the continental United States due to the economic linkages between local economies, with approximately 25 percent of the total impact reaching non-border states. Beyond the $312 million in added commerce from Mexico into the United States, a 10-minute reduction in border wait times would promote the creation of nearly 18,700 direct and indirect jobs in Mexico, increase labor income per sector by an average of $17,474, and simulate growth for various Mexican economic sectors, particularly manufacturing, wholesale trade, and mining. More specifically, a one-minute reduction in border wait times would increase the average production (or output) per sector—for Mexico’s top ten sectors exporting to the United States—by 2 percent. This reduction in border wait times would also boost intermediate sales and aggregate demand in Mexico by 2.4 percent and 1.7 percent, respectively. These findings illustrate the economic benefits of prioritizing investments at the US-Mexico border to reduce commercial and noncommercial wait times. They are understood as the lower range of the potential national-level economic benefits of deepened US-Mexico collaboration to create a more efficient and secure border. A forthcoming second study will build on these findings, disaggregating the economic impact of reduced wait times for US and Mexican states and counties at the border and beyond. Trucks pass through the U.S. border and into the United States from Juarez, Mexico in El Paso, Texas, U.S. June 18, 2018. REUTERS/Mike Blake 6 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Introduction The US-Mexico border is a hub of cultural and commercial exchange, fostering continued growth and collaboration between the United States and Mexico. Stretching over 2,000 miles, it has more than forty-four active ports of entry, with fifteen million US and Mexican citizens residing in border counties. In July 2022 alone, the United States and Mexico traded over $65 billion in goods,1 with more than $53 billion crossing the southern border via trucks and trains.2 Approximately five million US jobs depend on trade with Mexico,3 meaning that one in every twenty-nine workers in the United States has a job created or supported by US-Mexico trade. These jobs are spread throughout the US economy in terms of geography and industries. In Mexico’s automotive sector, US-Mexico trade supports more than one million jobs directly and 4.5 million indirectly.4 In addition to importing and exporting final products, the United States and Mexico jointly produce goods. Cross-border production sharing has contributed to greater economic integration, resilience, and competitiveness while helping to insulate the US and Mexican economies from global competitors. Similarly, US-Mexico trade in services contributes to the commercial relationship, with over $62 billion traded in 2019.5 On July 12, 2022, US President Joseph R. Biden and Mexican President Andrés Manuel López Obrador met in Washington, DC, to discuss how safer and more efficient borders would enhance shared commerce.6 During their meeting, the United States committed to investing $3.4 billion and Mexico $1.5 billion to undertake major projects to modernize land ports of entry on the northern and southern borders. These efforts will create jobs, bolster shared security, and enhance supply chain resilience by promoting legitimate trade and travel. New investments should continue to enhance shared commerce while addressing long-standing efficiency and security challenges, including excessive wait times, inconsistent federal policies, outdated screening technologies, and the illicit flow of weapons, drugs, contraband, and people. Future US-Mexico cooperation should also build on prior efforts to modernize border infrastructure, expedite processing times, and implement joint production programs through accords such as the United States Mexico-Canada Agreement (USMCA). It could also prioritize new information-sharing infrastructure, shared defense strategies, bilateral-processing mechanisms, and expanded trusted traveler programs. The long-term institutionalization of standing working groups like the US-Mexico High-Level Economic Dialogue (HLED) will help the United States and Mexico align priorities and advance shared development goals moving forward—as evidenced through the joint commitments made at the September 12, 2022, HLED meeting.7 This report—the first in a two-part series—shows that US-Mexico cooperation aimed at creating a more efficient, resilient, and secure border will enhance shared commerce and economic well-being through the expedited flow of goods and people. Reduced border wait times would allow more commercial and noncommercial vehicles to enter the United States from Mexico, bolstering cross border trade and spending and stimulating competitiveness, economic integration, and job creation. This report includes national-level findings, while a second report disaggregates results by county and state, showing that investing in the US-Mexico border will pay dividends far beyond the border. 7 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Why Invest in the US-Mexico Border? The United States and Mexico rely on each other to meet their populations’ demand for goods and services. Mexico stands as one of the United States’ largest trading partners in terms of goods, ranking first in 2019 with more than $614 billion in total (two-way) goods traded that year.8 Recent disruptions to cross-border commerce illustrate this interdependence, with important economic implications for populations on both sides of the border. As COVID-19 first raged worldwide, shutting down economies in the spring of 2020, the US-Mexico border was not immune to the global lockdown. Disruptions in cross-border flows of goods and people resulted in unemployment, curtailed retail sales, and decreased revenue for the tourism industry. In Texas alone, the tourism industry lost $1.02 billion over the course of eight months of border closures. In Mexico, agricultural exports decreased 5.9 percent between March and May of 2020, with a 17.9 percent decrease in sugar exports compared to 2019.9 Avocados are another example of US-Mexico economic interdependence. Approximately nine of ten avocados in US supermarkets come from Mexico.10 In 2021 alone, the United States imported more than 1.1 million metric tons of avocados from Mexico, totaling over $2.8 billion. However, a temporary suspension of avocado imports—due to a verbal threat received by a US inspector in Michoacán—led to concerns over shortages and price increases across the United States.11 Fortunately, the eight-day suspension did not have a lasting impact on local economies or spoil the fruit waiting for export. Soon after the suspension was lifted, avocados quickly returned to US supermarkets to satisfy consumer demand. The story of COVID-related commerce disruptions and the avocado example not only illustrate the two countries’ economic interdependence but also the importance of safe and efficient borders. According to US Customs and Border Protection (CBP), the average border-crossing wait time per truck regularly surpasses 125 minutes during regular-to-peak crossing hours.12 Multiplied by the average of 19,617 trucks crossing the border daily, the lost revenue amounts to millions of dollars annually for the United States and Mexico. Cross-border spending by noncommercial entities (families and individuals) also directly impacts the US and Mexican economies. Cities along the southern border of the United States have become attractive commercial poles that draw customers from Mexico up to 75 miles (120 kilometers) away for daily consumption of goods and services. This is partly due to trade mechanisms becoming antiquated under new international trade agreements (originally designed to retain customers in local markets and supply border counties with national products) and the limitations of the Mexican domestic market, which often translates to higher prices and lower quality in goods such as food, clothing, footwear, and household equipment. The United States and Mexico have created a series of tools to expedite border crossings for pedestrians, trains, and commercial and noncommercial vehicles, including Unified Cargo Processing,13 Global Entry, Secure Electronic Network for Travelers Rapid Inspection (SENTRI),14 Customs Trade Partnership Against Terrorism,15 and other trusted traveler programs. However, these mechanisms only serve a small portion of daily border crossers, given high annual fees and other prohibitive eligibility requirements. For example, only 175,000 citizens in the United States and Mexico have become SENTRI card holders.16 Building on these and other programs is essential as US and Mexican leaders work together to tap the full economic potential of our shared border. 8 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Border Wait Times: A Continued Challenge Bottlenecks at land ports of entry along the US-Mexico border present a long-term challenge for economic integration, supply chain resilience, and competitiveness. While international production sharing programs such as the USMCA and the Maquiladora Export Industry17 have promoted mutually beneficial trade, they have contributed to border congestion by increasing the volume of vehicles requiring border inspections. Congestion and associated wait times are compounded by outdated technologies and limited information sharing within and between agencies in Mexico and the United States. Curtailing the illegal flow of weapons, drugs, contraband, and people also requires stringent and time-consuming border inspections that may lead to border delays. As shown in Figure 1, non-expedited cargo (commercial vehicles) entering the United States from Mexico undergoes a multistep inspection process. The first processing step involves examination by Mexican border agents who verify paperwork for outgoing goods, ensuring that tariffs are accurately assigned.18 Once cargo reaches US inspection booths, CBP officers first examine relevant documentation for incoming merchandise and drivers, who are then subject to automated regulation and tariff compliance reviews. At the officers’ discretion, cargo can undergo an additional canine or gamma ray inspection before being cleared for crossing. Noncommercial vehicles entering the United States from Mexico also undergo a multistep inspection process. Depending on the type of border crossing (i.e., land or bridge), vehicles could be required to pay tolls in cash or via electronic toll collection systems. Once completed, vehicles continue to US inspection points, where they can undergo up to two separate inspections. At the primary inspection booth, CBP officials verify travelers’ documentation and inquire about the purpose of their visit to the United States. If the Interagency Border Inspection System finds records of norm violation,20 CBP officers direct the vehicle toward secondary inspection. At the secondary inspection, officers conduct a thorough identity investigation, after which access to the United States is either granted or denied. Figure 1: Inspection Process for Commercial Vehicles at the US-Mexico Border19 1. Mexican Export Lot 2. US Federal Compound 3. State Safety Facility Warehouse / Yard Mexican export documentation verifications and cargo inspection selection Mexican export cargo inspection CBP primary inspection (document inspection) Secondary inspection VACIS, X-Ray, FMCSA `Others Visual vehicle safety inspection Detailed state truck safety inspection Warehouse / Yard Mexico United SOURCE: US Department of Transportation, Federal Highway Administration, “Border-wide Assessment of Intelligent Transportation System (ITS) Technology—Current and Future Concepts,” https://ops.fhwa.dot.gov/publications/fhwahop12015/ch2.htm, 2022. 9 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Trucks wait in a long queue for border customs control to cross into the U.S., in one of the main roads of Tijuana, Mexico, April 18, 2019. REUTERS/Andres Martinez Casares - RC1CE4339C90 Despite the implementation of numerous interventions to enhance the border-user experience, border users consulted while preparing this report expressed concerns about inconsistent federal policies that are not well attuned to their needs.21 For example, outdated technologies at port facilities lead to inaccurate time projections on official agency platforms, making border users turn to social media to better estimate wait and crossing times. Similarly, double inspection processes and unstandardized documentation requirements in different ports of entry generate delays in border crossings, which ultimately increase transport expenses. Finding ways to efficiently process the large volume of commercial and noncommercial vehicles crossing the border while safeguarding national security should remain a priority for the bilateral relationship. This will improve the border-user experience and result in substantial economic gains for both countries. 10 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER The Economic Impact of a More Efficient US-Mexico Border Reduced wait times at the US-Mexico directly impact the US and Mexican economies through increased cross border commerce (commercial vehicles) and spending (noncommercial vehicles). This section quantifies the nationwide dollar value that would result from additional traffic entering the United States from Mexico following a 10-minute reduction in border wait times. The economic impact is estimated for the US and Mexican economies. OUR APPROACH The Atlantic Council’s Adrienne Arsht Latin America Center partnered with the Hunt Institute for Global Competitiveness at the University of Texas at El Paso and El Colegio de la Frontera Norte to produce this two-part study. Findings in this first report result from roundtables, focus groups, and individual consultations carried out virtually across both countries and in-person in Washington, DC; El Paso, Texas; and Tijuana, Mexico; and the analysis of economic data from the United States and Mexico. This study utilizes two economic models; one uses US data, emphasizing the US economy, and another employs Mexican data, focusing on the Mexican economy. As a starting point, both sides of the border were viewed independently to account for discrepancies in data availability and the specific methodologies of local partners and stakeholders. By later harmonizing findings and data, the scope and range of results were extended, ultimately determining the costs and benefits of reducing border wait times for both economies. USEFUL TERMS • Commercial traffic: loaded or unloaded vehicles (usually trucks or trains) that cross the US-Mexico border with the intent to distribute goods produced in the country of origin. • Expenditure: the amount of money spent by noncommercial entities (families and individuals). • Aggregate demand: the total amount of demand for all finished goods and services produced in an economy. • Final good: a product that the final consumer uses or consumes. It does not require any additional processing. • Gross output: the measure of total economic activity in the production of new goods and services during an accounting period. • Labor income: the sum of employee compensation (wages and benefits) and proprietor income. • Intermediate good: a product used to produce a final good. • Intermediate sale: the sale of intermediate goods used in the production of final goods. • Noncommercial traffic: vehicles carrying passengers (tourists, workers, others) that do not transport goods to sell in the destination country. 11 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER The United States: Border Efficiency to Strengthen the Economy By John Byrd, John Gibson, Mayra Maldonado, and Roberto Ransom. University of Texas at El Paso’s Hunt Institute for Global Competitiveness Improved border management and the implementation of new technologies at the US-Mexico border have the potential to enhance border security and expedite legitimate trade and travel, stimulating the US and Mexican economies. A more efficient border would allow more commercial and noncommercial traffic to enter the United States from Mexico, resulting in additional goods for US consumers and businesses and more shoppers buying US goods and services. KEY TAKEAWAYS: A 10-minute reduction in wait times at the US-Mexico border would: • Five-hundred thirty-two additional commercial vehicles loaded with goods entering the United States from Mexico every month would generate an additional commercial intake of nearly $26 million monthly or $312 million annually. The extra inventory resulting from increased imports would reduce US domestic prices, thus promoting economic well-being for US citizens. • Sixty-thousand two-hundred forty additional noncommercial vehicles entering the United States from Mexico every month would generate an additional economic intake of $450,000 monthly, or $5.4 million annually. Border states would absorb approximately 75 percent of this economic impact, and the other 25 percent would reach non-border states in the United States. The Economic Impact of Additional Commercial Crossings In 2021, more than 4.7 million container trucks loaded with over $345.9 million worth of cargo entered the United States from Mexico via the US-Mexico border.22 Research shows that a one minute reduction in commercial wait times would result in 53 additional commercial crossings (see regression analysis in Appendix B). This means that a 10-minute reduction in wait times would result in approximately another 532 container trucks entering the United States every month. These containers may be loaded or unloaded. Therefore, estimating the economic impact of additional commercial crossings would require determining the proportion of loaded containers entering the United States via land ports of entry and the average cargo value of loaded containers. Data from the US Bureau of Transportation shows that approximately 73.1 percent of containers crossing the US-Mexico border are loaded with an average value of $66,798. Table 1 shows a breakdown of the average container value and the number of loaded and unloaded containers crossing the border through individual border counties. 12 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table 1: Proportion of Loaded Containers and Average Container Value (2019) State County Loaded Containers 2019 Unloaded Containers 2019 Loaded + Unloaded Containers Exports 2019 Imports 2019 Total Trade 2019 Average Value per Truck Texas El Paso 610,869 184,426 795,295 $31,717,503,019 $46,613,712,212 $78,331,215,231 $76,307 Texas Hudspeth 0 0 0 $- $- $- $- Texas Presidio 8,418 1,791 10,209 $144,896,195 $200,275,710 $345,171,905 $23,791 Texas Val Verde 59,951 15,651 75,602 $2,068,951,047 $3,082,037,002 $5,150,988,049 $51,409 Texas Maverick 149,732 30,298 180,030 $7,453,868,613 $22,197,870,144 $29,651,738,757 $148,251 Texas Webb 1,711,670 658,639 2,370,309 $95,124,653,587 $135,741,587,991 $230,866,241,578 $79,304 Texas Starr 38,611 17,958 56,569 $92,580,893 $387,724,994 $480,305,887 $10,042 Texas Hidalgo 502,312 213,297 715,609 $13,222,562,811 $23,522,857,942 $36,745,420,753 $46,829 Texas Cameron 153,280 134,796 288,076 $8,910,096,389 $8,930,388,221 $17,840,484,610 $58,262 New Mexico Luna 15,960 794 16,754 $23,980,387 $116,358,933 $140,339,320 $7,291 New Mexico Dona Ana 114,701 19,916 134,617 $14,098,068,953 $16,344,483,518 $30,442,552,471 $142,496 Arizona Yuma 28,342 8,823 37,165 $506,644,995 $875,099,032 $1,381,744,027 $30,876 Arizona Pima 303 12 315 $3,518,870 $1,794,662 $5,313,532 $5,923 Arizona Santa Cruz 293,771 66,136 359,907 $10,369,174,240 $15,633,063,045 $26,002,237,285 $53,215 Arizona Cochise 21,775 8,253 30,028 $802,531,798 $1,153,252,535 $1,955,784,333 $52,962 California San Diego 798,230 258,912 1,057,142 $17,279,207,288 $32,480,486,882 $49,759,694,170 $40,691 California Imperial 258,227 134,805 393,032 $7,023,568,716 $11,087,270,453 $18,110,839,169 $42,936 Total US Border 4,766,152 1,754,507 6,520,659 $208,841,807,801 $318,368,263,276 $527,210,071,077 Average $66,798 SOURCE: The Hunt Institute for Global Competitiveness and the COLEF using data from the Department of Transportation and the US Census Bureau. Based on these findings, a 10-minute reduction in commercial wait times would allow $26 million23 in additional cargo value to enter the United States monthly or $312 million annually. This added commerce from Mexico into the United States consists of various finished and intermediate goods demanded by US consumers and businesses. While it may be argued that additional consumer goods entering the United States via the southern border would result in fewer jobs in the United States, the extra inventory generated by these other imports would also drive down domestic prices. Furthermore, the inflow of intermediate goods serves as vital inputs that support US businesses. As such, more data and analysis are required to determine which of these offsetting effects dominate. The Economic Impact of Additional Noncommercial Crossings24 Improvements in border management tools and practices could also expedite the flow of noncommercial crossings, with positive repercussions for the US economy due to additional cross border spending. In 2021, nearly 126 million people entered the United States from Mexico to purchase goods and services from US businesses. As shown in Table 2, these purchases generated an economic impact of $12.3 billion for the US economy.25 While the four US border states—Arizona, California, New Mexico, and Texas—absorb 75 percent of this impact, approximately 25 percent 13 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table 2: Economic Impact of Cross-Border Spending in the United States (2022) Impact Employment Labor Income Value Added Output 1 - Direct 2 - Indirect 3 - Induced 60,619.16 $1,812,022,814.56 $2,765,047,740.91 $5,036,142,293.41 21,166.07 $1,234,825,927.30 $1,980,607,178.46 $4,118,866,436.04 18,648.05 $977,441,701.68 $1,771,486,445.19 $3,177,688,817.94 100,433.29 $4,024,290,443.54 $6,517,141,364.56 $12,332,697,547.38 SOURCE: The Hunt Institute for Global Competitiveness and the COLEF, using IMPLAN. bleeds directly into non-border states. This means that spending by shoppers from Mexico in US border states has an economic impact of $3.1 billion in the other forty-six US states. Research finds that a 10-minute reduction in wait times at the US-Mexico border would result in an average of approximately 5,020 additional noncommercial crossings every month, or 60,240 every year (see regression results in Appendix B). Determining the economic impact of these additional crossings requires data on the spending patterns of noncommercial crossers and a model to assess the economic impact of this spending. Appendix C provides technical details on how the data and model were used to calculate impact. Research shows that a 10-minute reduction in noncommercial wait times at the US-Mexico border would lead to a $450,000 positive economic impact on the US economy every month. Over the course of one year, this would add up to a monetary intake of $5.4 million. The top three industries that would most benefit from additional cross-border spending is concentrated in areas where tourists or temporary visitors are likely to spend money, particularly retail, full service restaurants, and general merchandise industries. For further information on sector-specific impacts, see Appendix C. Trucks wait in a queue for border customs control, to cross into the United States, at the Zaragoza-Ysleta border crossing bridge in Ciudad Juarez, Mexico April 30, 2020. REUTERS/Jose Luis Gonzalez 14 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Mexico: The Potential Economic Gains of Border Efficiency By David Gaytan, Noé Arón Fuentes Flores, Alejandro Brugués Rodríguez, and Jorge Eduardo Mendoza Cota. El Colegio de la Frontera Norte KEY TAKEAWAYS: A one-minute reduction in wait times at the US-Mexico border would: • Boost Mexican exports to the United States, increasing sectoral output by an average of 2 percent, intermediate sales by an average of 2.4 percent, and aggregate demand by an average of 1.7 percent. Sectors benefiting the most from reduced commercial wait times are those for which production is largely driven by US demand for export goods such as mining, manufacturing, wholesale trade, and agriculture. A 10-minute reduction in wait times at the US-Mexico border would: • Create nearly 18,700 additional direct and indirect Mexican jobs. These posts would be largely concentrated in financial services; wholesale trade; sports, cultural, and other recreational services; and professional, scientific, and technical services. • Lead to an overall increase of $174,474 in labor income. Expediting the flow of commercial traffic from Mexico into the United States would boost cross-border commerce, which impacts aggregate demand in Mexico, causing a change in total gross output and intermediate sales.26 These effects can be disaggregated by sector in the Mexican economy. Macroeconomic Impact of Additional Commercial Crossings Determining the sectoral economic impact of a more efficient US-Mexico border requires understanding the relationship between Mexico’s exports per sector and US demand for export goods. The United States stands as Mexico’s largest export market, with approximately 80 percent of Mexican exports destined for the United States.27 Nearly 100 percent of these exports are concentrated in ten sectors,28 accounting for $349 billion in 2018 and $358 billion in 2019 (for more information, see Appendix F).29 Therefore, this study only considers Mexico’s top-ten sectors in terms of exports to the United States. Within this group, the manufacturing and maquiladora export industries are particularly important, producing more than 60 percent of Mexico’s total exports to the United States. Today, Mexico stands as the top US supplier of motor vehicles and motor vehicle parts.30 Findings show that, on average, Mexican exports to the United States drive 38 percent of Mexican production (or output) per sector (for a detailed breakdown, see Appendix F). For mining, manufacturing, wholesale trade, and agriculture, exports to the United States drive more than 50 percent of total gross output. These four sectors alone are responsible for 84.4 percent of the total dollar value generated from exports to the United States, accounting for $664.26 billion out of the total $787.16 billion in total production. A significant portion of Mexican exports enters the United States via land ports across the US-Mexico border. An average of twenty-eight commercial vehicles with export goods arrive at the border every hour, with the average truck taking approximately 20 minutes to cross the border (for more information, see Appendix D3). Reducing wait times would boost Mexican exports by allowing additional commercial crossings into the United States. This would strengthen Mexican supply chains by stimulating the exchange of intermediate and final goods between sectors in response to the increased demand for export goods. Given that approximately 73.1 percent of containers crossing the US-Mexico border are loaded with an average value of $66,798,31 a one-minute reduction in commercial wait times would increase 15 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER sectoral output (total gross output) by an average of 2 percent. This output growth would be driven by a 1.7 percent increase in average demand per sector, occurring as a result of additional Mexican exports entering the United States. Intermediate sales (the sectoral exchange of intermediate goods for the production of additional export goods) would grow by an average of 2.4 percent per sector. Appendix D includes a detailed description of the two models used in the analysis, a queuing and input-output model. As Figure 2 shows, the benefits of increased commercial crossings into the United States are unequally distributed across sectors of the Mexican economy. The mining, manufacturing, and wholesale trade sectors experience the highest growth rates in production, at 3.62 percent, 3.62 percent, and 3.33 percent, respectively. These three sectors also have the largest increase in aggregate demand, growing at 3.88 percent, 5.20 percent, and 3.63 percent, respectively. Regarding intermediate sales, the agricultural and mining sectors have growth rates higher than 3 percent. Appendix F has a detailed breakdown of nominal and percentage growth in production (total gross output), intermediate sales, and aggregate demand following a one-minute reduction in border wait times. Economic Impact on Employment and Labor Income of Additional Commercial Crossings Moreover, this study finds that a 10-minute reduction in border wait times would promote the creation of nearly 18,700 indirect and direct jobs in Mexico over the course of one year, with 5,505 new positions opening in financial and insurance services, 3,684 in mass media information, 3,216 in wholesale trade, and 2,448 in professional, scientific, and technical posts. The loss in labor is far smaller, with an estimated 793 jobs lost in manufacturing and 210 in the transportation, postage, and warehousing sectors. (For detailed analysis, see Appendix G). A ten-minute reduction in commercial wait times would also result in a $174,474 increase in labor income. When disaggregated by sector, labor income growth is higher in the wholesale trade, financial and insurance services, information services, and mining sectors. Interestingly, this change would lead to more equitable distribution of labor income across Mexican economic sectors. However, the variation is driven mainly by increased production by sector rather than overall productivity. (For more information, see Appendix G). Figure 2: Growth of Total Gross Output, Aggregate Demand, and Intermediate Sales Total Production Growth Aggregate Demand Growth Intermediate Sales GrowthSOURCE: In-house prepared graph based on estimates for 2018 data, obtained from the National Institute of Statistics and Geography, 2022. 16 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Conclusion Trucks wait in a long queue for border customs control to cross into the United States at the World Trade Bridge in Nuevo Laredo, Mexico April 2, 2019. REUTERS/Daniel Becerril A more efficient US-Mexico border would expedite legitimate trade and travel, enhancing cross-border commerce and benefiting the US and Mexican economies. Streamlined border crossings could be achieved through improvements in border management practices and the adoption of new technologies. These efforts would also bolster shared security between the United States and Mexico. This report focused on the economic impact of expediting commercial and noncommercial crossings from Mexico into the United States. Reduced border wait times would increase the supply of goods and services for US consumers and stimulate spending in the United States while boosting Mexican exports into the United States. This would lead to an increasingly competitive, economically integrated, and resilient bilateral relationship. In the United States, a 10-minute reduction in border wait times would facilitate the crossing of 532 additional loaded trucks every month, generating an added commercial intake of nearly $26 million per month. In one year, the economic impact on the US economy would be $312 million. Similarly, it would allow 60,240 additional noncommercial vehicles to enter the United States every month, generating an extra economic intake of $450,000 monthly, or $5.4 million annually. The benefits of increased cross-border commerce and spending would extend throughout the United States due to the economic linkages between local economies. For Mexico’s top ten export sectors to the United States, a one minute reduction in commercial wait times would, on average, increase production (total gross output) by 2 percent, intermediate sales by 2.4 percent, and aggregate demand by 1.7 percent. Results show the mining, manufacturing, wholesale trade, and agricultural sectors would benefit the most from additional commerce from Mexico into the United States. Historically, more than 50 percent of production in these sectors has been driven by US demand for export goods. Expediting the flow of commercial vehicles from Mexico into the United States by ten minutes would increase labor income by $174,474 and promote the creation of nearly 18,700 additional direct and indirect jobs in Mexico, particularly in financial services; mass media information; wholesale trade; and professional, scientific, and technical services. These numbers illustrate the lower-bound economic gains that would result from reduced wait times at the US-Mexico border, stemming from potential improvements in border management practices and tools. They emphasize the economic interdependence of the United States and Mexico, outlining how a further coordinated, binational approach to the border would benefit both countries. A subsequent study will disaggregate national-level findings and thus determine the impact of a more efficient and secure US-Mexico border at the state and county level in the United States and Mexico. 17 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Methodology US-focused analysis The Hunt Institute for Global Competitiveness used a two-step process to calculate the economic impact of reducing border wait times for commercial and noncommercial crossings. First, regression analysis was employed to determine the relationship between average wait times (in minutes) and the average number of crossings (commercial and noncommercial) at major US-Mexico land ports of entry. Additional factors impacting this relationship, such as employment and crime on both sides of the border, the number of lanes in operation, and total expenditures made by the US Department of Homeland Security (DHS), were considered. The analysis used data from various sources, including CBP, the US Department of Transportation’s Bureau of Transportation Statistics, the US Department of Labor’s Bureau of Labor Statistics, Instituto Nacional de Estadística y Geografía (INEGI, or National Institute of Statistics and Geography), and the Instituto Mexicano de Seguro Social (Mexican Institute of Social Security). To account for disruptions in border traffic patterns stemming from COVID-19 and its accompanying policy changes, the study captures data between April 2016 and December 2019, before the pandemic’s onset. The second step in the analysis was quantifying the economic impact of additional crossings resulting from reduced wait times. Because of the different types of data available for commercial and noncommercial crossings; this study used various methods to quantify their effects. For commercial crossings, the proportion of loaded container crossings and the average value per container— obtained from the US Department of Transportation—were used to determine the dollar value associated with increased container crossings. For noncommercial crossings, survey data from the City of El Paso’s International Bridges Department on travel and spending patterns were used to model the economic impact of spending by additional noncommercial crossers. Appendices A through C include more technical information and a detailed, step by-step explanation of the analysis. Mexico-focused analysis El Colegio de la Frontera Norte used a three-step process and two economic models to determine the economic impact of reduced border wait times for commercial vehicles. The analysis used data from the US Bureau of Transportation Statistics, CBP, the North American Industry Classification System (NAICS), Mexico’s INEGI, Automated Census Information System (ACIS), and Servicio de Administración Tributaria (SAT, or Tax Administration Service). The first step was to estimate the average inspection rate of commercial vehicles at US-Mexico border land ports of entry (see Appendix D3 for detailed analysis). Then, a queuing model was used to determine how reduced wait times affect Mexican exports to the United States. Finally, an input-output model was implemented to establish how changes in exports affect production (total gross output), intermediate sales, and aggregate demand for Mexico’s top ten sectors in terms of exports to the United States. Appendix D provides a detailed, technical description of the queueing and input output models, while Appendix F includes analysis results. 18 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendices The following Appendices provide additional details on the economic analysis summarized in the main report. Given its technical nature, this section can be skipped by more casual readers. Appendices A, B, and C explain the US-focused analysis by the Hunt Institute for Global Competitiveness and Appendices D, E, F, and G expand on the Mexico-focused analysis by El Colegio de la Frontera Norte. US-FOCUSED ANALYSIS APPENDIX A 20 Provides a detailed description of the data used in the regression analysis. APPENDIX B 24 Outlines the regression model used to estimate the relationship between border wait times and commercial and noncommercial crossings. APPENDIX C 25 Gives an overview of IMPLAN and how it was used to measure the economic impact of noncommercial crossings. MEXICO-FOCUSED ANALYSIS APPENDIX D 28 Provides more details on the input-output and queuing models. APPENDIX E 31 Describes the data used in the analysis. APPENDIX F 32 Explains the economic impact analysis with and without reduced border wait times. APPENDIX G 36 Describes the analysis of economic impact on employment and labor income. 19 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX A: DATA USED FOR THE FIXED EFFECTS MODEL While report results are presented at the national level, the analysis by the Hunt Institute for Global Competitiveness is built from county level data focusing on major US-Mexico land ports of entry. Map 1 shows the counties on the US-Mexico border for which data was collected and analyzed. These counties have one or more land ports of entry. Map 2 presents CBP sectors and selected counties’ ports of entry within each sector. Map 1. US Border Counties on the US-Mexico Border SOURCE: The Hunt Institute for Global Competitiveness and El Colegio de la Frontera Norte (COLEF). 20 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Map 2. CBP Sectors Along the US-Mexico Border SOURCE: The Hunt Institute for Global Competitiveness and COLEF using data from CBP. Table A1 lists every US county that touches the US-Mexico border. The list includes the name of every port of entry within that county, the names of the corresponding Mexican counties, and the CBP sector that contains that county. 21 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table A1: US-Mexico Border States, Counties, Cities, Ports of Entry, Mexican Sister Cities, and CBP Sectors State County City PoE Sister City CBP Sector California Arizona New Mexico Texas San Diego San Ysidro San Ysidro Tijuana, Baja California San Diego Sector, California Otay Mesa Otay Mesa - Commercial Otay Mesa - Passenger Otay Mesa - Pedestrian Cross Border Express Tecate Tecate Imperial Calexico Calexico - East Mexicali, Baja California El Centro Sector, California Calexico - West Andrade Andrade Yuma San Luis San Luis - San Luis I San Luis Rio Colorado, Sonora Yuma Sector, Arizona San Luis - San Luis II Pima Lukeville Lukeville Puerto Peñasco, Sonora Tucson Sector, Arizona Sasabe Sasabe Sáric, Sonora Santa Cruz Nobales Nogales - Deconcini Nogales, Sonora Nogales - Mariposa Nogales - Morley Gate Cochise Naco Naco Naco, Sonora Douglas Douglas (Raul Hector Castro) Agua Prieta, Sonora Luna Columbus Columbus Asencion, Chihuahua El Paso Sector, New Mexico Doña Ana Santa Teresa Santa Teresa - Santa Teresa Port of Entry Ciudad Juarez, Chihuahua El Paso El Paso El Paso - Bridge of the Americas (BOTA) Ciudad Juarez, Chihuahua El Paso Sector, Texas El Paso - Paso del Norte (PDN) El Paso - Stanton DCL El Paso - Ysleta Hudspeth Fort Hancock Fort Hancock - Fort Hancock El Paso Fabens Fabens - Tornillo Guadalupe, Chihuahua Presidio Presidio Presidio Ojinaga, Chihuahua Big Bend Sector, Texas Val Verde Del Rio Del Rio Acuña, Coahuila Del Rio Sector, Texas Maverick Eagle Pass Eagle Pass - Bridge I Piedras Negras, Coahuila Eagle Pass - Bridge II Webb Laredo Laredo - Bridge I Nuevo Laredo, Tamaulipas Laredo Sector, Texas Laredo - Bridge II Laredo - Colombia Solidarity Laredo - World Trade Bridge Starr Roma Roma Ciudad Miguel Aleman, Tamaulipas Rio Grande Rio Grande City Camargo, Tamaulipas Rio Grande Valley Sector Hidalgo County Hidalgo/ Pharr Hidalgo/Pharr - Anzalduas International Bridge Reynosa, Tamaulipas Hidalgo/Pharr - Hidalgo Hidalgo/Pharr - PharrProgreso - Donna International Bridge Hidalgo Progreso Progreso - Donna International Bridge Rio Bravo, Tamaulipas Progreso - Progreso International Bridge Cameron Brownsville Brownsville - B&M Matamoros, Coahuila Brownsville - Gateway Brownsville - Los Indios Brownsville - Veterans International SOURCE: The Hunt Institute for Global Competitiveness and El Colegio de la Frontera Norte (COLEF) using data from CBP. 22 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Running the necessary regressions to determine the impact of border wait times on border crossings requires data on several variables in various geographies. The data gathered for the regression analysis includes: 1. Average wait times: Border wait times at ports of entry were obtained from CBP. The research team used this data to estimate the monthly average border wait time (in minutes) for every land port of entry. This data was available for commercial vehicles, personal vehicles, and pedestrian modes of crossing, but not for rail crossings.32 Commercial vehicle data for the Hudspeth port of entry were unavailable for this variable.33 2. Total number of crossings per month: Data was captured from the US Department of Transportation’s Bureau of Transportation Statistics for each port of entry on the US-Mexico border and mode of crossing (commercial vehicles, noncommercial vehicles, and pedestrian crossings). The analysis uses these data to estimate the total number of crossings per city and county. The data for the Fort Hancock port of entry was unavailable for this variable. 3. Number of operational lanes per month: The total number of operating lanes per hour per port of entry was taken from the CBP for every port of entry. This analysis used the point of entry level data to estimate the number of operational lanes by city and county. The research team estimated an hourly average for every port of entry, using it to estimate a monthly average of the number of lanes in operation per port of entry. The commercial vehicles data for the Eagle Pass port of entry were not available for this variable. 4. Total number of existing lanes: The total number of existing lanes for every port of entry was captured from CBP. Commercial vehicle data for the Fort Hancock port of entry were unavailable for this variable. 5. Total employment (United States): The monthly data of total non-farm employment information for each US county on the US-Mexico border with ports of entry was obtained from the US Department of Labor’s Bureau of Labor Statistics. 6. Total employment (Mexico): The monthly data on total non-farm employment for each of the Mexican counties on the US-Mexico border with a port of entry was acquired from the Instituto Mexicano del Seguro Social (IMSS or Mexico’s Institute of Social Security). 7. Illegal Apprehensions: CBP provided its complete monthly number of illegal apprehensions for every sector within the southern border. See Map 2 for the boundaries of each CBP sector. This variable serves as a measure of crime in the United States. 8. Homicide rate: The total number of homicides per county was obtained for every northern Mexican municipality from the Secretariado Ejecutivo del Sistema Nacional de Seguridad Publica (Mexico’s Executive Secretary of the National Public Security System), the Mexican agency that compiles the total number of homicides per county. Mexican population data is available from two Mexican agencies, the Instituto Nacional de Estadística y Geografía (INEGI or the National Institute of Statistics and Geography) and the Consejo Nacional de Población (CONAPO or the National Council on Population). This variable serves as a measure of crime in Mexico. 9. Federal Expenditures (United States): Federal costs data were obtained for the following federal agencies: CBP, US Coast Guard, Transportation Security Administration, Federal Law Enforcement Training Center, and US Immigration and Customs Enforcement. These expenses were gathered for the following counties: San Diego and Imperial in California; Yuma, Pima, Santa Cruz, and Cochise in Arizona; Luna and Doña Ana in New Mexico; and El Paso, Presidio, Val Verde, Maverick, Webb, Starr, Hidalgo, and Cameron in Texas. 10. Trade: The data obtained from the US Trade Census consists of the value of the total imports and exports that cross the US-Mexico border ports of entry every month. 23 ATLANTIC COUNCIL APPENDIX B THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX B: FIXED EFFECTS MODEL Calculating the economic impact of a more efficient and secure border, requires understanding the relationship between wait times and the number of border crossings. The data across counties shows a low yet positive correlation between noncommercial crossings and wait times, suggesting that increased wait times are associated with more border crossings.34 This counterintuitive finding is explained by the fact that increased border usage (or border congestion) results in both longer wait times and more crossings. Therefore, to determine the underlying relationship between border wait time and crossings, the research team used an econometric model to control for other factors that may influence border crossings. The following equation is estimated by fixed effects using monthly county-level data from April 2016 through December 2019.35 crossit = β1waitit + β2Xit+ i+uit ,t = 1,2, ..., T In the estimation equation, crossit and waitit denote the number of crossings (either commercial or noncommercial) and average wait times in county i at time t, respectively. All additional time-varying explanatory variables are included in Xit, while i denotes the time constant fixed effect for county i and uit denotes the error term.36 The additional controls in Xit account for other factors influencing crossings and include a measure of employment in the United States and Mexico, a measure of crime in both countries, the number (or proportion) of lanes in operation, total expenditures by DHS, and a measure of trade (included in the commercial regression only). The left panel of Table B1 provides regression results for commercial crossings, while the right panel shows results for noncommercial crossings. The coefficient estimate on wait times is of primary interest, which is negative and statistically significant in both regressions. Specifically, the analysis found that a one-minute reduction in wait times results in 53 additional commercial crossings and 502 noncommercial crossings on average per month. The coefficient on wait times in the commercial crossing regression is statistically significant at 10 percent. Each additional commercial crossing represents another cargo container (loaded or unloaded) crossing into the United States via a land port of entry. The coefficient on wait times in the noncommercial crossings regression is statistically significant at 5 percent. Each additional noncommercial crossing represents a personal vehicle crossing into the United States via a land port of entry. Regression results suggest an inverse relationship between wait times and commercial and noncommercial border crossings. Including additional time-varying controls and time-constant fixed effects helped to reverse the counterintuitive finding of a positive correlation reported above. As such, Table B1 describes the underlying relationship between border wait times and border crossings. These findings can be used to determine how improved border management techniques or the adoption of new technologies affect commercial and noncommercial border crossings. Table B1: Fixed Effects Regression Results Regression Results Commercial Crossings Noncommercial Crossings Wait times -53.23* -502.05 (30.34) (227.18) Employment in US 0.03 0.23 (0.05) (0.41) Employment in Mexico -0.01 0.05 (0.02) (0.17) Crime in US -0.03 -1.16* (0.04) (0.43) Crime in Mexico -17.60* -30.00 (5.56) (98.12) Lanes operational 487.29 314031.50* (1998.54) (68954.24) DHS Expenditures -0.002 0.01 (0.001) (0.01) Trade 8.92E-06* - (5.09E-07) - Constant 8307.01 268168.40* (6615.80) (48439.59) Sample Size 554 585 R^2 0.95 0.76 SOURCE: The Hunt Institute for Global Competitiveness and the COLEF, using data from the US Department of Transportation. NOTE: The standard error is in parentheses. Statistically significant at 1 percent. Statistically significant at 5 percent. Statistically significant at 10 percent. 24 ATLANTIC COUNCIL APPENDIX C THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX C: ECONOMIC IMPACT ANALYSIS OF BORDER CROSSINGS The regression results presented in Appendix B established a link between border wait times and commercial and noncommercial crossings. This serves as the first step in understanding the economic impact of reduced border wait times. Additional data is needed to determine the economic impact of reductions in border wait times. The following subsections explain the steps taken to produce the economic impact results described in the main text. Appendix C1: Economic Impact of Commercial Crossings The regression results described in Appendix B indicate that a one-minute reduction in average commercial wait times results in approximately fifty-three additional container crossings per month. Data from the US Department of Transportation’s Bureau of Transportation Statistics were used to estimate that approximately 73.1 percent of these containers would be loaded with an average value of $66,798 (for a detailed breakdown of the proportion of loaded containers crossing the US-Mexico border and their average cargo value, see table 1 on page 13). This means that a 10-minute reduction in wait times would result in 532 additional container crossings, of which 388 would be loaded with $25,879,549 in cargo value. Appendix C2: Economic Impact of Noncommercial Crossings Individuals crossing from Mexico into the United States make purchases on the US borders and in states, contributing to local economies. Due to underlying economic linkages, this spending has an amplified national impact. To estimate this impact, the research team used IMPLAN—a regional economic impact software—, data on expenditure patterns, and the average number of border crossings aggregated to the county level. Below is an overview of the data and model used to estimate the economic impact of the expenditures that result from these noncommercial border crossings. A 2019 study by the City of El Paso International Bridges Department quantifies the social and economic cross-border activities from vehicle and pedestrian crossings through the El Paso–Ciudad Juárez port of entry. The study consisted of two surveys. First, a short questionnaire administered to US-Mexico border crossers between October 1 and December 31, 2019. Residents who indicated Mexico as their primary place of residence received an entry survey, while those indicating the United States as their primary place of residence received an exit survey. The entry survey captured the planned activities and expenditures of those traveling to El Paso from Ciudad Juárez, while the exit survey captured the activities and spending already made by those traveling to Ciudad Juárez from El Paso. 25 ATLANTIC COUNCIL APPENDIX C THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Survey respondents were asked questions related to four categories: • Demographics • Reasons for crossing • Anticipated spending (including the area of spending) • Trip characteristics This report focused on survey responses related to the intended destination (El Paso or other) and expected spending across various categories. The survey results indicate that approximately 80 percent of individuals crossing the border (by vehicle and as pedestrians) remained in El Paso, while 20 percent continued to another location. Of the 80 percent who stayed in El Paso, approximately 64 percent of those who crossed by vehicle and 47 percent who crossed as pedestrians reported positive expected expenditures. The survey data breaks down the dollar amount individuals expected to spend within twenty categories.37 This information was used to calculate the average expenditure per crosser, for both vehicle and pedestrian crossings. These expenditures were then scaled by the total number of vehicle and pedestrian crossings in 2019 (after scaling by the proportion of crossers who remained in El Paso and reported spending money) to determine the average expenditure of crossings in 2019 for El Paso County. To establish the economic impact of these expenditures at the national level, the average expenditures by crossers in 2019 were computed for the following border counties: • Texas: Presidio, Val Verde, Maverick, Webb, Starr, Hidalgo, and Cameron • New Mexico: Luna and Doña Ana • Arizona: Yuma, Pima, Santa Cruz, and Cochise • California: San Diego and Imperial Unfortunately, detailed expenditure data were unavailable for the other border counties. However, the El Paso survey was used with the assumption that spending patterns across the twenty categories do not change across counties. First, the average expenditures per crosser for each category was recovered from the El Paso survey. These expenditures were then scaled up or down based on the average household income in the neighboring Mexican state relative to the average household income in Chihuahua (the Mexican state neighboring El Paso). Once this income adjustment was made, the average 2019 expenditures were scaled by the number of vehicle and pedestrian crossings in 2019 for each border county listed above. This exercise reveals the total spending in the twenty categories for each of the sixteen border counties considered in the analysis.38 These findings were used as inputs into IMPLAN to estimate the economic impact of expenditures by individuals crossing the US-Mexico border. First, the twenty expenditure categories from the survey were mapped into comparable IMPLAN industries. Then, industry output (spending) was reduced in these industries for each of the sixteen counties. Twenty adverse output (spending) events were modeled separately in the sixteen counties for a total of 320 events. The rest of the United States was then built up, county-by county for Texas, New Mexico, Arizona, and California; and state-by state for the non-border states. Finally, the national-level analysis was run using IMPLAN’s multiregion input-output feature, allowing for additional indirect linkages between regions within the analysis. Tables C2.1 and C2.2 present the main findings. 26 ATLANTIC COUNCIL APPENDIX C THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table C2.1: Economic Impact of Removing Cross-Border Spending in the United States (2022) Impact Employment Labor Income Value Added Output 1 - Direct 2 - Indirect 3 - Induced -60,619.16 -$1,812,022,814.56 -$2,765,047,740.91 -$5,036,142,293.41 -21,166.07 -$1,234,825,927.30 -$1,980,607,178.46 -$4,118,866,436.04 -18,648.05 -$977,441,701.68 -$1,771,486,445.19 -$3,177,688,817.94 -100,433.29 -$4,024,290,443.54 -$6,517,141,364.56 -$12,332,697,547.38 Source: The Hunt Institute for Global Competitiveness and the COLEF, using IMPLAN. As shown on Table C2.1, removing cross-border spending by noncommercial crossers results in approximately 100,433 fewer jobs in the United States. Approximately 60 percent of this job loss is directly caused by reduced expenditure. The remaining 40 percent is due to indirect and induced effects. Removing cross border spending would also result in a loss of $12,332,697,547 in economic output. Approximately 41 percent of this output loss is explained by the direct effects of reducing expenditures and 59 percent by indirect or induced effects. Table C2.2 includes the top five most impacted industries in terms of output lost due to the reduction in cross-border spending by noncommercial crossers. As expected, these industries are concentrated in areas where tourists or temporary visitors would likely spend money. The three sectors with the largest output loss include retail, full-service restaurants, and general merchandise. As such, the entire output loss within these industries was due to sectoral linkages with other areas experiencing direct impacts. IMPLAN results in Table C2 can be combined with the regression results in Appendix B to determine the economic impact of reducing noncommercial border wait times. The research team divided the total output loss resulting from eliminating noncommercial crossings by the total number of crossers in 2019, 87,812,443.39 This yields a value of $140.44 which can be interpreted as the output loss associated with losing one noncommercial crosser or the output gain associated with one additional noncommercial crosser. Table C2.2: Top Five Industries with Reductions in Economic Output from Removing Cross-Border Spending in the United States (2022) Impact 1 - Direct 2 - Indirect 3 - InducedImpact output Industry display Impact output Impact output Impact output Retail: Clothing and ccessories -$2,161,062,814.49 -$707,698.49 -$23,321,554.17 -$2,185,092,067.16 Other real estate services $0.00 -$740,224,149.66 -$130,392,264.37 -$870,616,414.03 Full service restaurants -$713,075,639.37 -$28,572,142.09 -$65,051,510.06 -$806,699,291.52 General merchandise -$575,957,329.13 -$2,040,513.78 -$36,955,115.99 -$614,952,958.90 Management $0.00 -$397,735,328.22 -$56,187,767.71 -$453,923,095.93 1 2 3 4 5 Source: The Hunt Institute for Global Competitiveness and the COLEF, using IMPLAN. 27 ATLANTIC COUNCIL APPENDIX D THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX D: DESCRIPTION OF THE INPUT-OUTPUT AND QUEUING MODELS Appendix D1: The queueing model This study uses a queuing model to evaluate how wait times for commercial vehicles at the US-Mexico border affect Mexican exports to the United States. A queueing model mathematically describes a queuing system, making specific assumptions about the probabilistic nature of the number and type of servers (commercial vehicles), the arrival and service processes (border processing rates), and the queue discipline and organization. For this study, this can be described as: E'j,t = E'j,0- ∆ %(λ-μ)αj ∑ E'j,0 (1) Where; E'j,t = commercial vehicles processed per hour at t ≥1. E'j,0 = commercial vehicles processed per hour at t=0. λ = the average number of commercial vehicles arriving per hour.40 μ = the average number of commercial vehicles dispatched per hour.41 α = the share of sectoral exports in total exports per hour (E'j,0 / ∑ E'j,0). ∑ E'j,0 = the total number of commercial vehicles per hour in the economy. The E'j,0 vector also serve as a measure of Mexican exports, given that commercial vehicles entering the United States are loaded with Mexican goods. In equation (1), the assigned volume is the number of commercial vehicles arriving at a border checkpoint every hour (λ), while the volume processed is the processing capacity of the checkpoint per hour (μ). To conduct the queuing analysis, these two variables must be known beforehand. Appendix D3 shows how they were defined. Besides the variables λ and μ, the queuing model considers other key variables, including the value of exports transported by commercial vehicles and the number of lanes in operation. The former was determined using data from the US Department of Transportation’s Bureau of Transportation Statistics (see Appendix C1), and the latter with data from CBP. Additionally, this study considers the system in its steadystate of operation, i.e., during time intervals when λ and μ behave normally. This means that anomalous states of operation are removed from the analysis (such as the first 30 minutes in the workday when personnel perform preparatory activities). As equation (1) shows, when the volume of commercial vehicles in the system is processed immediately [(λ-μ) = 0], there would be no queues. As a result, wait times would be insignificant, and the value of Mexican exports entering the United States in commercial vehicles would be E'j,0. However, when the assigned volume of commercial vehicles is greater than the volume of vehicles processed [(λ-μ) > 0], a queue forms, leading to increased wait times and reducing the number of commercial vehicles crossing the border with Mexican export goods (reducing E'j,t). This calculation produces approximate wait times, which are sufficiently accurate to understand the overall distribution of traffic between land ports of entry across the US-Mexico border. Once approximate wait times are established, it is important to verify the model’s validity. Using a chi-square goodness of fit test, the observed distribution of the variables λ and μ is compared with their theoretical distribution, demonstrating the degree of adjustment between the sample (the average service rate for one checkpoint) and the population (the average service rate for all checkpoints across the US-Mexico border). This hypothesis test concludes, with a certain degree of statistical significance, that the sample in this study is representative of the full population. 28 ATLANTIC COUNCIL APPENDIX D THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix D2: Intersectoral input-output model Input-output models are a form of macroeconomic analysis based on the interdependencies (the flow of goods and services) between different economic sectors. They are commonly used to estimate the impacts of positive or negative economic shocks and their ripple effects throughout an economy. This study uses an input-output model to determine how increased Mexican exports stemming from reduced border wait times (previously established using a queuing model; see Appendix D1) affect aggregate demand in Mexico (calculated as aggregate demand = C + I + G + Nx, where: C = consumer spending; I = private investment and corporate spending; G = government spending; and Nx = net exports (exports minus imports). Economic sectors respond to increases in aggregate demand directly by supplying final goods (increasing output) or indirectly by producing intermediate goods for sectors that respond directly (increasing intermediate sales). Therefore, findings are then used to calculate the impact on total gross output and intermediate sales across sectors of the Mexican economy. Equation (2) estimates the impact of increased demand for Mexican exports on output per sector: Xj,0= (I-A)-1Yj,0 (2) Where: Xj,0 = the total gross output vector per sector at t=0. (I-A)-1 = the Leontief inverse (or the matrix of indirect and direct multipliers). In which I = identity matrix and A = technical coefficient matrix. Yj,0 = the aggregate demand vector per sector at t=0. Therefore, equation (2) could be re-written as: Xj,0= (I-A)-1E'j,0 (3) Where: E'j,0 = the exports vector per sector at t=0. As discussed in Appendix D1, E'j,0 can be interpreted as “commercial vehicles processed by the customs system every hour” and equation (3) expressed as: Xj,t = (I-A)-1E'j,t (4) Where E'j,0 = commercial vehicles processed per hour at t ≥ 1. This interpretation makes two assumptions: (a) that the system operates at full capacity and (b) that the volume of commercial vehicles in the system is processed immediately [(λ-μ) = 0], resulting in no wait times (see Appendix D1). In other words, the input-output model is static. However, this is not always the case, given that commercial vehicle arrivals and departures to and from border checkpoints do not happen at fixed intervals (they are uncertain). Therefore, by incorporating specific trajectories describing the behavior of E'j,t (changes to the number of commercial vehicles processed by customs checkpoints due to reduced wait times), the static input output model can be used to estimate the impact of increased Mexican exports on total gross output per sector. This is calculated with the equation: Lj,t = ∑ [Xj,t+Xj,0] (5) Where: Lj,t = the impact on total gross output. Xj,0 = the total gross output vector per sector at t=0 (before reduced wait times and no changes to E'j,0). Xj,t = the total gross output vector per sector at t ≥1 (after reduced wait times and changes to E'j,t). j = 1- n sectors. 29 ATLANTIC COUNCIL APPENDIX D THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix D3: Establishing the assigned volume and processing rate of commercial vehicles Estimating the average processing capacity of a port of entry requires data on the volume of commercial vehicles serviced and the number of lanes, hours, and days in operation for that port of entry. For land ports of entry across the US-Mexico border, these data were obtained from the Bureau of Transportation Statistics’ Border Crossing Data.42 Table D3 shows data for the Otay Mesa port of entry in Baja, California, the third-busiest on the US-Mexico border.43 The Otay Mesa example helps to illustrate how processing capacity was calculated for other ports of entry as part of this study. On average, one lane in the Otay Mesa port of entry operates 65 hours per week. Together, its ten lanes would operate 650 hours per week, meaning that, together, the lanes of the Otay Mesa port of entry operate for approximately 33,800 hours in one year (52 weeks). Given that 962,577 commercial vehicles are serviced per year, a total of 18,511 trucks would cross the border weekly. For one lane, this translates to 1,851 trucks per week, 370 per day, and 28.5 per hour. Having established the number of commercial vehicles serviced per hour (28.5 vehicles), an M/M/1 queue was simulated (see Appendix D1) to estimate the average processing capacity (μ), showing that border wait times for commercial vehicles are approximately 21.5 minutes.44 Enhanced border management practices and the implementation of new technologies would improve the processing capacity of ports of entry, reduce commercial wait times, and allow more Mexican exports to enter the United States. This would boost total gross output, aggregate demand, and intermediated sales across various sectors in the Mexican economy, as well as employment and labor income (see Appendices F and G for input-output analysis results). Table D3: Data for the Otay Mesa Port of Entry Item Value Total number of commercial vehicles serviced per year Hours in operation per day Days in operation per week Maximum number of lanes in operation 962,577 13 5 10 FUENTE: Cálculos propios con base en Información procedente de <https://bwt.cbp.gov/> y <Border Crossing/Entry Data - Bureau of Transportation Statistics 30 ATLANTIC COUNCIL APPENDIX E THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX E: DATA USED FOR THE ANALYSIS This study relied on the North American Industry Classification System (NAICS) and the Sistema Automatizado de Información Censal (ACIS or Automated Census Information System) to further understand Mexico’s productive sector and commercial relationship with the United States. It also used data from the Instituto Nacional de Estadística y Geografía (INEGI or the National Institute of Statistics and Geography). The NAICS, jointly developed by the US Economic Classification Policy Committee, INEGI, and Statistics Canada, classifies North American business statistics, allowing for a high level of comparability between economic activities in the United States, Mexico, and Canada. The sectors shown in Table E1, classified by NAICS in 2018, were used for this study. The INEGI used data from economic censuses in Mexico, systematized in the ACIS,45 to produce an input-output matrix46 for the Mexican economy in 2013. It then used a RAS method to estimate a matrix for 2018.47 The 2018 matrix was used as part of this study to determine the top ten Mexican sectors exporting to the United States, which were later used in the intersectoral input output analysis described in Appendix D2. Results on the economic impact of reduced border wait times on sectoral output, aggregate demand, and intermediate sales appear in Appendix F2. Additionally, the 2018 input-output matrix and vectors for employment and labor income in Mexico were used to estimate how reduced commercial wait times affect employment and labor income, as shown in Appendix G. The vectors were calculated using data from the ACIS. Table E: Sectoral Classification of the North American Industry Classification System (NAICS) (2018) NAICS Code Sector 11 Agriculture, animal breeding and exploitation, forestry, fishing and hunting 21 Mining 22 Electric power generation, transmission and diffusion, water and gas supply through pipelines to final consumers 23 Construction 31-33 Manufacturing industries 43 Wholesale trade 46 Retail trade 48-49 Transportation, postage, and warehousing 51 Mass media information 52 Financial and insurance services 53 Real estate and rental services of personal and intangible property 54 Professional, scientific, and technical services 55 Corporate 56 Business support services and waste and residue management and remediation services 61 Educational services 62 Health and social welfare services 71 Cultural, sports, and other recreational services 72 Temporary accommodation services and food and beverage preparation services 81 Other services, except government activities. 93 Legislative, governmental, law enforcement, and international and extraterritorial organization activities SOURCE: The Colegio de la Frontera Norte using the 2018 sectoral classification of the NAICS 31 ATLANTIC COUNCIL APPENDIX F THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX F: ECONOMIC IMPACT ANALYSIS OF BORDER CROSSINGS This study first established a baseline of Mexican exports to the United States without reduced wait times, which allowed for the determination of the top ten sectors exporting to the United States and the effect that exports have on sectoral output in Mexico. Then, an analysis with reduced border wait times was conducted, and baseline results were compared with new findings to determine the relative and absolute variation in sectoral output, aggregate demand, and intermediate sales stemming from reduced wait times. The values in all Appendix F tables appear in 2018 US dollars, using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results have yet to be adjusted to 2022 values, using inflation and consumer price index (CPI) historical data from the United States. Appendix F1: Analysis without reduced border wait times Assessing the economic impact of a one-minute reduction in border wait times requires understanding the US-Mexico commercial relationship and how it drives sectoral output in Mexico. As shown in Figure F1, ten sectors produced 99.86 percent of total Mexican exports to the United States in 2018. Therefore, this study considers these ten sectors. Figure F1: Top Ten Mexican Sectors in Terms of Exports to the United States (2018) • 31-33 - Manufacturing 0.82% • 43 - Wholesale trade • 21 - Mining • 48-49 - Transportation, postage, and warehousing • 46 - Retail trade • 11 - Agriculture, animal breeding and exploitation, forestry, fishing, and hunting • 52 - Financial and insurance services • 22 - Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers • 51 - Mass media information • 54 - Professional, scientific, and technical services SOURCE: In-house, prepared using 2018 using data obtained from INEGI (2022). 1.92% 3.97% 6.30% 6.81% 16.80% 0.05% 0.05% 0.02% 63.24% 32 ATLANTIC COUNCIL APPENDIX F THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER The input-output analysis was employed to estimate the baseline output per sector driven by Mexican exports to the United States, using equation (3) in Appendix D2 [Xj,0 = (I-A)-1E'j,0]. Table F1 includes results in relative and absolute terms, showing that, on average, Mexican exports to the United States drive 38 percent of total gross output per sector in Mexico. Table F1: Total Gross Output (TGO) Driven by Mexican Exports to the United States (2018)48 NAICS classification code Sector Total Percentage 21 Mining 976,753.75 68.91% 31-33 Manufacturing 9,992,494.79 68.79% 43 Wholesale trade 1,724,997.69 63.26% 11 Agriculture, animal breeding and exploitation, forestry, fishing, and hunting 630,344.07 50.86% 22 Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers 234,304.63 31.91% 48-49 Transportation, postage, and warehousing 682,499.14 27.21% 54 Professional, scientific, and technical services 155,642.26 26.37% 46 Retail trade 477,034.24 17.72% 52 Financial and insurance services 185,136.92 13.40% 51 Mass media information 79,296.98 12.22% Total 15,138,504.47 380.65% Average 1,513,850.45 38.07% SOURCE: In-house, prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 33 ATLANTIC COUNCIL APPENDIX F THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix F2: Analysis with reduced wait times A second input-output analysis was performed to determine how the positive economic shock (increased Mexican exports caused by reduced border wait times) affected total gross production per sector (Xj,t). This is estimated using equation (4) in Appendix D2 [Xj,t= (I-A)-1E'j,t], where E'j,t is the exports vector and j the number of sectors. Given the interdependencies between sectors, the economic impact of reduced border wait times spreads throughout productive sectors in the Mexican economy. Therefore, results show the average percentage increase in output, aggregate demand, and final sales per sector driven by additional Mexican exports to the United States (caused by a one-minute reduction in border wait times). Table F2.1 shows findings in terms of total gross output, while Tables F2.2 and F2.3 include results for aggregate demand and intermediate sales, respectively. NAICS Table F2.1: Growth in Total Gross Output (TGO)49 Total Gross Output Classification Sectors code Absolute (TGO) Change driven by Mexican exports Percentage increase 11 Agriculture, animal breeding and exploitation, forestry, fishing, and hunting 61,870,394,408.39 63,525,716,328.93 2.68% 21 Mining 70,768,853,919.12 73,333,868,768.35 3.62% 22 Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers 36,661,826,110.83 37,277,124,334.51 1.68% 31-33 Manufacturing industries 725,175,223,165.25 751,416,123,114.45 3.62% 43 Wholesale trade 136,148,265,851.22 140,678,214,854.59 3.33% 46 Retail trade 134,388,874,388.42 135,641,595,360.59 0.93% 48-49 Transportation, postage, and warehousing 125,222,060,808.79 127,014,345,127.69 1.43% 51 Mass media information 32,404,278,182.73 32,612,516,876.33 0.64% 52 Financial and insurance services 68,962,248,726.91 69,448,429,551.32 0.70% 54 Professional, scientific, and technical services 29,468,317,923.12 29,877,043,990.12 1.39% Average 142,107,034,348.48 146,082,497,830.69 2.00% SOURCE: In-house, prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 34 ATLANTIC COUNCIL APPENDIX F NAICS THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table F2.2: Growth in intermediate sales50 Intermediate Sales Classification Sectors code Absolute intermediate sales Change driven by Mexican exports Percentage increase 11 Agriculture, animal breeding and exploitation, forestry, fishing, and hunting 37,715,987,831.23 39,017,404,257.82 3.45% 21 Mining 38,319,742,304.75 39,627,221,214.17 3.41% 22 Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers 26,093,440,432.45 26,698,820,186.23 2.32% 31-33 Manufacturing industries 500,578,423,695.96 515,136,851,491.74 2.91% 43 Wholesale trade 50,588,439,711.28 52,014,146,106.25 2.82% 46 Retail trade 20,372,948,351.47 20,891,889,251.96 2.55% 48-49 Transportation, postage, and warehousing 27,507,131,659.31 28,135,165,832.62 2.28% 51 Mass media information 14,218,572,797.10 14,418,468,679.28 1.41% 52 Financial and insurance services 23,171,318,014.63 23,506,746,665.51 1.45% 54 Professional, scientific, and technical services 27,550,006,467.55 27,955,133,873.68 1.47% Average 76,611,601,126.57 78,740,184,755.93 2.41% SOURCE: In-house, prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). Table F2.3: Growth in final demand51 NAICS Classification Sectors Final demand code Absolute aggregate demand Change driven by Mexican exports Percentage increase 11 Agriculture, animal breeding and exploitation, forestry, fishing, and hunting 24,154,406,577.15 24,508,312,071.11 1.47% 21 Mining 32,449,111,614.37 33,706,647,554.19 3.88% 22 Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers 10,568,385,678.38 10,578,304,148.28 0.09% 31-33 Manufacturing industries 224,596,799,469.30 236,279,271,622.71 5.20% 43 Wholesale trade 85,559,826,139.94 88,664,068,748.35 3.63% 46 Retail trade 114,015,926,036.95 114,749,706,108.63 0.64% 48-49 Transportation, postage, and warehousing 97,714,929,149.48 98,879,179,295.07 1.19% 51 Mass media information 18,185,705,385.62 18,194,048,197.05 0.05% 52 Financial and insurance services 45,790,930,712.28 45,941,682,885.81 0.33% 54 Professional, scientific, and technical services 1,918,311,455.57 1,921,910,116.43 0.19% Average 65,495,433,221.90 67,342,313,074.76 1.67% SOURCE: In-house, prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 35 ATLANTIC COUNCIL APPENDIX G THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX G: ECONOMIC IMPACT ON EMPLOYMENT AND LABOR INCOME Appendix G1: Employment The effect of a 10-minute reduction in commercial wait times on direct employment in Mexico was estimated using the multiplier: l= LT [diag(X)-1] (6) Where: l = the direct employment coefficient LT = the employment generated per sector52 [diag(X)-1] = the diagonal matrix of total gross output (obtained via the input-output model) To assess the impact on direct and indirect employment, the direct employment coefficient (l) is multiplied by the Leontief inverse: MED-1 = l[(I-A)-1] (7) Table G1 shows the original jobs per sector and the new jobs created as a result of increased exports following a 10-minute reduction in commercial wait times. It also includes the difference between these two values and the relative increase and net variation in employment. Results show that 18,697 jobs would be created in one year. NAICS Classification code Table G1: Impact on Direct and Indirect Employment of a More Efficient US-Mexico Border Sectores Original New Difference Relative Increase Net Variation 11 Agriculture, animal breeding and ex ploitation, forestry, fishing, and hunting 5.9 6.6 0.7 0.3% 748.2 21 Mining 5.9 8.1 2.2 1.2% 2,220.1 22 Electric power generation, transmis sion and diffusion, and water and gas supply through pipelines to final consumers 7.4 7.5 0.1 0.1% 129.3 31-33 Manufacturing industries 13.6 12.8 -0.8 0.0% -793.1 43 Wholesale trade 8.4 11.6 3.2 0.2% 3,216.0 46 Retail trade 24.7 26.4 1.7 0.0% 1,748.8 48-49 Transportation, postage, and ware housing 10.3 10.1 -0.2 0.0% -210.3 51 Mass media information 12.0 15.7 3.7 1.0% 3,684.5 52 Financial and insurance services 10.1 15.6 5.5 0.8% 5,505.5 54 Professional, scientific, and technical services 18.6 21 2.4 0.3% 2,448.6 Total 116.9 135.4 18.5 3.9% 1,8697.6 Average 11.7 13.5 1.9 0.4% 1,869.8 SOURCE: In-house prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 36 ATLANTIC COUNCIL APPENDIX G THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix G2: Labor income The effect of a 10-minute reduction in commercial wait times on labor income in Mexico was estimated using a two-step process. First, the labor income coefficient was determined with the equation: r= RemT [diag(X)-1] (8) Where: r = the labor income coefficient RemT = the labor income per sector 53 [diag(X)-1] = the diagonal matrix of total gross output Second, the labor income coefficient (r) was multiplied by the Leontief inverse: MRemD-1 =r[(I-A)-1] (9) Table G2 shows the direct and indirect effects on labor income of increased Mexican exports to the United States stemming reductions in commercial wait times. It includes labor income per sector before reduced wait times (original), labor income after reduced wait times (new), the difference between these two values, and the relative increase and net variation in labor income. Results show that, overall, labor income would increase by $17,474 with a one-minute reduction in border wait times or $174,474 with a ten minute reduction. NAICS Table G2: Impact on Labor Income of a More Efficient US-Mexico Border One-minute 10-minute Relative Classification code Sector Original New Difference reduction in wait times reduction in wait times weight Agriculture, animal breeding and exploita tion, forestry, fishing, and hunting 0.04 0.05 0.01 $ 324.72 $3,247.21 Mining 0.10 0.15 0.05 $ 2,643.81 $26,438.14 Electric power genera tion, transmission and diffusion, and water and gas supply through pipe lines to final consumers 0.08 0.09 0.01 $ 711.73 $7,117.31 Manufacturing industries 0.14 0.15 0.01 $ 467.19 $4,671.91 Wholesale trade 0.08 0.16 0.08 $ 3,852.29 $38,522.90 Retail trade 0.09 0.13 0.04 $ 1,766.03 $17,660.32 Transportation, postage, and warehousing 0.10 0.10 0.00 $ (89.37) $(893.65) Mass media information 0.17 0.23 0.06 $ 2,895.81 $28,958.10 Financial and insurance services 0.16 0.23 0.07 $ 3,574.24 $35,742.39 Professional, scientific, and technical services 0.14 0.17 0.03 $ 1,327.86 $13,278.59 Total $ 17,474.32 $174,743.23 111.9% 21 15.1% 224.1% 31-33 2.7% 43 22.0% 46 10.1% 48-49 -0.5% 51 16.6% 52 20.5% 54 7.6% Average $ 1,747.43 $17,474.32 SOURCE: In-house prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 37 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Acknowledgments This report was informed by roundtables, focus groups, and consultations carried out in the United States and Mexico and the analysis of economic data. We thank the many individuals and institutions who participated in project activities and research efforts. It was a true pleasure to work with our partners at the University of Texas at El Paso’s (UTEP’s) Hunt Institute for Global Competitiveness and Colegio de la Frontera Norte (COLEF). We are deeply grateful to the Adrienne Arsht Latin America Center (AALAC) team, who worked tirelessly to produce this report, particularly to Camila Hernández and Ignacia Ulloa, who provided invaluable writing and editorial support. Thank you to Jason Marczak, senior director for AALAC, and Maria Fernanda Bozmoski, deputy director for programs, for their guidance and editorial support. We thank AALAC Non-Resident Fellow Bosco Martí and the Global Nexus team, specifically Ruben Olmos, Ana Margarita Martínez, and Alejandro Vales, for providing crucial expertise and contributions. Our gratitude extends to Rhonda Shore for her diligent editorial work and to Donald Partyka and Anais Gonzalez for their exceptional design skills. Most importantly, we thank the US Department of State’s Bureau for International Narcotics and Law Enforcement Affairs for giving the Atlantic Council, UTEP, and COLEF the opportunity to produce this report in service of daily border users and strengthening the US and Mexican economies. 38 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Endnotes 1 Government of the United States, “Trade in Goods with Mexico,” US Census Bureau, accessed August 16, 2022, https://www.census.gov/foreign-trade/balance/c2010.html; and Government of the United States, “Monthly U.S. International Trade in Goods and Services, June 2022,” US Census Bureau and US Department of Commerce, August 4, 2022, https://www.census.gov/foreign-trade/Press-Release/current_press_release/ft900.pdf. 2 Government of the United States, “Overview of US- North American Freight by Port, Commodity Group, and Mode - Value (in Millions),” US Department of Transportation, accessed August 16, 2022, https://explore.dot.gov/views/Dashboard_PortbyCommodity/Overview?%3Aembed=y&%3Aiid=1&%3AisGuestRedirectFromVizportal=y. 3 Government of Mexico, “US-Mexico Trade Relation,” Embassy of Mexico to the United States of America, Section of Economic Affairs, February 2022, https://embamex.sre.gob.mx/eua/images/stories/economicos/2022/documents/US-MX_Trade_Website_02-2022.pdf. 4 Government of Mexico, Secretariat of Foreign Affairs, Embassy of Mexico to the United States of America, Office of Political Affairs. Information acquired September 8, 2022. 5 Government of the United States, “Mexico: US-Mexico Trade Facts,” Office of the US Trade Representative, accessed August 14, 2022, https://ustr.gov/countries-regions/americas/mexico. 6 Joint Statement by President Biden and President Lopez Obrador, The White House, July 12, 2022, https://www.whitehouse.gov/briefing-room/statements-releases/2022/07/12/president-biden-and-president-lopez-obrador-joint-statement/. 7 The US-Mexico High-Level Economic Dialogue is an opportunity for Mexico and the United States to advance strategic economic and commercial priorities to foster economic development and growth, job creation, and global competitiveness and reduce poverty and inequality. 8 Government of the United States, “Mexico: US-Mexico Trade Facts,” US Trade Representative, accessed August 16, 2022, https://ustr.gov/countries-regions/americas/mexico. 9 Zahniser, Stephen. “COVID-19 Working Paper: U.S.-Mexico Agricultural Trade in 2020,” United States Department of Agriculture, Economic Research Service. January, 2022. 10 Michoacán, Mexico, exports approximately 80 percent of its avocado supply directly to the United States. Government of the United States, “Fresh Avocado Imports from Mexico Resume,” Animal and Plant Inspection Service, United States Department of Agriculture, accessed August 20, 2022. https://www.aphis.usda.gov/aphis/newsroom/stakeholder-info/sa_by_date/sa-2022/avocado-imports-mexico. 11 Ibid 12 Government of the United States, “Hourly Wait Times Trends vs Current,” Customs and Border Protection, accessed August 17, 2022, https://bwt.cbp.gov/details/09250401/POV. 13 Unified Cargo Processing is a program for joint inspection of northbound cargo via free and secure trade lanes. John Davis, “U.S. and Mexico United in Cargo Processing,” US Customs and Border Protection, last modified January 4, 2022, https://www.cbp.gov/frontline/cargo-processing.. 14 Global Entry and the Secure Electronic Network for Travelers Rapid Inspection are risk-based programs that allow expedited clearance for pre-approved, low-risk travelers upon arrival in the United States. Government of the United States, “Global Entry: Trusted Traveler Program Enrollment,” US Customs and Border Protection, last modified September 6, 2022, https://www.cbp.gov/travel/trusted-traveler-programs/global-entry; and Government of the United States, “Secure Electronic Network for Travelers Rapid Inspection,” US Customs and Border Protection, last modified January 4, 2022, https://www.cbp.gov/travel/trusted-traveler-programs/sentri. 15 The Customs Trade Partnership Against Terrorism is a voluntary supply chain security partnership used by the public and private sectors. Government of the United States, “CTPAT: Customs Trade Partnership Against Terrorism,” US Customs and Border Protection, last modified August 29, 2022, https://www.cbp.gov/border-security/ports-entry/cargo-security/CTPAT. 16 “SENTRI Program Requirements,” Immigration Passport Visa Service, accessed August 17, 2022, http://immigrationpassportvisa.com/travel/sentri-pass program-requirements/#:~:text=Over%20175%2C000%20US%20citizens%20and%20Mexican%20citizens%20have%20become%20card%20holders. 17 The Maquiladora Export Industry is a conglomerate of intermediate-good manufacturing companies. 18 According to the North American Industry Classification System (NAICS), a classification scheme for Mexican productive activities that dates to 1993 and collects information on businesses, households, and individuals. In the development of this study, the consortium also referred to the Automated Census Information System (ACIS), which allowed for adjustments and specifications of data. For additional information on NAICS and ACIS, see Appendix G. 19 Vehicle and Cargo Inspection System (VACIS) and Federal Motor Carrier Safety Administration (FMCSA). 20 The Interagency Border Inspection System is a computer-based system that provides law enforcement access to drivers’ criminal records and other information used to screen vehicles crossing the border. 21 Border users were consulted during roundtables hosted by the Atlantic Council. The first took place on May 10, 2022, in El Paso, Texas, in collaboration with the Hunt Institute for Global Competitiveness at the University of Texas at El Paso. The second occurred on July 12, 2022, in Tijuana, Mexico, in collaboration with El Colegio de la Frontera Norte. 22 According to research by the Hunt Institute for Global Competitiveness, 4,720,967 container trucks crossed the border in 2021. 23 A 10-minute reduction in commercial wait times would allow $25,879,549 million, specifically in additional cargo value, to enter the United States monthly. See Appendix C1 for more information. 24 This section focuses on crossings by individuals and families in noncommercial vehicles alone. Migrant caravans at the US-Mexico border disrupted standard pedestrian crossing patterns during the sample period, preventing the analysis of pedestrian traffic using the regression model described in Appendix B. Further research is needed to estimate the economic impact of additional pedestrian crossings following a reduction in border wait times. 25 Per Table 2, these purchases generated an economic impact of $12,332,697,547 for the US economy. The economic impact of cross-border spending was determined by mapping out expenditure categories and running INPLAN’s multi-region input-output feature. 26 Given the nature of available data for the input-output analysis (macroeconomic data from Mexico’s National Institute of Statistics and Geography (INEGI), which captures the commercial relationship between the United States and Mexico), this section exclusively focuses on commercial crossings from Mexico into the United States. The economic impact for Mexican families and workers was estimated by considering how changes in the US-Mexico commercial relationship affect employment and labor income. 27 Government of the United States, “U.S.-Mexico Trade Relations,” Congressional Research Service, updated April 25, 2021, https://sgp.fas.org/crs/row/IF11175.pdf. 28 The ten sectors are mining; manufacturing; wholesale trade; agriculture, animal breeding and exploitation, forestry, fishing, and hunting; electric power generation, transmission and diffusion, and water and gas supply; transportation, postage, and warehousing; professional, scientific, and technical services; retail trade; financial and insurance services; and mass media information. 29 “U.S.-Mexico Trade Relations,” Congressional Research Service. https://sgp.fas.org/crs/row/IF11175.pdf 30 “México supera a Japón y lidera por primera vez envíos de autos a Estados Unidos” (“Mexico surpasses Japan and leads car shipments to the United States for the first time”), El Economista, September 5, 2022, https://dfsud.com/america/mexico-supera-a-japon-y-lidera-por-primera-vez-envios-de-autos-a-estados. 31 See Appendix C1. 32 As described in the report, the regression analysis did not include pedestrian crossings due to the impact of migrant caravans during the period under study. 39 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER 33 Missing data was excluded from averages. 34 The correlation between wait times and crossings is 0.2977. This is likely because congestion at the border may result in both increased wait times and a higher number of crossings. 35 The sample ends prior to 2020 to avoid disruptions in border crossings due to COVID-19. See Appendix A for a detailed description of the data. 36 The fixed effect, i, accounts for time-constant heterogeneity between counties in the analysis. Estimating the regression equation by fixed effects removes this time-constant heterogeneity, effectively controlling for the immutable differences between counties. 37 Spending categories include clothing, general merchandise, auto parts, groceries, electronics, restaurants, gas, sports and music, building, furniture, personal care services, fast food, health, business and other professional services, amusement and recreation, accommodation, bar, theater, transportation and parking, and other products. 38 The sixteen counties used in the analysis were El Paso, Presidio, Val Verde, Maverick, Webb, Starr, Hidalgo, Cameron, Luna, Dona Ana, Yuma, Pima, Santa Cruz, Cochise, San Diego, and Imperial. 39 The total number of crossers was determined using data from the Bureau of Transportation Statistics. 40 This could also be the average arrival rate. 41 This could also be the average service rate. 42 Government of the United States, “Bureau of Transportation Statistics: Border Crossing/Entry Data,” US Department of Transportation, accessed August 18, 2022, https://www.bts.gov/browse-statistical-products-and-data/border-crossing-data/border-crossingentry-data#:~:text=Border%20 crossing%20data%20are%20collected,comparable%20data%20on%20outbound%20crossings.. 43 Scott Mall, “FreightWaves Classics: Otay Mesa Land Port is third-busiest on U.S.-Mexico border,” Freightwaves, May 12, 2021, https://www.freightwaves.com/news/freightwaves-classics-otay-mesa-land-port-is-third-busiest-on-us-mexico-border. 44 Ports of entry with extremely atypical wait times (anomalies) were disregarded in this paper’s analysis. 45 The ACIS systematizes information from Mexico’s four most recent economic censuses, which occurred in 2019, 2014, 2009, and 2004. 46 An input-output matrix represents national or regional economic accounting that records how industries trade with one another and produce for consumption and investments. 47 The RAS method is an interactive method for data reconciliation. It scales an input-output table bi-proportionally to achieve consistency between given row and column sums. For a detailed description of the methodology used by INEGI, see “Matrices de Contabilidad Social de México: Fuentes y metodología,” INEGI, accessed August 18, 2022, https://inegi.org.mx/contenidos/investigacion/mcsm/doc/fuente_y_metodologia.pdf. 48 Originally in 2018 Mexican pesos and converted to US dollars using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results are in 2018 values. 49 Originally in 2018 Mexican pesos and converted to US dollars using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results are in 2018 values. 50 Originally in 2018 Mexican pesos and converted to US dollars using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results are in 2018 values. 51 Originally in 2018 Mexican pesos and converted to US dollars using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results are in 2018 values. 52 Total employment per sector was obtained from INEGI, using 2018 data. 53 Total labor income per sector was obtained from INEGI, using 2018 data in Mexican pesos (millions). 40 ATLANTIC COUNCIL CHAIRMAN John F.W. Rogers EXECUTIVE CHAIRMAN EMERITUS James L. Jones PRESIDENT ANDCEO Frederick Kempe EXECUTIVE VICE CHAIRS Adrienne Arsht Stephen J. Hadley VICE CHAIRS Robert J. Abernethy C. Boyden Gray Alexander V. Mirtchev TREASURER George Lund DIRECTORS Todd Achilles Timothy D. Adams Michael Andersson David D. Aufhauser Barbara Barrett Colleen Bell Stephen Biegun Linden P. Blue Adam Boehler John Bonsell Philip M. Breedlove Myron Brilliant Esther Brimmer Richard R. Burt Teresa Carlson James E. Cartwright John E. Chapoton Ahmed Charai Melanie Chen Michael Chertoff George Chopivsky Wesley K. Clark Helima Croft Ankit N. Desai Dario Deste Paula J. Dobriansky Joseph F. Dunford, Jr. Richard Edelman Thomas J. Egan, Jr. Stuart E. Eizenstat Mark T. Esper Michael Fisch Alan H. Fleischmann Jendayi E. Frazer Meg Gentle Thomas H. Glocer John B. Goodman Sherri W. Goodman Jarosław Grzesiak Murathan Günal Frank Haun Michael V. Hayden Tim Holt Karl V. Hopkins Kay Bailey Hutchison Ian Ihnatowycz Mark Isakowitz Wolfgang F. Ischinger Deborah Lee James Joia M. Johnson Safi Kalo Andre Kelleners Brian L. Kelly Henry A. Kissinger John E. Klein C. Jeffrey Knittel Joseph Konzelmann Franklin D. Kramer Laura Lane Almar Latour Yann Le Pallec Jan M. Lodal Douglas Lute Jane Holl Lute William J. Lynn Mark Machin Umer Mansha Marco Margheri Michael Margolis Chris Marlin William Marron Christian Marrone Gerardo Mato Timothy McBride Erin McGrain John M. McHugh Judith A. Miller Dariusz Mioduski Michael J. Morell Richard Morningstar Georgette Mosbacher Majida Mourad Dambisa F. Moyo Virginia A. Mulberger Mary Claire Murphy Edward J. Newberry Franco Nuschese Joseph S. Nye Ahmet M.Ören Sally A. Painter Ana I. Palacio Kostas Pantazopoulos Alan Pellegrini David H. Petraeus Lisa Pollina Daniel B. Poneman Dina H. Powell dddMcCormick Michael Punke Ashraf Qazi Thomas J. Ridge Gary Rieschel Lawrence Di Rita Michael J. Rogers Charles O. Rossotti Harry Sachinis C. Michael Scaparrotti Ivan A. Schlager Rajiv Shah Gregg Sherrill Jeff Shockey Ali Jehangir Siddiqui Kris Singh Walter Slocombe Christopher Smith Clifford M. Sobel James G. Stavridis Michael S. Steele Richard J.A. Steele Mary Streett Gil Tenzer Frances M. Townsend Clyde C. Tuggle Melanne Verveer Charles F. Wald Michael F. Walsh Ronald Weiser Al Williams Maciej Witucki Neal S. Wolin Jenny Wood Guang Yang Mary C. Yates Dov S. Zakheim HONORARY DIRECTORS James A. Baker, III Ashton B. Carter Robert M. Gates James N. Mattis Michael G. Mullen Leon E. Panetta William J. Perry Condoleezza Rice Horst Teltschik William H. 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Declare: "I need more provided context", when a User query implies interest in a new field or topic. EVIDENCE: Atlantic Council ADRIENNE ARSHT LATIN AMERICA CENTER The Economic Impact of aMore Efficient US-MexicoBorder How Reducing Wait Times at Land Ports of Entry Would Promote Commerce, Resilience, and Job Creation Report Contributors: Alejandro Brugués Rodríguez, John Byrd, Noé Arón Fuentes Flores, David Gaytan, John Gibson, Camila Hernández, Mayra Maldonado, Jason Marczak, Jorge Eduardo Mendoza Cota, Roberto Ransom, and Ignacia Ulloa Atlantic Council ADRIENNE ARSHT LATIN AMERICA CENTER The Atlantic Council’s nonpartisan Adrienne Arsht Latin America Center (AALAC) broadens understanding of regional transformations while demonstrating why Latin America and the Caribbean matter for the world. The center focuses on pressing political, economic, and social issues that will define the region’s trajectory, proposing constructive, results-oriented solutions to inform public sector, business, and multilateral action based on a shared vision for a more prosperous, inclusive, and sustainable future. AALAC – home to the premier Caribbean Initiative – builds consensus for action in advancing innovative policy perspectives within select lines of programing: U.S. policy in the Western Hemisphere; Colombia’s future; Venezuela’s multidimensional crisis; Central American prosperity; US-Mexico ties; China in the Americas; Brazil’s trajectory; Caribbean development; regional economic development and commerce; and energy transitions. Jason Marczak serves as the center’s senior director. This report is written and published in accordance with the Atlantic Council Policy on Intellectual Independence. The authors are solely responsible for its analysis and recommendations. The Atlantic Council and its donors do not determine, nor do they necessarily endorse or advocate for, any of this report’s conclusions. Atlantic Council 1030 15th Street NW, 12th Floor Washington, DC 20005 For more information, please visit www.AtlanticCouncil.org. ISBN-13: 978-1-61977-250-2 September 2022 A joint report by the Atlantic Council’s Adrienne Arsht Latin America Center, the University of Texas at El Paso’s Hunt Institute for Global Competitiveness, and El Colegio de la Frontera Norte. Atlantic Council ADRIENNE ARSHT LATIN AMERICA CENTER The Economic Impact of aMore Efficient US-MexicoBorder How Reducing Wait Times at Land Ports of Entry Would Promote Commerce, Resilience, and Job Creation (The first of a two-part series on the US-Mexico Border) Report Contributors: Alejandro Brugués Rodríguez, John Byrd, Noé Arón Fuentes Flores, David Gaytan, John Gibson, Camila Hernández, Mayra Maldonado, Jason Marczak, Jorge Eduardo Mendoza Cota, Roberto Ransom, and Ignacia Ulloa Table of Contents EXECUTIVE SUMMARY 6 INTRODUCTION 7 WHY INVEST IN THE US-MEXICO BORDER? 8 BORDER WAIT TIMES: A CONTINUED CHALLENGE 9 THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER 11 The United States: Increased border efficiency would strengthen the economy 12 Mexico: The potential economic gains of a more efficient border 15 CONCLUSION 17 METHODOLOGY 18 APPENDICES 19 ACKNOWLEDGMENTS 38 THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER “We know that long wait times at the border can hurt our businesses and economy, especially in my district. Ensuring our ports of entry have sufficient funding to reduce wait times is necessary to keep our economy on track and ensure businesses on both sides of the border succeed.” The Hon. Juan Vargas Representative (D-CA-51) US HOUSE OF REPRESENTATIVES “Strengthened US-Mexico collaboration at our border will unlock significant economic growth, promote supply chain resilience, and boost competitiveness, benefiting Mexican workers and families. These benefits will reverberate far beyond the border, reaching states throughout Mexico. Now is the time to invest in initiatives to create an even more efficient and secure shared border.” H.E. Luz Maria de la Mora Subsecretary of International Commerce, Secretariat of the Economy UNITED MEXICAN STATES “Our border communities rely on efficient and effective infrastructure for work, trade, tourism and other economic exchanges across the US-Mexico border. As the North American region seeks to retain its competitive global advantage, it is more important than ever for these communities to have access to top-notch ports of entry, staffing and technology. With the proper tools for border management, our border cities will be enabled to prosper now and well into the future.” The Hon. Tony Gonzales Representative (R-TX-23) US HOUSE OF REPRESENTATIVES 5 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Executive Summary Improvements in border management and the adoption of new technologies at the US-Mexico border have the potential to enhance security and generate economic benefits for the United States and Mexico through expedited flows of goods and people. Reduced border wait times would lead to more traffic entering the United States from Mexico, both in terms of commercial trucks loaded with goods for US consumers and shoppers ready to buy US goods. This report quantifies the economic impact of this additional commerce and cross-border spending, which would lead to further economic prosperity in the two countries. Research shows that a 10-minute reduction in wait times could lead to an additional $26 million worth of cargo entering the United States each month via commercial vehicles. This translates to more than $312 million in further commerce from Mexico into the United States annually. The extra inventory of finished and intermediate goods would drive down US domestic prices, creating increased economic well-being for US citizens. This report also finds that reducing border wait times by 10 minutes has a positive annual impact of $5.4 million on the US economy due to purchases by additional families and individuals entering the United States from Mexico. While the immediate effect of these purchases is most evident in border communities, economic benefits would spread to the continental United States due to the economic linkages between local economies, with approximately 25 percent of the total impact reaching non-border states. Beyond the $312 million in added commerce from Mexico into the United States, a 10-minute reduction in border wait times would promote the creation of nearly 18,700 direct and indirect jobs in Mexico, increase labor income per sector by an average of $17,474, and simulate growth for various Mexican economic sectors, particularly manufacturing, wholesale trade, and mining. More specifically, a one-minute reduction in border wait times would increase the average production (or output) per sector—for Mexico’s top ten sectors exporting to the United States—by 2 percent. This reduction in border wait times would also boost intermediate sales and aggregate demand in Mexico by 2.4 percent and 1.7 percent, respectively. These findings illustrate the economic benefits of prioritizing investments at the US-Mexico border to reduce commercial and noncommercial wait times. They are understood as the lower range of the potential national-level economic benefits of deepened US-Mexico collaboration to create a more efficient and secure border. A forthcoming second study will build on these findings, disaggregating the economic impact of reduced wait times for US and Mexican states and counties at the border and beyond. Trucks pass through the U.S. border and into the United States from Juarez, Mexico in El Paso, Texas, U.S. June 18, 2018. REUTERS/Mike Blake 6 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Introduction The US-Mexico border is a hub of cultural and commercial exchange, fostering continued growth and collaboration between the United States and Mexico. Stretching over 2,000 miles, it has more than forty-four active ports of entry, with fifteen million US and Mexican citizens residing in border counties. In July 2022 alone, the United States and Mexico traded over $65 billion in goods,1 with more than $53 billion crossing the southern border via trucks and trains.2 Approximately five million US jobs depend on trade with Mexico,3 meaning that one in every twenty-nine workers in the United States has a job created or supported by US-Mexico trade. These jobs are spread throughout the US economy in terms of geography and industries. In Mexico’s automotive sector, US-Mexico trade supports more than one million jobs directly and 4.5 million indirectly.4 In addition to importing and exporting final products, the United States and Mexico jointly produce goods. Cross-border production sharing has contributed to greater economic integration, resilience, and competitiveness while helping to insulate the US and Mexican economies from global competitors. Similarly, US-Mexico trade in services contributes to the commercial relationship, with over $62 billion traded in 2019.5 On July 12, 2022, US President Joseph R. Biden and Mexican President Andrés Manuel López Obrador met in Washington, DC, to discuss how safer and more efficient borders would enhance shared commerce.6 During their meeting, the United States committed to investing $3.4 billion and Mexico $1.5 billion to undertake major projects to modernize land ports of entry on the northern and southern borders. These efforts will create jobs, bolster shared security, and enhance supply chain resilience by promoting legitimate trade and travel. New investments should continue to enhance shared commerce while addressing long-standing efficiency and security challenges, including excessive wait times, inconsistent federal policies, outdated screening technologies, and the illicit flow of weapons, drugs, contraband, and people. Future US-Mexico cooperation should also build on prior efforts to modernize border infrastructure, expedite processing times, and implement joint production programs through accords such as the United States Mexico-Canada Agreement (USMCA). It could also prioritize new information-sharing infrastructure, shared defense strategies, bilateral-processing mechanisms, and expanded trusted traveler programs. The long-term institutionalization of standing working groups like the US-Mexico High-Level Economic Dialogue (HLED) will help the United States and Mexico align priorities and advance shared development goals moving forward—as evidenced through the joint commitments made at the September 12, 2022, HLED meeting.7 This report—the first in a two-part series—shows that US-Mexico cooperation aimed at creating a more efficient, resilient, and secure border will enhance shared commerce and economic well-being through the expedited flow of goods and people. Reduced border wait times would allow more commercial and noncommercial vehicles to enter the United States from Mexico, bolstering cross border trade and spending and stimulating competitiveness, economic integration, and job creation. This report includes national-level findings, while a second report disaggregates results by county and state, showing that investing in the US-Mexico border will pay dividends far beyond the border. 7 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Why Invest in the US-Mexico Border? The United States and Mexico rely on each other to meet their populations’ demand for goods and services. Mexico stands as one of the United States’ largest trading partners in terms of goods, ranking first in 2019 with more than $614 billion in total (two-way) goods traded that year.8 Recent disruptions to cross-border commerce illustrate this interdependence, with important economic implications for populations on both sides of the border. As COVID-19 first raged worldwide, shutting down economies in the spring of 2020, the US-Mexico border was not immune to the global lockdown. Disruptions in cross-border flows of goods and people resulted in unemployment, curtailed retail sales, and decreased revenue for the tourism industry. In Texas alone, the tourism industry lost $1.02 billion over the course of eight months of border closures. In Mexico, agricultural exports decreased 5.9 percent between March and May of 2020, with a 17.9 percent decrease in sugar exports compared to 2019.9 Avocados are another example of US-Mexico economic interdependence. Approximately nine of ten avocados in US supermarkets come from Mexico.10 In 2021 alone, the United States imported more than 1.1 million metric tons of avocados from Mexico, totaling over $2.8 billion. However, a temporary suspension of avocado imports—due to a verbal threat received by a US inspector in Michoacán—led to concerns over shortages and price increases across the United States.11 Fortunately, the eight-day suspension did not have a lasting impact on local economies or spoil the fruit waiting for export. Soon after the suspension was lifted, avocados quickly returned to US supermarkets to satisfy consumer demand. The story of COVID-related commerce disruptions and the avocado example not only illustrate the two countries’ economic interdependence but also the importance of safe and efficient borders. According to US Customs and Border Protection (CBP), the average border-crossing wait time per truck regularly surpasses 125 minutes during regular-to-peak crossing hours.12 Multiplied by the average of 19,617 trucks crossing the border daily, the lost revenue amounts to millions of dollars annually for the United States and Mexico. Cross-border spending by noncommercial entities (families and individuals) also directly impacts the US and Mexican economies. Cities along the southern border of the United States have become attractive commercial poles that draw customers from Mexico up to 75 miles (120 kilometers) away for daily consumption of goods and services. This is partly due to trade mechanisms becoming antiquated under new international trade agreements (originally designed to retain customers in local markets and supply border counties with national products) and the limitations of the Mexican domestic market, which often translates to higher prices and lower quality in goods such as food, clothing, footwear, and household equipment. The United States and Mexico have created a series of tools to expedite border crossings for pedestrians, trains, and commercial and noncommercial vehicles, including Unified Cargo Processing,13 Global Entry, Secure Electronic Network for Travelers Rapid Inspection (SENTRI),14 Customs Trade Partnership Against Terrorism,15 and other trusted traveler programs. However, these mechanisms only serve a small portion of daily border crossers, given high annual fees and other prohibitive eligibility requirements. For example, only 175,000 citizens in the United States and Mexico have become SENTRI card holders.16 Building on these and other programs is essential as US and Mexican leaders work together to tap the full economic potential of our shared border. 8 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Border Wait Times: A Continued Challenge Bottlenecks at land ports of entry along the US-Mexico border present a long-term challenge for economic integration, supply chain resilience, and competitiveness. While international production sharing programs such as the USMCA and the Maquiladora Export Industry17 have promoted mutually beneficial trade, they have contributed to border congestion by increasing the volume of vehicles requiring border inspections. Congestion and associated wait times are compounded by outdated technologies and limited information sharing within and between agencies in Mexico and the United States. Curtailing the illegal flow of weapons, drugs, contraband, and people also requires stringent and time-consuming border inspections that may lead to border delays. As shown in Figure 1, non-expedited cargo (commercial vehicles) entering the United States from Mexico undergoes a multistep inspection process. The first processing step involves examination by Mexican border agents who verify paperwork for outgoing goods, ensuring that tariffs are accurately assigned.18 Once cargo reaches US inspection booths, CBP officers first examine relevant documentation for incoming merchandise and drivers, who are then subject to automated regulation and tariff compliance reviews. At the officers’ discretion, cargo can undergo an additional canine or gamma ray inspection before being cleared for crossing. Noncommercial vehicles entering the United States from Mexico also undergo a multistep inspection process. Depending on the type of border crossing (i.e., land or bridge), vehicles could be required to pay tolls in cash or via electronic toll collection systems. Once completed, vehicles continue to US inspection points, where they can undergo up to two separate inspections. At the primary inspection booth, CBP officials verify travelers’ documentation and inquire about the purpose of their visit to the United States. If the Interagency Border Inspection System finds records of norm violation,20 CBP officers direct the vehicle toward secondary inspection. At the secondary inspection, officers conduct a thorough identity investigation, after which access to the United States is either granted or denied. Figure 1: Inspection Process for Commercial Vehicles at the US-Mexico Border19 1. Mexican Export Lot 2. US Federal Compound 3. State Safety Facility Warehouse / Yard Mexican export documentation verifications and cargo inspection selection Mexican export cargo inspection CBP primary inspection (document inspection) Secondary inspection VACIS, X-Ray, FMCSA `Others Visual vehicle safety inspection Detailed state truck safety inspection Warehouse / Yard Mexico United SOURCE: US Department of Transportation, Federal Highway Administration, “Border-wide Assessment of Intelligent Transportation System (ITS) Technology—Current and Future Concepts,” https://ops.fhwa.dot.gov/publications/fhwahop12015/ch2.htm, 2022. 9 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Trucks wait in a long queue for border customs control to cross into the U.S., in one of the main roads of Tijuana, Mexico, April 18, 2019. REUTERS/Andres Martinez Casares - RC1CE4339C90 Despite the implementation of numerous interventions to enhance the border-user experience, border users consulted while preparing this report expressed concerns about inconsistent federal policies that are not well attuned to their needs.21 For example, outdated technologies at port facilities lead to inaccurate time projections on official agency platforms, making border users turn to social media to better estimate wait and crossing times. Similarly, double inspection processes and unstandardized documentation requirements in different ports of entry generate delays in border crossings, which ultimately increase transport expenses. Finding ways to efficiently process the large volume of commercial and noncommercial vehicles crossing the border while safeguarding national security should remain a priority for the bilateral relationship. This will improve the border-user experience and result in substantial economic gains for both countries. 10 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER The Economic Impact of a More Efficient US-Mexico Border Reduced wait times at the US-Mexico directly impact the US and Mexican economies through increased cross border commerce (commercial vehicles) and spending (noncommercial vehicles). This section quantifies the nationwide dollar value that would result from additional traffic entering the United States from Mexico following a 10-minute reduction in border wait times. The economic impact is estimated for the US and Mexican economies. OUR APPROACH The Atlantic Council’s Adrienne Arsht Latin America Center partnered with the Hunt Institute for Global Competitiveness at the University of Texas at El Paso and El Colegio de la Frontera Norte to produce this two-part study. Findings in this first report result from roundtables, focus groups, and individual consultations carried out virtually across both countries and in-person in Washington, DC; El Paso, Texas; and Tijuana, Mexico; and the analysis of economic data from the United States and Mexico. This study utilizes two economic models; one uses US data, emphasizing the US economy, and another employs Mexican data, focusing on the Mexican economy. As a starting point, both sides of the border were viewed independently to account for discrepancies in data availability and the specific methodologies of local partners and stakeholders. By later harmonizing findings and data, the scope and range of results were extended, ultimately determining the costs and benefits of reducing border wait times for both economies. USEFUL TERMS • Commercial traffic: loaded or unloaded vehicles (usually trucks or trains) that cross the US-Mexico border with the intent to distribute goods produced in the country of origin. • Expenditure: the amount of money spent by noncommercial entities (families and individuals). • Aggregate demand: the total amount of demand for all finished goods and services produced in an economy. • Final good: a product that the final consumer uses or consumes. It does not require any additional processing. • Gross output: the measure of total economic activity in the production of new goods and services during an accounting period. • Labor income: the sum of employee compensation (wages and benefits) and proprietor income. • Intermediate good: a product used to produce a final good. • Intermediate sale: the sale of intermediate goods used in the production of final goods. • Noncommercial traffic: vehicles carrying passengers (tourists, workers, others) that do not transport goods to sell in the destination country. 11 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER The United States: Border Efficiency to Strengthen the Economy By John Byrd, John Gibson, Mayra Maldonado, and Roberto Ransom. University of Texas at El Paso’s Hunt Institute for Global Competitiveness Improved border management and the implementation of new technologies at the US-Mexico border have the potential to enhance border security and expedite legitimate trade and travel, stimulating the US and Mexican economies. A more efficient border would allow more commercial and noncommercial traffic to enter the United States from Mexico, resulting in additional goods for US consumers and businesses and more shoppers buying US goods and services. KEY TAKEAWAYS: A 10-minute reduction in wait times at the US-Mexico border would: • Five-hundred thirty-two additional commercial vehicles loaded with goods entering the United States from Mexico every month would generate an additional commercial intake of nearly $26 million monthly or $312 million annually. The extra inventory resulting from increased imports would reduce US domestic prices, thus promoting economic well-being for US citizens. • Sixty-thousand two-hundred forty additional noncommercial vehicles entering the United States from Mexico every month would generate an additional economic intake of $450,000 monthly, or $5.4 million annually. Border states would absorb approximately 75 percent of this economic impact, and the other 25 percent would reach non-border states in the United States. The Economic Impact of Additional Commercial Crossings In 2021, more than 4.7 million container trucks loaded with over $345.9 million worth of cargo entered the United States from Mexico via the US-Mexico border.22 Research shows that a one minute reduction in commercial wait times would result in 53 additional commercial crossings (see regression analysis in Appendix B). This means that a 10-minute reduction in wait times would result in approximately another 532 container trucks entering the United States every month. These containers may be loaded or unloaded. Therefore, estimating the economic impact of additional commercial crossings would require determining the proportion of loaded containers entering the United States via land ports of entry and the average cargo value of loaded containers. Data from the US Bureau of Transportation shows that approximately 73.1 percent of containers crossing the US-Mexico border are loaded with an average value of $66,798. Table 1 shows a breakdown of the average container value and the number of loaded and unloaded containers crossing the border through individual border counties. 12 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table 1: Proportion of Loaded Containers and Average Container Value (2019) State County Loaded Containers 2019 Unloaded Containers 2019 Loaded + Unloaded Containers Exports 2019 Imports 2019 Total Trade 2019 Average Value per Truck Texas El Paso 610,869 184,426 795,295 $31,717,503,019 $46,613,712,212 $78,331,215,231 $76,307 Texas Hudspeth 0 0 0 $- $- $- $- Texas Presidio 8,418 1,791 10,209 $144,896,195 $200,275,710 $345,171,905 $23,791 Texas Val Verde 59,951 15,651 75,602 $2,068,951,047 $3,082,037,002 $5,150,988,049 $51,409 Texas Maverick 149,732 30,298 180,030 $7,453,868,613 $22,197,870,144 $29,651,738,757 $148,251 Texas Webb 1,711,670 658,639 2,370,309 $95,124,653,587 $135,741,587,991 $230,866,241,578 $79,304 Texas Starr 38,611 17,958 56,569 $92,580,893 $387,724,994 $480,305,887 $10,042 Texas Hidalgo 502,312 213,297 715,609 $13,222,562,811 $23,522,857,942 $36,745,420,753 $46,829 Texas Cameron 153,280 134,796 288,076 $8,910,096,389 $8,930,388,221 $17,840,484,610 $58,262 New Mexico Luna 15,960 794 16,754 $23,980,387 $116,358,933 $140,339,320 $7,291 New Mexico Dona Ana 114,701 19,916 134,617 $14,098,068,953 $16,344,483,518 $30,442,552,471 $142,496 Arizona Yuma 28,342 8,823 37,165 $506,644,995 $875,099,032 $1,381,744,027 $30,876 Arizona Pima 303 12 315 $3,518,870 $1,794,662 $5,313,532 $5,923 Arizona Santa Cruz 293,771 66,136 359,907 $10,369,174,240 $15,633,063,045 $26,002,237,285 $53,215 Arizona Cochise 21,775 8,253 30,028 $802,531,798 $1,153,252,535 $1,955,784,333 $52,962 California San Diego 798,230 258,912 1,057,142 $17,279,207,288 $32,480,486,882 $49,759,694,170 $40,691 California Imperial 258,227 134,805 393,032 $7,023,568,716 $11,087,270,453 $18,110,839,169 $42,936 Total US Border 4,766,152 1,754,507 6,520,659 $208,841,807,801 $318,368,263,276 $527,210,071,077 Average $66,798 SOURCE: The Hunt Institute for Global Competitiveness and the COLEF using data from the Department of Transportation and the US Census Bureau. Based on these findings, a 10-minute reduction in commercial wait times would allow $26 million23 in additional cargo value to enter the United States monthly or $312 million annually. This added commerce from Mexico into the United States consists of various finished and intermediate goods demanded by US consumers and businesses. While it may be argued that additional consumer goods entering the United States via the southern border would result in fewer jobs in the United States, the extra inventory generated by these other imports would also drive down domestic prices. Furthermore, the inflow of intermediate goods serves as vital inputs that support US businesses. As such, more data and analysis are required to determine which of these offsetting effects dominate. The Economic Impact of Additional Noncommercial Crossings24 Improvements in border management tools and practices could also expedite the flow of noncommercial crossings, with positive repercussions for the US economy due to additional cross border spending. In 2021, nearly 126 million people entered the United States from Mexico to purchase goods and services from US businesses. As shown in Table 2, these purchases generated an economic impact of $12.3 billion for the US economy.25 While the four US border states—Arizona, California, New Mexico, and Texas—absorb 75 percent of this impact, approximately 25 percent 13 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table 2: Economic Impact of Cross-Border Spending in the United States (2022) Impact Employment Labor Income Value Added Output 1 - Direct 2 - Indirect 3 - Induced 60,619.16 $1,812,022,814.56 $2,765,047,740.91 $5,036,142,293.41 21,166.07 $1,234,825,927.30 $1,980,607,178.46 $4,118,866,436.04 18,648.05 $977,441,701.68 $1,771,486,445.19 $3,177,688,817.94 100,433.29 $4,024,290,443.54 $6,517,141,364.56 $12,332,697,547.38 SOURCE: The Hunt Institute for Global Competitiveness and the COLEF, using IMPLAN. bleeds directly into non-border states. This means that spending by shoppers from Mexico in US border states has an economic impact of $3.1 billion in the other forty-six US states. Research finds that a 10-minute reduction in wait times at the US-Mexico border would result in an average of approximately 5,020 additional noncommercial crossings every month, or 60,240 every year (see regression results in Appendix B). Determining the economic impact of these additional crossings requires data on the spending patterns of noncommercial crossers and a model to assess the economic impact of this spending. Appendix C provides technical details on how the data and model were used to calculate impact. Research shows that a 10-minute reduction in noncommercial wait times at the US-Mexico border would lead to a $450,000 positive economic impact on the US economy every month. Over the course of one year, this would add up to a monetary intake of $5.4 million. The top three industries that would most benefit from additional cross-border spending is concentrated in areas where tourists or temporary visitors are likely to spend money, particularly retail, full service restaurants, and general merchandise industries. For further information on sector-specific impacts, see Appendix C. Trucks wait in a queue for border customs control, to cross into the United States, at the Zaragoza-Ysleta border crossing bridge in Ciudad Juarez, Mexico April 30, 2020. REUTERS/Jose Luis Gonzalez 14 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Mexico: The Potential Economic Gains of Border Efficiency By David Gaytan, Noé Arón Fuentes Flores, Alejandro Brugués Rodríguez, and Jorge Eduardo Mendoza Cota. El Colegio de la Frontera Norte KEY TAKEAWAYS: A one-minute reduction in wait times at the US-Mexico border would: • Boost Mexican exports to the United States, increasing sectoral output by an average of 2 percent, intermediate sales by an average of 2.4 percent, and aggregate demand by an average of 1.7 percent. Sectors benefiting the most from reduced commercial wait times are those for which production is largely driven by US demand for export goods such as mining, manufacturing, wholesale trade, and agriculture. A 10-minute reduction in wait times at the US-Mexico border would: • Create nearly 18,700 additional direct and indirect Mexican jobs. These posts would be largely concentrated in financial services; wholesale trade; sports, cultural, and other recreational services; and professional, scientific, and technical services. • Lead to an overall increase of $174,474 in labor income. Expediting the flow of commercial traffic from Mexico into the United States would boost cross-border commerce, which impacts aggregate demand in Mexico, causing a change in total gross output and intermediate sales.26 These effects can be disaggregated by sector in the Mexican economy. Macroeconomic Impact of Additional Commercial Crossings Determining the sectoral economic impact of a more efficient US-Mexico border requires understanding the relationship between Mexico’s exports per sector and US demand for export goods. The United States stands as Mexico’s largest export market, with approximately 80 percent of Mexican exports destined for the United States.27 Nearly 100 percent of these exports are concentrated in ten sectors,28 accounting for $349 billion in 2018 and $358 billion in 2019 (for more information, see Appendix F).29 Therefore, this study only considers Mexico’s top-ten sectors in terms of exports to the United States. Within this group, the manufacturing and maquiladora export industries are particularly important, producing more than 60 percent of Mexico’s total exports to the United States. Today, Mexico stands as the top US supplier of motor vehicles and motor vehicle parts.30 Findings show that, on average, Mexican exports to the United States drive 38 percent of Mexican production (or output) per sector (for a detailed breakdown, see Appendix F). For mining, manufacturing, wholesale trade, and agriculture, exports to the United States drive more than 50 percent of total gross output. These four sectors alone are responsible for 84.4 percent of the total dollar value generated from exports to the United States, accounting for $664.26 billion out of the total $787.16 billion in total production. A significant portion of Mexican exports enters the United States via land ports across the US-Mexico border. An average of twenty-eight commercial vehicles with export goods arrive at the border every hour, with the average truck taking approximately 20 minutes to cross the border (for more information, see Appendix D3). Reducing wait times would boost Mexican exports by allowing additional commercial crossings into the United States. This would strengthen Mexican supply chains by stimulating the exchange of intermediate and final goods between sectors in response to the increased demand for export goods. Given that approximately 73.1 percent of containers crossing the US-Mexico border are loaded with an average value of $66,798,31 a one-minute reduction in commercial wait times would increase 15 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER sectoral output (total gross output) by an average of 2 percent. This output growth would be driven by a 1.7 percent increase in average demand per sector, occurring as a result of additional Mexican exports entering the United States. Intermediate sales (the sectoral exchange of intermediate goods for the production of additional export goods) would grow by an average of 2.4 percent per sector. Appendix D includes a detailed description of the two models used in the analysis, a queuing and input-output model. As Figure 2 shows, the benefits of increased commercial crossings into the United States are unequally distributed across sectors of the Mexican economy. The mining, manufacturing, and wholesale trade sectors experience the highest growth rates in production, at 3.62 percent, 3.62 percent, and 3.33 percent, respectively. These three sectors also have the largest increase in aggregate demand, growing at 3.88 percent, 5.20 percent, and 3.63 percent, respectively. Regarding intermediate sales, the agricultural and mining sectors have growth rates higher than 3 percent. Appendix F has a detailed breakdown of nominal and percentage growth in production (total gross output), intermediate sales, and aggregate demand following a one-minute reduction in border wait times. Economic Impact on Employment and Labor Income of Additional Commercial Crossings Moreover, this study finds that a 10-minute reduction in border wait times would promote the creation of nearly 18,700 indirect and direct jobs in Mexico over the course of one year, with 5,505 new positions opening in financial and insurance services, 3,684 in mass media information, 3,216 in wholesale trade, and 2,448 in professional, scientific, and technical posts. The loss in labor is far smaller, with an estimated 793 jobs lost in manufacturing and 210 in the transportation, postage, and warehousing sectors. (For detailed analysis, see Appendix G). A ten-minute reduction in commercial wait times would also result in a $174,474 increase in labor income. When disaggregated by sector, labor income growth is higher in the wholesale trade, financial and insurance services, information services, and mining sectors. Interestingly, this change would lead to more equitable distribution of labor income across Mexican economic sectors. However, the variation is driven mainly by increased production by sector rather than overall productivity. (For more information, see Appendix G). Figure 2: Growth of Total Gross Output, Aggregate Demand, and Intermediate Sales Total Production Growth Aggregate Demand Growth Intermediate Sales GrowthSOURCE: In-house prepared graph based on estimates for 2018 data, obtained from the National Institute of Statistics and Geography, 2022. 16 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Conclusion Trucks wait in a long queue for border customs control to cross into the United States at the World Trade Bridge in Nuevo Laredo, Mexico April 2, 2019. REUTERS/Daniel Becerril A more efficient US-Mexico border would expedite legitimate trade and travel, enhancing cross-border commerce and benefiting the US and Mexican economies. Streamlined border crossings could be achieved through improvements in border management practices and the adoption of new technologies. These efforts would also bolster shared security between the United States and Mexico. This report focused on the economic impact of expediting commercial and noncommercial crossings from Mexico into the United States. Reduced border wait times would increase the supply of goods and services for US consumers and stimulate spending in the United States while boosting Mexican exports into the United States. This would lead to an increasingly competitive, economically integrated, and resilient bilateral relationship. In the United States, a 10-minute reduction in border wait times would facilitate the crossing of 532 additional loaded trucks every month, generating an added commercial intake of nearly $26 million per month. In one year, the economic impact on the US economy would be $312 million. Similarly, it would allow 60,240 additional noncommercial vehicles to enter the United States every month, generating an extra economic intake of $450,000 monthly, or $5.4 million annually. The benefits of increased cross-border commerce and spending would extend throughout the United States due to the economic linkages between local economies. For Mexico’s top ten export sectors to the United States, a one minute reduction in commercial wait times would, on average, increase production (total gross output) by 2 percent, intermediate sales by 2.4 percent, and aggregate demand by 1.7 percent. Results show the mining, manufacturing, wholesale trade, and agricultural sectors would benefit the most from additional commerce from Mexico into the United States. Historically, more than 50 percent of production in these sectors has been driven by US demand for export goods. Expediting the flow of commercial vehicles from Mexico into the United States by ten minutes would increase labor income by $174,474 and promote the creation of nearly 18,700 additional direct and indirect jobs in Mexico, particularly in financial services; mass media information; wholesale trade; and professional, scientific, and technical services. These numbers illustrate the lower-bound economic gains that would result from reduced wait times at the US-Mexico border, stemming from potential improvements in border management practices and tools. They emphasize the economic interdependence of the United States and Mexico, outlining how a further coordinated, binational approach to the border would benefit both countries. A subsequent study will disaggregate national-level findings and thus determine the impact of a more efficient and secure US-Mexico border at the state and county level in the United States and Mexico. 17 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Methodology US-focused analysis The Hunt Institute for Global Competitiveness used a two-step process to calculate the economic impact of reducing border wait times for commercial and noncommercial crossings. First, regression analysis was employed to determine the relationship between average wait times (in minutes) and the average number of crossings (commercial and noncommercial) at major US-Mexico land ports of entry. Additional factors impacting this relationship, such as employment and crime on both sides of the border, the number of lanes in operation, and total expenditures made by the US Department of Homeland Security (DHS), were considered. The analysis used data from various sources, including CBP, the US Department of Transportation’s Bureau of Transportation Statistics, the US Department of Labor’s Bureau of Labor Statistics, Instituto Nacional de Estadística y Geografía (INEGI, or National Institute of Statistics and Geography), and the Instituto Mexicano de Seguro Social (Mexican Institute of Social Security). To account for disruptions in border traffic patterns stemming from COVID-19 and its accompanying policy changes, the study captures data between April 2016 and December 2019, before the pandemic’s onset. The second step in the analysis was quantifying the economic impact of additional crossings resulting from reduced wait times. Because of the different types of data available for commercial and noncommercial crossings; this study used various methods to quantify their effects. For commercial crossings, the proportion of loaded container crossings and the average value per container— obtained from the US Department of Transportation—were used to determine the dollar value associated with increased container crossings. For noncommercial crossings, survey data from the City of El Paso’s International Bridges Department on travel and spending patterns were used to model the economic impact of spending by additional noncommercial crossers. Appendices A through C include more technical information and a detailed, step by-step explanation of the analysis. Mexico-focused analysis El Colegio de la Frontera Norte used a three-step process and two economic models to determine the economic impact of reduced border wait times for commercial vehicles. The analysis used data from the US Bureau of Transportation Statistics, CBP, the North American Industry Classification System (NAICS), Mexico’s INEGI, Automated Census Information System (ACIS), and Servicio de Administración Tributaria (SAT, or Tax Administration Service). The first step was to estimate the average inspection rate of commercial vehicles at US-Mexico border land ports of entry (see Appendix D3 for detailed analysis). Then, a queuing model was used to determine how reduced wait times affect Mexican exports to the United States. Finally, an input-output model was implemented to establish how changes in exports affect production (total gross output), intermediate sales, and aggregate demand for Mexico’s top ten sectors in terms of exports to the United States. Appendix D provides a detailed, technical description of the queueing and input output models, while Appendix F includes analysis results. 18 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendices The following Appendices provide additional details on the economic analysis summarized in the main report. Given its technical nature, this section can be skipped by more casual readers. Appendices A, B, and C explain the US-focused analysis by the Hunt Institute for Global Competitiveness and Appendices D, E, F, and G expand on the Mexico-focused analysis by El Colegio de la Frontera Norte. US-FOCUSED ANALYSIS APPENDIX A 20 Provides a detailed description of the data used in the regression analysis. APPENDIX B 24 Outlines the regression model used to estimate the relationship between border wait times and commercial and noncommercial crossings. APPENDIX C 25 Gives an overview of IMPLAN and how it was used to measure the economic impact of noncommercial crossings. MEXICO-FOCUSED ANALYSIS APPENDIX D 28 Provides more details on the input-output and queuing models. APPENDIX E 31 Describes the data used in the analysis. APPENDIX F 32 Explains the economic impact analysis with and without reduced border wait times. APPENDIX G 36 Describes the analysis of economic impact on employment and labor income. 19 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX A: DATA USED FOR THE FIXED EFFECTS MODEL While report results are presented at the national level, the analysis by the Hunt Institute for Global Competitiveness is built from county level data focusing on major US-Mexico land ports of entry. Map 1 shows the counties on the US-Mexico border for which data was collected and analyzed. These counties have one or more land ports of entry. Map 2 presents CBP sectors and selected counties’ ports of entry within each sector. Map 1. US Border Counties on the US-Mexico Border SOURCE: The Hunt Institute for Global Competitiveness and El Colegio de la Frontera Norte (COLEF). 20 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Map 2. CBP Sectors Along the US-Mexico Border SOURCE: The Hunt Institute for Global Competitiveness and COLEF using data from CBP. Table A1 lists every US county that touches the US-Mexico border. The list includes the name of every port of entry within that county, the names of the corresponding Mexican counties, and the CBP sector that contains that county. 21 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table A1: US-Mexico Border States, Counties, Cities, Ports of Entry, Mexican Sister Cities, and CBP Sectors State County City PoE Sister City CBP Sector California Arizona New Mexico Texas San Diego San Ysidro San Ysidro Tijuana, Baja California San Diego Sector, California Otay Mesa Otay Mesa - Commercial Otay Mesa - Passenger Otay Mesa - Pedestrian Cross Border Express Tecate Tecate Imperial Calexico Calexico - East Mexicali, Baja California El Centro Sector, California Calexico - West Andrade Andrade Yuma San Luis San Luis - San Luis I San Luis Rio Colorado, Sonora Yuma Sector, Arizona San Luis - San Luis II Pima Lukeville Lukeville Puerto Peñasco, Sonora Tucson Sector, Arizona Sasabe Sasabe Sáric, Sonora Santa Cruz Nobales Nogales - Deconcini Nogales, Sonora Nogales - Mariposa Nogales - Morley Gate Cochise Naco Naco Naco, Sonora Douglas Douglas (Raul Hector Castro) Agua Prieta, Sonora Luna Columbus Columbus Asencion, Chihuahua El Paso Sector, New Mexico Doña Ana Santa Teresa Santa Teresa - Santa Teresa Port of Entry Ciudad Juarez, Chihuahua El Paso El Paso El Paso - Bridge of the Americas (BOTA) Ciudad Juarez, Chihuahua El Paso Sector, Texas El Paso - Paso del Norte (PDN) El Paso - Stanton DCL El Paso - Ysleta Hudspeth Fort Hancock Fort Hancock - Fort Hancock El Paso Fabens Fabens - Tornillo Guadalupe, Chihuahua Presidio Presidio Presidio Ojinaga, Chihuahua Big Bend Sector, Texas Val Verde Del Rio Del Rio Acuña, Coahuila Del Rio Sector, Texas Maverick Eagle Pass Eagle Pass - Bridge I Piedras Negras, Coahuila Eagle Pass - Bridge II Webb Laredo Laredo - Bridge I Nuevo Laredo, Tamaulipas Laredo Sector, Texas Laredo - Bridge II Laredo - Colombia Solidarity Laredo - World Trade Bridge Starr Roma Roma Ciudad Miguel Aleman, Tamaulipas Rio Grande Rio Grande City Camargo, Tamaulipas Rio Grande Valley Sector Hidalgo County Hidalgo/ Pharr Hidalgo/Pharr - Anzalduas International Bridge Reynosa, Tamaulipas Hidalgo/Pharr - Hidalgo Hidalgo/Pharr - PharrProgreso - Donna International Bridge Hidalgo Progreso Progreso - Donna International Bridge Rio Bravo, Tamaulipas Progreso - Progreso International Bridge Cameron Brownsville Brownsville - B&M Matamoros, Coahuila Brownsville - Gateway Brownsville - Los Indios Brownsville - Veterans International SOURCE: The Hunt Institute for Global Competitiveness and El Colegio de la Frontera Norte (COLEF) using data from CBP. 22 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Running the necessary regressions to determine the impact of border wait times on border crossings requires data on several variables in various geographies. The data gathered for the regression analysis includes: 1. Average wait times: Border wait times at ports of entry were obtained from CBP. The research team used this data to estimate the monthly average border wait time (in minutes) for every land port of entry. This data was available for commercial vehicles, personal vehicles, and pedestrian modes of crossing, but not for rail crossings.32 Commercial vehicle data for the Hudspeth port of entry were unavailable for this variable.33 2. Total number of crossings per month: Data was captured from the US Department of Transportation’s Bureau of Transportation Statistics for each port of entry on the US-Mexico border and mode of crossing (commercial vehicles, noncommercial vehicles, and pedestrian crossings). The analysis uses these data to estimate the total number of crossings per city and county. The data for the Fort Hancock port of entry was unavailable for this variable. 3. Number of operational lanes per month: The total number of operating lanes per hour per port of entry was taken from the CBP for every port of entry. This analysis used the point of entry level data to estimate the number of operational lanes by city and county. The research team estimated an hourly average for every port of entry, using it to estimate a monthly average of the number of lanes in operation per port of entry. The commercial vehicles data for the Eagle Pass port of entry were not available for this variable. 4. Total number of existing lanes: The total number of existing lanes for every port of entry was captured from CBP. Commercial vehicle data for the Fort Hancock port of entry were unavailable for this variable. 5. Total employment (United States): The monthly data of total non-farm employment information for each US county on the US-Mexico border with ports of entry was obtained from the US Department of Labor’s Bureau of Labor Statistics. 6. Total employment (Mexico): The monthly data on total non-farm employment for each of the Mexican counties on the US-Mexico border with a port of entry was acquired from the Instituto Mexicano del Seguro Social (IMSS or Mexico’s Institute of Social Security). 7. Illegal Apprehensions: CBP provided its complete monthly number of illegal apprehensions for every sector within the southern border. See Map 2 for the boundaries of each CBP sector. This variable serves as a measure of crime in the United States. 8. Homicide rate: The total number of homicides per county was obtained for every northern Mexican municipality from the Secretariado Ejecutivo del Sistema Nacional de Seguridad Publica (Mexico’s Executive Secretary of the National Public Security System), the Mexican agency that compiles the total number of homicides per county. Mexican population data is available from two Mexican agencies, the Instituto Nacional de Estadística y Geografía (INEGI or the National Institute of Statistics and Geography) and the Consejo Nacional de Población (CONAPO or the National Council on Population). This variable serves as a measure of crime in Mexico. 9. Federal Expenditures (United States): Federal costs data were obtained for the following federal agencies: CBP, US Coast Guard, Transportation Security Administration, Federal Law Enforcement Training Center, and US Immigration and Customs Enforcement. These expenses were gathered for the following counties: San Diego and Imperial in California; Yuma, Pima, Santa Cruz, and Cochise in Arizona; Luna and Doña Ana in New Mexico; and El Paso, Presidio, Val Verde, Maverick, Webb, Starr, Hidalgo, and Cameron in Texas. 10. Trade: The data obtained from the US Trade Census consists of the value of the total imports and exports that cross the US-Mexico border ports of entry every month. 23 ATLANTIC COUNCIL APPENDIX B THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX B: FIXED EFFECTS MODEL Calculating the economic impact of a more efficient and secure border, requires understanding the relationship between wait times and the number of border crossings. The data across counties shows a low yet positive correlation between noncommercial crossings and wait times, suggesting that increased wait times are associated with more border crossings.34 This counterintuitive finding is explained by the fact that increased border usage (or border congestion) results in both longer wait times and more crossings. Therefore, to determine the underlying relationship between border wait time and crossings, the research team used an econometric model to control for other factors that may influence border crossings. The following equation is estimated by fixed effects using monthly county-level data from April 2016 through December 2019.35 crossit = β1waitit + β2Xit+ i+uit ,t = 1,2, ..., T In the estimation equation, crossit and waitit denote the number of crossings (either commercial or noncommercial) and average wait times in county i at time t, respectively. All additional time-varying explanatory variables are included in Xit, while i denotes the time constant fixed effect for county i and uit denotes the error term.36 The additional controls in Xit account for other factors influencing crossings and include a measure of employment in the United States and Mexico, a measure of crime in both countries, the number (or proportion) of lanes in operation, total expenditures by DHS, and a measure of trade (included in the commercial regression only). The left panel of Table B1 provides regression results for commercial crossings, while the right panel shows results for noncommercial crossings. The coefficient estimate on wait times is of primary interest, which is negative and statistically significant in both regressions. Specifically, the analysis found that a one-minute reduction in wait times results in 53 additional commercial crossings and 502 noncommercial crossings on average per month. The coefficient on wait times in the commercial crossing regression is statistically significant at 10 percent. Each additional commercial crossing represents another cargo container (loaded or unloaded) crossing into the United States via a land port of entry. The coefficient on wait times in the noncommercial crossings regression is statistically significant at 5 percent. Each additional noncommercial crossing represents a personal vehicle crossing into the United States via a land port of entry. Regression results suggest an inverse relationship between wait times and commercial and noncommercial border crossings. Including additional time-varying controls and time-constant fixed effects helped to reverse the counterintuitive finding of a positive correlation reported above. As such, Table B1 describes the underlying relationship between border wait times and border crossings. These findings can be used to determine how improved border management techniques or the adoption of new technologies affect commercial and noncommercial border crossings. Table B1: Fixed Effects Regression Results Regression Results Commercial Crossings Noncommercial Crossings Wait times -53.23* -502.05 (30.34) (227.18) Employment in US 0.03 0.23 (0.05) (0.41) Employment in Mexico -0.01 0.05 (0.02) (0.17) Crime in US -0.03 -1.16* (0.04) (0.43) Crime in Mexico -17.60* -30.00 (5.56) (98.12) Lanes operational 487.29 314031.50* (1998.54) (68954.24) DHS Expenditures -0.002 0.01 (0.001) (0.01) Trade 8.92E-06* - (5.09E-07) - Constant 8307.01 268168.40* (6615.80) (48439.59) Sample Size 554 585 R^2 0.95 0.76 SOURCE: The Hunt Institute for Global Competitiveness and the COLEF, using data from the US Department of Transportation. NOTE: The standard error is in parentheses. Statistically significant at 1 percent. Statistically significant at 5 percent. Statistically significant at 10 percent. 24 ATLANTIC COUNCIL APPENDIX C THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX C: ECONOMIC IMPACT ANALYSIS OF BORDER CROSSINGS The regression results presented in Appendix B established a link between border wait times and commercial and noncommercial crossings. This serves as the first step in understanding the economic impact of reduced border wait times. Additional data is needed to determine the economic impact of reductions in border wait times. The following subsections explain the steps taken to produce the economic impact results described in the main text. Appendix C1: Economic Impact of Commercial Crossings The regression results described in Appendix B indicate that a one-minute reduction in average commercial wait times results in approximately fifty-three additional container crossings per month. Data from the US Department of Transportation’s Bureau of Transportation Statistics were used to estimate that approximately 73.1 percent of these containers would be loaded with an average value of $66,798 (for a detailed breakdown of the proportion of loaded containers crossing the US-Mexico border and their average cargo value, see table 1 on page 13). This means that a 10-minute reduction in wait times would result in 532 additional container crossings, of which 388 would be loaded with $25,879,549 in cargo value. Appendix C2: Economic Impact of Noncommercial Crossings Individuals crossing from Mexico into the United States make purchases on the US borders and in states, contributing to local economies. Due to underlying economic linkages, this spending has an amplified national impact. To estimate this impact, the research team used IMPLAN—a regional economic impact software—, data on expenditure patterns, and the average number of border crossings aggregated to the county level. Below is an overview of the data and model used to estimate the economic impact of the expenditures that result from these noncommercial border crossings. A 2019 study by the City of El Paso International Bridges Department quantifies the social and economic cross-border activities from vehicle and pedestrian crossings through the El Paso–Ciudad Juárez port of entry. The study consisted of two surveys. First, a short questionnaire administered to US-Mexico border crossers between October 1 and December 31, 2019. Residents who indicated Mexico as their primary place of residence received an entry survey, while those indicating the United States as their primary place of residence received an exit survey. The entry survey captured the planned activities and expenditures of those traveling to El Paso from Ciudad Juárez, while the exit survey captured the activities and spending already made by those traveling to Ciudad Juárez from El Paso. 25 ATLANTIC COUNCIL APPENDIX C THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Survey respondents were asked questions related to four categories: • Demographics • Reasons for crossing • Anticipated spending (including the area of spending) • Trip characteristics This report focused on survey responses related to the intended destination (El Paso or other) and expected spending across various categories. The survey results indicate that approximately 80 percent of individuals crossing the border (by vehicle and as pedestrians) remained in El Paso, while 20 percent continued to another location. Of the 80 percent who stayed in El Paso, approximately 64 percent of those who crossed by vehicle and 47 percent who crossed as pedestrians reported positive expected expenditures. The survey data breaks down the dollar amount individuals expected to spend within twenty categories.37 This information was used to calculate the average expenditure per crosser, for both vehicle and pedestrian crossings. These expenditures were then scaled by the total number of vehicle and pedestrian crossings in 2019 (after scaling by the proportion of crossers who remained in El Paso and reported spending money) to determine the average expenditure of crossings in 2019 for El Paso County. To establish the economic impact of these expenditures at the national level, the average expenditures by crossers in 2019 were computed for the following border counties: • Texas: Presidio, Val Verde, Maverick, Webb, Starr, Hidalgo, and Cameron • New Mexico: Luna and Doña Ana • Arizona: Yuma, Pima, Santa Cruz, and Cochise • California: San Diego and Imperial Unfortunately, detailed expenditure data were unavailable for the other border counties. However, the El Paso survey was used with the assumption that spending patterns across the twenty categories do not change across counties. First, the average expenditures per crosser for each category was recovered from the El Paso survey. These expenditures were then scaled up or down based on the average household income in the neighboring Mexican state relative to the average household income in Chihuahua (the Mexican state neighboring El Paso). Once this income adjustment was made, the average 2019 expenditures were scaled by the number of vehicle and pedestrian crossings in 2019 for each border county listed above. This exercise reveals the total spending in the twenty categories for each of the sixteen border counties considered in the analysis.38 These findings were used as inputs into IMPLAN to estimate the economic impact of expenditures by individuals crossing the US-Mexico border. First, the twenty expenditure categories from the survey were mapped into comparable IMPLAN industries. Then, industry output (spending) was reduced in these industries for each of the sixteen counties. Twenty adverse output (spending) events were modeled separately in the sixteen counties for a total of 320 events. The rest of the United States was then built up, county-by county for Texas, New Mexico, Arizona, and California; and state-by state for the non-border states. Finally, the national-level analysis was run using IMPLAN’s multiregion input-output feature, allowing for additional indirect linkages between regions within the analysis. Tables C2.1 and C2.2 present the main findings. 26 ATLANTIC COUNCIL APPENDIX C THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table C2.1: Economic Impact of Removing Cross-Border Spending in the United States (2022) Impact Employment Labor Income Value Added Output 1 - Direct 2 - Indirect 3 - Induced -60,619.16 -$1,812,022,814.56 -$2,765,047,740.91 -$5,036,142,293.41 -21,166.07 -$1,234,825,927.30 -$1,980,607,178.46 -$4,118,866,436.04 -18,648.05 -$977,441,701.68 -$1,771,486,445.19 -$3,177,688,817.94 -100,433.29 -$4,024,290,443.54 -$6,517,141,364.56 -$12,332,697,547.38 Source: The Hunt Institute for Global Competitiveness and the COLEF, using IMPLAN. As shown on Table C2.1, removing cross-border spending by noncommercial crossers results in approximately 100,433 fewer jobs in the United States. Approximately 60 percent of this job loss is directly caused by reduced expenditure. The remaining 40 percent is due to indirect and induced effects. Removing cross border spending would also result in a loss of $12,332,697,547 in economic output. Approximately 41 percent of this output loss is explained by the direct effects of reducing expenditures and 59 percent by indirect or induced effects. Table C2.2 includes the top five most impacted industries in terms of output lost due to the reduction in cross-border spending by noncommercial crossers. As expected, these industries are concentrated in areas where tourists or temporary visitors would likely spend money. The three sectors with the largest output loss include retail, full-service restaurants, and general merchandise. As such, the entire output loss within these industries was due to sectoral linkages with other areas experiencing direct impacts. IMPLAN results in Table C2 can be combined with the regression results in Appendix B to determine the economic impact of reducing noncommercial border wait times. The research team divided the total output loss resulting from eliminating noncommercial crossings by the total number of crossers in 2019, 87,812,443.39 This yields a value of $140.44 which can be interpreted as the output loss associated with losing one noncommercial crosser or the output gain associated with one additional noncommercial crosser. Table C2.2: Top Five Industries with Reductions in Economic Output from Removing Cross-Border Spending in the United States (2022) Impact 1 - Direct 2 - Indirect 3 - InducedImpact output Industry display Impact output Impact output Impact output Retail: Clothing and ccessories -$2,161,062,814.49 -$707,698.49 -$23,321,554.17 -$2,185,092,067.16 Other real estate services $0.00 -$740,224,149.66 -$130,392,264.37 -$870,616,414.03 Full service restaurants -$713,075,639.37 -$28,572,142.09 -$65,051,510.06 -$806,699,291.52 General merchandise -$575,957,329.13 -$2,040,513.78 -$36,955,115.99 -$614,952,958.90 Management $0.00 -$397,735,328.22 -$56,187,767.71 -$453,923,095.93 1 2 3 4 5 Source: The Hunt Institute for Global Competitiveness and the COLEF, using IMPLAN. 27 ATLANTIC COUNCIL APPENDIX D THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX D: DESCRIPTION OF THE INPUT-OUTPUT AND QUEUING MODELS Appendix D1: The queueing model This study uses a queuing model to evaluate how wait times for commercial vehicles at the US-Mexico border affect Mexican exports to the United States. A queueing model mathematically describes a queuing system, making specific assumptions about the probabilistic nature of the number and type of servers (commercial vehicles), the arrival and service processes (border processing rates), and the queue discipline and organization. For this study, this can be described as: E'j,t = E'j,0- ∆ %(λ-μ)αj ∑ E'j,0 (1) Where; E'j,t = commercial vehicles processed per hour at t ≥1. E'j,0 = commercial vehicles processed per hour at t=0. λ = the average number of commercial vehicles arriving per hour.40 μ = the average number of commercial vehicles dispatched per hour.41 α = the share of sectoral exports in total exports per hour (E'j,0 / ∑ E'j,0). ∑ E'j,0 = the total number of commercial vehicles per hour in the economy. The E'j,0 vector also serve as a measure of Mexican exports, given that commercial vehicles entering the United States are loaded with Mexican goods. In equation (1), the assigned volume is the number of commercial vehicles arriving at a border checkpoint every hour (λ), while the volume processed is the processing capacity of the checkpoint per hour (μ). To conduct the queuing analysis, these two variables must be known beforehand. Appendix D3 shows how they were defined. Besides the variables λ and μ, the queuing model considers other key variables, including the value of exports transported by commercial vehicles and the number of lanes in operation. The former was determined using data from the US Department of Transportation’s Bureau of Transportation Statistics (see Appendix C1), and the latter with data from CBP. Additionally, this study considers the system in its steadystate of operation, i.e., during time intervals when λ and μ behave normally. This means that anomalous states of operation are removed from the analysis (such as the first 30 minutes in the workday when personnel perform preparatory activities). As equation (1) shows, when the volume of commercial vehicles in the system is processed immediately [(λ-μ) = 0], there would be no queues. As a result, wait times would be insignificant, and the value of Mexican exports entering the United States in commercial vehicles would be E'j,0. However, when the assigned volume of commercial vehicles is greater than the volume of vehicles processed [(λ-μ) > 0], a queue forms, leading to increased wait times and reducing the number of commercial vehicles crossing the border with Mexican export goods (reducing E'j,t). This calculation produces approximate wait times, which are sufficiently accurate to understand the overall distribution of traffic between land ports of entry across the US-Mexico border. Once approximate wait times are established, it is important to verify the model’s validity. Using a chi-square goodness of fit test, the observed distribution of the variables λ and μ is compared with their theoretical distribution, demonstrating the degree of adjustment between the sample (the average service rate for one checkpoint) and the population (the average service rate for all checkpoints across the US-Mexico border). This hypothesis test concludes, with a certain degree of statistical significance, that the sample in this study is representative of the full population. 28 ATLANTIC COUNCIL APPENDIX D THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix D2: Intersectoral input-output model Input-output models are a form of macroeconomic analysis based on the interdependencies (the flow of goods and services) between different economic sectors. They are commonly used to estimate the impacts of positive or negative economic shocks and their ripple effects throughout an economy. This study uses an input-output model to determine how increased Mexican exports stemming from reduced border wait times (previously established using a queuing model; see Appendix D1) affect aggregate demand in Mexico (calculated as aggregate demand = C + I + G + Nx, where: C = consumer spending; I = private investment and corporate spending; G = government spending; and Nx = net exports (exports minus imports). Economic sectors respond to increases in aggregate demand directly by supplying final goods (increasing output) or indirectly by producing intermediate goods for sectors that respond directly (increasing intermediate sales). Therefore, findings are then used to calculate the impact on total gross output and intermediate sales across sectors of the Mexican economy. Equation (2) estimates the impact of increased demand for Mexican exports on output per sector: Xj,0= (I-A)-1Yj,0 (2) Where: Xj,0 = the total gross output vector per sector at t=0. (I-A)-1 = the Leontief inverse (or the matrix of indirect and direct multipliers). In which I = identity matrix and A = technical coefficient matrix. Yj,0 = the aggregate demand vector per sector at t=0. Therefore, equation (2) could be re-written as: Xj,0= (I-A)-1E'j,0 (3) Where: E'j,0 = the exports vector per sector at t=0. As discussed in Appendix D1, E'j,0 can be interpreted as “commercial vehicles processed by the customs system every hour” and equation (3) expressed as: Xj,t = (I-A)-1E'j,t (4) Where E'j,0 = commercial vehicles processed per hour at t ≥ 1. This interpretation makes two assumptions: (a) that the system operates at full capacity and (b) that the volume of commercial vehicles in the system is processed immediately [(λ-μ) = 0], resulting in no wait times (see Appendix D1). In other words, the input-output model is static. However, this is not always the case, given that commercial vehicle arrivals and departures to and from border checkpoints do not happen at fixed intervals (they are uncertain). Therefore, by incorporating specific trajectories describing the behavior of E'j,t (changes to the number of commercial vehicles processed by customs checkpoints due to reduced wait times), the static input output model can be used to estimate the impact of increased Mexican exports on total gross output per sector. This is calculated with the equation: Lj,t = ∑ [Xj,t+Xj,0] (5) Where: Lj,t = the impact on total gross output. Xj,0 = the total gross output vector per sector at t=0 (before reduced wait times and no changes to E'j,0). Xj,t = the total gross output vector per sector at t ≥1 (after reduced wait times and changes to E'j,t). j = 1- n sectors. 29 ATLANTIC COUNCIL APPENDIX D THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix D3: Establishing the assigned volume and processing rate of commercial vehicles Estimating the average processing capacity of a port of entry requires data on the volume of commercial vehicles serviced and the number of lanes, hours, and days in operation for that port of entry. For land ports of entry across the US-Mexico border, these data were obtained from the Bureau of Transportation Statistics’ Border Crossing Data.42 Table D3 shows data for the Otay Mesa port of entry in Baja, California, the third-busiest on the US-Mexico border.43 The Otay Mesa example helps to illustrate how processing capacity was calculated for other ports of entry as part of this study. On average, one lane in the Otay Mesa port of entry operates 65 hours per week. Together, its ten lanes would operate 650 hours per week, meaning that, together, the lanes of the Otay Mesa port of entry operate for approximately 33,800 hours in one year (52 weeks). Given that 962,577 commercial vehicles are serviced per year, a total of 18,511 trucks would cross the border weekly. For one lane, this translates to 1,851 trucks per week, 370 per day, and 28.5 per hour. Having established the number of commercial vehicles serviced per hour (28.5 vehicles), an M/M/1 queue was simulated (see Appendix D1) to estimate the average processing capacity (μ), showing that border wait times for commercial vehicles are approximately 21.5 minutes.44 Enhanced border management practices and the implementation of new technologies would improve the processing capacity of ports of entry, reduce commercial wait times, and allow more Mexican exports to enter the United States. This would boost total gross output, aggregate demand, and intermediated sales across various sectors in the Mexican economy, as well as employment and labor income (see Appendices F and G for input-output analysis results). Table D3: Data for the Otay Mesa Port of Entry Item Value Total number of commercial vehicles serviced per year Hours in operation per day Days in operation per week Maximum number of lanes in operation 962,577 13 5 10 FUENTE: Cálculos propios con base en Información procedente de <https://bwt.cbp.gov/> y <Border Crossing/Entry Data - Bureau of Transportation Statistics 30 ATLANTIC COUNCIL APPENDIX E THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX E: DATA USED FOR THE ANALYSIS This study relied on the North American Industry Classification System (NAICS) and the Sistema Automatizado de Información Censal (ACIS or Automated Census Information System) to further understand Mexico’s productive sector and commercial relationship with the United States. It also used data from the Instituto Nacional de Estadística y Geografía (INEGI or the National Institute of Statistics and Geography). The NAICS, jointly developed by the US Economic Classification Policy Committee, INEGI, and Statistics Canada, classifies North American business statistics, allowing for a high level of comparability between economic activities in the United States, Mexico, and Canada. The sectors shown in Table E1, classified by NAICS in 2018, were used for this study. The INEGI used data from economic censuses in Mexico, systematized in the ACIS,45 to produce an input-output matrix46 for the Mexican economy in 2013. It then used a RAS method to estimate a matrix for 2018.47 The 2018 matrix was used as part of this study to determine the top ten Mexican sectors exporting to the United States, which were later used in the intersectoral input output analysis described in Appendix D2. Results on the economic impact of reduced border wait times on sectoral output, aggregate demand, and intermediate sales appear in Appendix F2. Additionally, the 2018 input-output matrix and vectors for employment and labor income in Mexico were used to estimate how reduced commercial wait times affect employment and labor income, as shown in Appendix G. The vectors were calculated using data from the ACIS. Table E: Sectoral Classification of the North American Industry Classification System (NAICS) (2018) NAICS Code Sector 11 Agriculture, animal breeding and exploitation, forestry, fishing and hunting 21 Mining 22 Electric power generation, transmission and diffusion, water and gas supply through pipelines to final consumers 23 Construction 31-33 Manufacturing industries 43 Wholesale trade 46 Retail trade 48-49 Transportation, postage, and warehousing 51 Mass media information 52 Financial and insurance services 53 Real estate and rental services of personal and intangible property 54 Professional, scientific, and technical services 55 Corporate 56 Business support services and waste and residue management and remediation services 61 Educational services 62 Health and social welfare services 71 Cultural, sports, and other recreational services 72 Temporary accommodation services and food and beverage preparation services 81 Other services, except government activities. 93 Legislative, governmental, law enforcement, and international and extraterritorial organization activities SOURCE: The Colegio de la Frontera Norte using the 2018 sectoral classification of the NAICS 31 ATLANTIC COUNCIL APPENDIX F THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX F: ECONOMIC IMPACT ANALYSIS OF BORDER CROSSINGS This study first established a baseline of Mexican exports to the United States without reduced wait times, which allowed for the determination of the top ten sectors exporting to the United States and the effect that exports have on sectoral output in Mexico. Then, an analysis with reduced border wait times was conducted, and baseline results were compared with new findings to determine the relative and absolute variation in sectoral output, aggregate demand, and intermediate sales stemming from reduced wait times. The values in all Appendix F tables appear in 2018 US dollars, using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results have yet to be adjusted to 2022 values, using inflation and consumer price index (CPI) historical data from the United States. Appendix F1: Analysis without reduced border wait times Assessing the economic impact of a one-minute reduction in border wait times requires understanding the US-Mexico commercial relationship and how it drives sectoral output in Mexico. As shown in Figure F1, ten sectors produced 99.86 percent of total Mexican exports to the United States in 2018. Therefore, this study considers these ten sectors. Figure F1: Top Ten Mexican Sectors in Terms of Exports to the United States (2018) • 31-33 - Manufacturing 0.82% • 43 - Wholesale trade • 21 - Mining • 48-49 - Transportation, postage, and warehousing • 46 - Retail trade • 11 - Agriculture, animal breeding and exploitation, forestry, fishing, and hunting • 52 - Financial and insurance services • 22 - Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers • 51 - Mass media information • 54 - Professional, scientific, and technical services SOURCE: In-house, prepared using 2018 using data obtained from INEGI (2022). 1.92% 3.97% 6.30% 6.81% 16.80% 0.05% 0.05% 0.02% 63.24% 32 ATLANTIC COUNCIL APPENDIX F THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER The input-output analysis was employed to estimate the baseline output per sector driven by Mexican exports to the United States, using equation (3) in Appendix D2 [Xj,0 = (I-A)-1E'j,0]. Table F1 includes results in relative and absolute terms, showing that, on average, Mexican exports to the United States drive 38 percent of total gross output per sector in Mexico. Table F1: Total Gross Output (TGO) Driven by Mexican Exports to the United States (2018)48 NAICS classification code Sector Total Percentage 21 Mining 976,753.75 68.91% 31-33 Manufacturing 9,992,494.79 68.79% 43 Wholesale trade 1,724,997.69 63.26% 11 Agriculture, animal breeding and exploitation, forestry, fishing, and hunting 630,344.07 50.86% 22 Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers 234,304.63 31.91% 48-49 Transportation, postage, and warehousing 682,499.14 27.21% 54 Professional, scientific, and technical services 155,642.26 26.37% 46 Retail trade 477,034.24 17.72% 52 Financial and insurance services 185,136.92 13.40% 51 Mass media information 79,296.98 12.22% Total 15,138,504.47 380.65% Average 1,513,850.45 38.07% SOURCE: In-house, prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 33 ATLANTIC COUNCIL APPENDIX F THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix F2: Analysis with reduced wait times A second input-output analysis was performed to determine how the positive economic shock (increased Mexican exports caused by reduced border wait times) affected total gross production per sector (Xj,t). This is estimated using equation (4) in Appendix D2 [Xj,t= (I-A)-1E'j,t], where E'j,t is the exports vector and j the number of sectors. Given the interdependencies between sectors, the economic impact of reduced border wait times spreads throughout productive sectors in the Mexican economy. Therefore, results show the average percentage increase in output, aggregate demand, and final sales per sector driven by additional Mexican exports to the United States (caused by a one-minute reduction in border wait times). Table F2.1 shows findings in terms of total gross output, while Tables F2.2 and F2.3 include results for aggregate demand and intermediate sales, respectively. NAICS Table F2.1: Growth in Total Gross Output (TGO)49 Total Gross Output Classification Sectors code Absolute (TGO) Change driven by Mexican exports Percentage increase 11 Agriculture, animal breeding and exploitation, forestry, fishing, and hunting 61,870,394,408.39 63,525,716,328.93 2.68% 21 Mining 70,768,853,919.12 73,333,868,768.35 3.62% 22 Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers 36,661,826,110.83 37,277,124,334.51 1.68% 31-33 Manufacturing industries 725,175,223,165.25 751,416,123,114.45 3.62% 43 Wholesale trade 136,148,265,851.22 140,678,214,854.59 3.33% 46 Retail trade 134,388,874,388.42 135,641,595,360.59 0.93% 48-49 Transportation, postage, and warehousing 125,222,060,808.79 127,014,345,127.69 1.43% 51 Mass media information 32,404,278,182.73 32,612,516,876.33 0.64% 52 Financial and insurance services 68,962,248,726.91 69,448,429,551.32 0.70% 54 Professional, scientific, and technical services 29,468,317,923.12 29,877,043,990.12 1.39% Average 142,107,034,348.48 146,082,497,830.69 2.00% SOURCE: In-house, prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 34 ATLANTIC COUNCIL APPENDIX F NAICS THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table F2.2: Growth in intermediate sales50 Intermediate Sales Classification Sectors code Absolute intermediate sales Change driven by Mexican exports Percentage increase 11 Agriculture, animal breeding and exploitation, forestry, fishing, and hunting 37,715,987,831.23 39,017,404,257.82 3.45% 21 Mining 38,319,742,304.75 39,627,221,214.17 3.41% 22 Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers 26,093,440,432.45 26,698,820,186.23 2.32% 31-33 Manufacturing industries 500,578,423,695.96 515,136,851,491.74 2.91% 43 Wholesale trade 50,588,439,711.28 52,014,146,106.25 2.82% 46 Retail trade 20,372,948,351.47 20,891,889,251.96 2.55% 48-49 Transportation, postage, and warehousing 27,507,131,659.31 28,135,165,832.62 2.28% 51 Mass media information 14,218,572,797.10 14,418,468,679.28 1.41% 52 Financial and insurance services 23,171,318,014.63 23,506,746,665.51 1.45% 54 Professional, scientific, and technical services 27,550,006,467.55 27,955,133,873.68 1.47% Average 76,611,601,126.57 78,740,184,755.93 2.41% SOURCE: In-house, prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). Table F2.3: Growth in final demand51 NAICS Classification Sectors Final demand code Absolute aggregate demand Change driven by Mexican exports Percentage increase 11 Agriculture, animal breeding and exploitation, forestry, fishing, and hunting 24,154,406,577.15 24,508,312,071.11 1.47% 21 Mining 32,449,111,614.37 33,706,647,554.19 3.88% 22 Electric power generation, transmission and diffusion, and water and gas supply through pipelines to final consumers 10,568,385,678.38 10,578,304,148.28 0.09% 31-33 Manufacturing industries 224,596,799,469.30 236,279,271,622.71 5.20% 43 Wholesale trade 85,559,826,139.94 88,664,068,748.35 3.63% 46 Retail trade 114,015,926,036.95 114,749,706,108.63 0.64% 48-49 Transportation, postage, and warehousing 97,714,929,149.48 98,879,179,295.07 1.19% 51 Mass media information 18,185,705,385.62 18,194,048,197.05 0.05% 52 Financial and insurance services 45,790,930,712.28 45,941,682,885.81 0.33% 54 Professional, scientific, and technical services 1,918,311,455.57 1,921,910,116.43 0.19% Average 65,495,433,221.90 67,342,313,074.76 1.67% SOURCE: In-house, prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 35 ATLANTIC COUNCIL APPENDIX G THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX G: ECONOMIC IMPACT ON EMPLOYMENT AND LABOR INCOME Appendix G1: Employment The effect of a 10-minute reduction in commercial wait times on direct employment in Mexico was estimated using the multiplier: l= LT [diag(X)-1] (6) Where: l = the direct employment coefficient LT = the employment generated per sector52 [diag(X)-1] = the diagonal matrix of total gross output (obtained via the input-output model) To assess the impact on direct and indirect employment, the direct employment coefficient (l) is multiplied by the Leontief inverse: MED-1 = l[(I-A)-1] (7) Table G1 shows the original jobs per sector and the new jobs created as a result of increased exports following a 10-minute reduction in commercial wait times. It also includes the difference between these two values and the relative increase and net variation in employment. Results show that 18,697 jobs would be created in one year. NAICS Classification code Table G1: Impact on Direct and Indirect Employment of a More Efficient US-Mexico Border Sectores Original New Difference Relative Increase Net Variation 11 Agriculture, animal breeding and ex ploitation, forestry, fishing, and hunting 5.9 6.6 0.7 0.3% 748.2 21 Mining 5.9 8.1 2.2 1.2% 2,220.1 22 Electric power generation, transmis sion and diffusion, and water and gas supply through pipelines to final consumers 7.4 7.5 0.1 0.1% 129.3 31-33 Manufacturing industries 13.6 12.8 -0.8 0.0% -793.1 43 Wholesale trade 8.4 11.6 3.2 0.2% 3,216.0 46 Retail trade 24.7 26.4 1.7 0.0% 1,748.8 48-49 Transportation, postage, and ware housing 10.3 10.1 -0.2 0.0% -210.3 51 Mass media information 12.0 15.7 3.7 1.0% 3,684.5 52 Financial and insurance services 10.1 15.6 5.5 0.8% 5,505.5 54 Professional, scientific, and technical services 18.6 21 2.4 0.3% 2,448.6 Total 116.9 135.4 18.5 3.9% 1,8697.6 Average 11.7 13.5 1.9 0.4% 1,869.8 SOURCE: In-house prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 36 ATLANTIC COUNCIL APPENDIX G THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix G2: Labor income The effect of a 10-minute reduction in commercial wait times on labor income in Mexico was estimated using a two-step process. First, the labor income coefficient was determined with the equation: r= RemT [diag(X)-1] (8) Where: r = the labor income coefficient RemT = the labor income per sector 53 [diag(X)-1] = the diagonal matrix of total gross output Second, the labor income coefficient (r) was multiplied by the Leontief inverse: MRemD-1 =r[(I-A)-1] (9) Table G2 shows the direct and indirect effects on labor income of increased Mexican exports to the United States stemming reductions in commercial wait times. It includes labor income per sector before reduced wait times (original), labor income after reduced wait times (new), the difference between these two values, and the relative increase and net variation in labor income. Results show that, overall, labor income would increase by $17,474 with a one-minute reduction in border wait times or $174,474 with a ten minute reduction. NAICS Table G2: Impact on Labor Income of a More Efficient US-Mexico Border One-minute 10-minute Relative Classification code Sector Original New Difference reduction in wait times reduction in wait times weight Agriculture, animal breeding and exploita tion, forestry, fishing, and hunting 0.04 0.05 0.01 $ 324.72 $3,247.21 Mining 0.10 0.15 0.05 $ 2,643.81 $26,438.14 Electric power genera tion, transmission and diffusion, and water and gas supply through pipe lines to final consumers 0.08 0.09 0.01 $ 711.73 $7,117.31 Manufacturing industries 0.14 0.15 0.01 $ 467.19 $4,671.91 Wholesale trade 0.08 0.16 0.08 $ 3,852.29 $38,522.90 Retail trade 0.09 0.13 0.04 $ 1,766.03 $17,660.32 Transportation, postage, and warehousing 0.10 0.10 0.00 $ (89.37) $(893.65) Mass media information 0.17 0.23 0.06 $ 2,895.81 $28,958.10 Financial and insurance services 0.16 0.23 0.07 $ 3,574.24 $35,742.39 Professional, scientific, and technical services 0.14 0.17 0.03 $ 1,327.86 $13,278.59 Total $ 17,474.32 $174,743.23 111.9% 21 15.1% 224.1% 31-33 2.7% 43 22.0% 46 10.1% 48-49 -0.5% 51 16.6% 52 20.5% 54 7.6% Average $ 1,747.43 $17,474.32 SOURCE: In-house prepared estimates based on estimates for 2018 using data obtained from INEGI (2022). 37 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Acknowledgments This report was informed by roundtables, focus groups, and consultations carried out in the United States and Mexico and the analysis of economic data. We thank the many individuals and institutions who participated in project activities and research efforts. It was a true pleasure to work with our partners at the University of Texas at El Paso’s (UTEP’s) Hunt Institute for Global Competitiveness and Colegio de la Frontera Norte (COLEF). We are deeply grateful to the Adrienne Arsht Latin America Center (AALAC) team, who worked tirelessly to produce this report, particularly to Camila Hernández and Ignacia Ulloa, who provided invaluable writing and editorial support. Thank you to Jason Marczak, senior director for AALAC, and Maria Fernanda Bozmoski, deputy director for programs, for their guidance and editorial support. We thank AALAC Non-Resident Fellow Bosco Martí and the Global Nexus team, specifically Ruben Olmos, Ana Margarita Martínez, and Alejandro Vales, for providing crucial expertise and contributions. Our gratitude extends to Rhonda Shore for her diligent editorial work and to Donald Partyka and Anais Gonzalez for their exceptional design skills. Most importantly, we thank the US Department of State’s Bureau for International Narcotics and Law Enforcement Affairs for giving the Atlantic Council, UTEP, and COLEF the opportunity to produce this report in service of daily border users and strengthening the US and Mexican economies. 38 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Endnotes 1 Government of the United States, “Trade in Goods with Mexico,” US Census Bureau, accessed August 16, 2022, https://www.census.gov/foreign-trade/balance/c2010.html; and Government of the United States, “Monthly U.S. International Trade in Goods and Services, June 2022,” US Census Bureau and US Department of Commerce, August 4, 2022, https://www.census.gov/foreign-trade/Press-Release/current_press_release/ft900.pdf. 2 Government of the United States, “Overview of US- North American Freight by Port, Commodity Group, and Mode - Value (in Millions),” US Department of Transportation, accessed August 16, 2022, https://explore.dot.gov/views/Dashboard_PortbyCommodity/Overview?%3Aembed=y&%3Aiid=1&%3AisGuestRedirectFromVizportal=y. 3 Government of Mexico, “US-Mexico Trade Relation,” Embassy of Mexico to the United States of America, Section of Economic Affairs, February 2022, https://embamex.sre.gob.mx/eua/images/stories/economicos/2022/documents/US-MX_Trade_Website_02-2022.pdf. 4 Government of Mexico, Secretariat of Foreign Affairs, Embassy of Mexico to the United States of America, Office of Political Affairs. Information acquired September 8, 2022. 5 Government of the United States, “Mexico: US-Mexico Trade Facts,” Office of the US Trade Representative, accessed August 14, 2022, https://ustr.gov/countries-regions/americas/mexico. 6 Joint Statement by President Biden and President Lopez Obrador, The White House, July 12, 2022, https://www.whitehouse.gov/briefing-room/statements-releases/2022/07/12/president-biden-and-president-lopez-obrador-joint-statement/. 7 The US-Mexico High-Level Economic Dialogue is an opportunity for Mexico and the United States to advance strategic economic and commercial priorities to foster economic development and growth, job creation, and global competitiveness and reduce poverty and inequality. 8 Government of the United States, “Mexico: US-Mexico Trade Facts,” US Trade Representative, accessed August 16, 2022, https://ustr.gov/countries-regions/americas/mexico. 9 Zahniser, Stephen. “COVID-19 Working Paper: U.S.-Mexico Agricultural Trade in 2020,” United States Department of Agriculture, Economic Research Service. January, 2022. 10 Michoacán, Mexico, exports approximately 80 percent of its avocado supply directly to the United States. Government of the United States, “Fresh Avocado Imports from Mexico Resume,” Animal and Plant Inspection Service, United States Department of Agriculture, accessed August 20, 2022. https://www.aphis.usda.gov/aphis/newsroom/stakeholder-info/sa_by_date/sa-2022/avocado-imports-mexico. 11 Ibid 12 Government of the United States, “Hourly Wait Times Trends vs Current,” Customs and Border Protection, accessed August 17, 2022, https://bwt.cbp.gov/details/09250401/POV. 13 Unified Cargo Processing is a program for joint inspection of northbound cargo via free and secure trade lanes. John Davis, “U.S. and Mexico United in Cargo Processing,” US Customs and Border Protection, last modified January 4, 2022, https://www.cbp.gov/frontline/cargo-processing.. 14 Global Entry and the Secure Electronic Network for Travelers Rapid Inspection are risk-based programs that allow expedited clearance for pre-approved, low-risk travelers upon arrival in the United States. Government of the United States, “Global Entry: Trusted Traveler Program Enrollment,” US Customs and Border Protection, last modified September 6, 2022, https://www.cbp.gov/travel/trusted-traveler-programs/global-entry; and Government of the United States, “Secure Electronic Network for Travelers Rapid Inspection,” US Customs and Border Protection, last modified January 4, 2022, https://www.cbp.gov/travel/trusted-traveler-programs/sentri. 15 The Customs Trade Partnership Against Terrorism is a voluntary supply chain security partnership used by the public and private sectors. Government of the United States, “CTPAT: Customs Trade Partnership Against Terrorism,” US Customs and Border Protection, last modified August 29, 2022, https://www.cbp.gov/border-security/ports-entry/cargo-security/CTPAT. 16 “SENTRI Program Requirements,” Immigration Passport Visa Service, accessed August 17, 2022, http://immigrationpassportvisa.com/travel/sentri-pass program-requirements/#:~:text=Over%20175%2C000%20US%20citizens%20and%20Mexican%20citizens%20have%20become%20card%20holders. 17 The Maquiladora Export Industry is a conglomerate of intermediate-good manufacturing companies. 18 According to the North American Industry Classification System (NAICS), a classification scheme for Mexican productive activities that dates to 1993 and collects information on businesses, households, and individuals. In the development of this study, the consortium also referred to the Automated Census Information System (ACIS), which allowed for adjustments and specifications of data. For additional information on NAICS and ACIS, see Appendix G. 19 Vehicle and Cargo Inspection System (VACIS) and Federal Motor Carrier Safety Administration (FMCSA). 20 The Interagency Border Inspection System is a computer-based system that provides law enforcement access to drivers’ criminal records and other information used to screen vehicles crossing the border. 21 Border users were consulted during roundtables hosted by the Atlantic Council. The first took place on May 10, 2022, in El Paso, Texas, in collaboration with the Hunt Institute for Global Competitiveness at the University of Texas at El Paso. The second occurred on July 12, 2022, in Tijuana, Mexico, in collaboration with El Colegio de la Frontera Norte. 22 According to research by the Hunt Institute for Global Competitiveness, 4,720,967 container trucks crossed the border in 2021. 23 A 10-minute reduction in commercial wait times would allow $25,879,549 million, specifically in additional cargo value, to enter the United States monthly. See Appendix C1 for more information. 24 This section focuses on crossings by individuals and families in noncommercial vehicles alone. Migrant caravans at the US-Mexico border disrupted standard pedestrian crossing patterns during the sample period, preventing the analysis of pedestrian traffic using the regression model described in Appendix B. Further research is needed to estimate the economic impact of additional pedestrian crossings following a reduction in border wait times. 25 Per Table 2, these purchases generated an economic impact of $12,332,697,547 for the US economy. The economic impact of cross-border spending was determined by mapping out expenditure categories and running INPLAN’s multi-region input-output feature. 26 Given the nature of available data for the input-output analysis (macroeconomic data from Mexico’s National Institute of Statistics and Geography (INEGI), which captures the commercial relationship between the United States and Mexico), this section exclusively focuses on commercial crossings from Mexico into the United States. The economic impact for Mexican families and workers was estimated by considering how changes in the US-Mexico commercial relationship affect employment and labor income. 27 Government of the United States, “U.S.-Mexico Trade Relations,” Congressional Research Service, updated April 25, 2021, https://sgp.fas.org/crs/row/IF11175.pdf. 28 The ten sectors are mining; manufacturing; wholesale trade; agriculture, animal breeding and exploitation, forestry, fishing, and hunting; electric power generation, transmission and diffusion, and water and gas supply; transportation, postage, and warehousing; professional, scientific, and technical services; retail trade; financial and insurance services; and mass media information. 29 “U.S.-Mexico Trade Relations,” Congressional Research Service. https://sgp.fas.org/crs/row/IF11175.pdf 30 “México supera a Japón y lidera por primera vez envíos de autos a Estados Unidos” (“Mexico surpasses Japan and leads car shipments to the United States for the first time”), El Economista, September 5, 2022, https://dfsud.com/america/mexico-supera-a-japon-y-lidera-por-primera-vez-envios-de-autos-a-estados. 31 See Appendix C1. 32 As described in the report, the regression analysis did not include pedestrian crossings due to the impact of migrant caravans during the period under study. 39 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER 33 Missing data was excluded from averages. 34 The correlation between wait times and crossings is 0.2977. This is likely because congestion at the border may result in both increased wait times and a higher number of crossings. 35 The sample ends prior to 2020 to avoid disruptions in border crossings due to COVID-19. See Appendix A for a detailed description of the data. 36 The fixed effect, i, accounts for time-constant heterogeneity between counties in the analysis. Estimating the regression equation by fixed effects removes this time-constant heterogeneity, effectively controlling for the immutable differences between counties. 37 Spending categories include clothing, general merchandise, auto parts, groceries, electronics, restaurants, gas, sports and music, building, furniture, personal care services, fast food, health, business and other professional services, amusement and recreation, accommodation, bar, theater, transportation and parking, and other products. 38 The sixteen counties used in the analysis were El Paso, Presidio, Val Verde, Maverick, Webb, Starr, Hidalgo, Cameron, Luna, Dona Ana, Yuma, Pima, Santa Cruz, Cochise, San Diego, and Imperial. 39 The total number of crossers was determined using data from the Bureau of Transportation Statistics. 40 This could also be the average arrival rate. 41 This could also be the average service rate. 42 Government of the United States, “Bureau of Transportation Statistics: Border Crossing/Entry Data,” US Department of Transportation, accessed August 18, 2022, https://www.bts.gov/browse-statistical-products-and-data/border-crossing-data/border-crossingentry-data#:~:text=Border%20 crossing%20data%20are%20collected,comparable%20data%20on%20outbound%20crossings.. 43 Scott Mall, “FreightWaves Classics: Otay Mesa Land Port is third-busiest on U.S.-Mexico border,” Freightwaves, May 12, 2021, https://www.freightwaves.com/news/freightwaves-classics-otay-mesa-land-port-is-third-busiest-on-us-mexico-border. 44 Ports of entry with extremely atypical wait times (anomalies) were disregarded in this paper’s analysis. 45 The ACIS systematizes information from Mexico’s four most recent economic censuses, which occurred in 2019, 2014, 2009, and 2004. 46 An input-output matrix represents national or regional economic accounting that records how industries trade with one another and produce for consumption and investments. 47 The RAS method is an interactive method for data reconciliation. It scales an input-output table bi-proportionally to achieve consistency between given row and column sums. For a detailed description of the methodology used by INEGI, see “Matrices de Contabilidad Social de México: Fuentes y metodología,” INEGI, accessed August 18, 2022, https://inegi.org.mx/contenidos/investigacion/mcsm/doc/fuente_y_metodologia.pdf. 48 Originally in 2018 Mexican pesos and converted to US dollars using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results are in 2018 values. 49 Originally in 2018 Mexican pesos and converted to US dollars using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results are in 2018 values. 50 Originally in 2018 Mexican pesos and converted to US dollars using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results are in 2018 values. 51 Originally in 2018 Mexican pesos and converted to US dollars using a conversion rate of 1 US dollar to 20.03 Mexican pesos. Results are in 2018 values. 52 Total employment per sector was obtained from INEGI, using 2018 data. 53 Total labor income per sector was obtained from INEGI, using 2018 data in Mexican pesos (millions). 40 ATLANTIC COUNCIL CHAIRMAN John F.W. Rogers EXECUTIVE CHAIRMAN EMERITUS James L. Jones PRESIDENT ANDCEO Frederick Kempe EXECUTIVE VICE CHAIRS Adrienne Arsht Stephen J. Hadley VICE CHAIRS Robert J. Abernethy C. Boyden Gray Alexander V. Mirtchev TREASURER George Lund DIRECTORS Todd Achilles Timothy D. Adams Michael Andersson David D. Aufhauser Barbara Barrett Colleen Bell Stephen Biegun Linden P. Blue Adam Boehler John Bonsell Philip M. Breedlove Myron Brilliant Esther Brimmer Richard R. Burt Teresa Carlson James E. Cartwright John E. Chapoton Ahmed Charai Melanie Chen Michael Chertoff George Chopivsky Wesley K. Clark Helima Croft Ankit N. Desai Dario Deste Paula J. Dobriansky Joseph F. Dunford, Jr. Richard Edelman Thomas J. Egan, Jr. Stuart E. Eizenstat Mark T. Esper Michael Fisch Alan H. Fleischmann Jendayi E. Frazer Meg Gentle Thomas H. Glocer John B. Goodman Sherri W. Goodman Jarosław Grzesiak Murathan Günal Frank Haun Michael V. Hayden Tim Holt Karl V. Hopkins Kay Bailey Hutchison Ian Ihnatowycz Mark Isakowitz Wolfgang F. Ischinger Deborah Lee James Joia M. Johnson Safi Kalo Andre Kelleners Brian L. Kelly Henry A. Kissinger John E. Klein C. Jeffrey Knittel Joseph Konzelmann Franklin D. Kramer Laura Lane Almar Latour Yann Le Pallec Jan M. Lodal Douglas Lute Jane Holl Lute William J. Lynn Mark Machin Umer Mansha Marco Margheri Michael Margolis Chris Marlin William Marron Christian Marrone Gerardo Mato Timothy McBride Erin McGrain John M. McHugh Judith A. Miller Dariusz Mioduski Michael J. Morell Richard Morningstar Georgette Mosbacher Majida Mourad Dambisa F. Moyo Virginia A. Mulberger Mary Claire Murphy Edward J. Newberry Franco Nuschese Joseph S. Nye Ahmet M.Ören Sally A. Painter Ana I. Palacio Kostas Pantazopoulos Alan Pellegrini David H. Petraeus Lisa Pollina Daniel B. Poneman Dina H. Powell dddMcCormick Michael Punke Ashraf Qazi Thomas J. Ridge Gary Rieschel Lawrence Di Rita Michael J. Rogers Charles O. Rossotti Harry Sachinis C. Michael Scaparrotti Ivan A. Schlager Rajiv Shah Gregg Sherrill Jeff Shockey Ali Jehangir Siddiqui Kris Singh Walter Slocombe Christopher Smith Clifford M. Sobel James G. Stavridis Michael S. Steele Richard J.A. Steele Mary Streett Gil Tenzer Frances M. Townsend Clyde C. Tuggle Melanne Verveer Charles F. Wald Michael F. Walsh Ronald Weiser Al Williams Maciej Witucki Neal S. Wolin Jenny Wood Guang Yang Mary C. Yates Dov S. Zakheim HONORARY DIRECTORS James A. Baker, III Ashton B. Carter Robert M. Gates James N. Mattis Michael G. Mullen Leon E. Panetta William J. Perry Condoleezza Rice Horst Teltschik William H. Webster Executive Committee Members List as of September12, 2022 The Atlantic Council is a nonpartisan organization that promotes constructive US leadership and engagement in international affairs based on the central role of the Atlantic community in meeting today’s global challenges. © 2021 The Atlantic Council of the United States. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means without permission in writing from the Atlantic Council, except in the case of brief quotations in news articles, critical articles, or reviews. Please direct inquiries to: Atlantic Council 1030 15th Street, NW, 12th Floor, Washington, DC 20005 (202) 463-7226, www.AtlanticCouncil.org Made possible by: USER: Please provide an analysis of the US-Mexico border and how a more efficient border would impact the economy. Assistant: Answer only* using the evidence. If unknown, say you cannot answer. Cite sources.	true	47	18	15,462	null	816
The information in this prompt is all you may use to answer any questions. You are not allowed to use any external resources or prior knowledge. When using acronyms, include the full form beside it for the first use.	Summarise all information relevant to law.	Congress passed and the President signed into law the National Quantum Initiative Act (NQI Act; P.L. 115-368; codified at 15 U.S.C. §§8801 et seq.) in December 2018 to accelerate quantum research and development (R&D) for the economic and national security of the United States and ensure the continued U.S. leadership in quantum information science and its technology applications. Since the enactment of the NQI Act, researchers have made progress in quantum R&D. The authorization of funding for several federal R&D activities under the NQI Act is set to expire at the end of FY2023. In the NQI Act, Congress defined the term quantum information science as “the use of the laws of quantum physics for the storage, transmission, manipulation, computing, or measurement of information.” Quantum computing, one of technology applications of quantum information science, uses a quantum bit, or qubit, as its basic data unit, to harness quantum properties such as superposition and entanglement. By generating and manipulating qubits, a quantum computer is capable of performing certain calculations significantly faster than conventional, non-quantum computers, known as classical computers, leading to new ways to solve some complex problems that were previously unsolvable. Researchers have demonstrated the potential for quantum computing applications in areas such as cryptography, machine learning, and scientific and engineering research, particularly using modeling, optimization, and simulation. The NQI Act is the primary federal law that supports R&D activities in quantum computing. It has been amended by the National Defense Authorization Act (NDAA) for FY2022 (P.L. 117-81) and the CHIPS and Science Act (Division B of P.L. 117-167). The current act contains four titles, directing (1) the President to implement an NQI Program with a 10-year plan to accelerate quantum R&D, invest in and coordinate fundamental federal R&D activities, and partner with industry and universities to advance goals and priorities in the NQI Program; (2) the National Institute of Standards and Technology (NIST) to carry out specified R&D activities and convene a stakeholder consortium to identify the future measurement, standards, cybersecurity, and needs for a robust quantum industry; (3) the National Science Foundation (NSF) to carry out a basic research and education program and award grants to establish Multidisciplinary Centers for Quantum Research and Education; and (4) the Department of Energy (DOE) to administer a number of programs, including a basic research program, National Quantum Information Science Research Centers, a program to accelerate innovation in quantum network infrastructure, and the Quantum User Expansion for Science and Technology program. The authorization of funding for the following activities under the NQI Act is set to expire in September 2023: NSF’s five university-based Quantum Leap Challenge Institutes, DOE’s five national lab-led research centers, and NIST’s R&D activities, including the industry-led Quantum Economic Development Consortium. Since the enactment of the NQI Act in 2018, researchers have made notable advances in quantum computing in three areas: demonstrating that a quantum processor could execute a complex computational task much faster than a classical supercomputer in an experiment; demonstrating the mitigation of calculation errors caused by the loss of information held by qubits—a major outstanding challenge to quantum computing—in an experiment; and scaling up quantum computing processors, thus enhancing their power and potential reliability. Some experts argue that sustained federal R&D investment is necessary to accelerate progress toward practical quantum computing and to maintain the leading role of U.S. researchers and institutions globally. There is less consensus, however, on the specific role the federal government should play in quantum R&D and how resources and support should be specifically targeted and prioritized. Congress faces policymaking in three areas. First, Congress may decide whether and how to reauthorize or expand federal R&D activities and support under the NQI Act. Second, Congress may choose whether to set policy priorities to ensure U.S. leadership in quantum computing, including (1) accelerating the development of practical quantum computers with near-term, useful applications; (2) supporting the development of an accessible, sustainable, and secure supply chain and domestic manufacturing capabilities; and (3) facilitating the development of a quantum-literate workforce. Congress may also consider whether to set policy priorities to protect national security interests in quantum computing by addressing risks; in particular, the anticipated compromise of current cryptographic systems that protect sensitive data and communications among government agencies, financial institutions, health service providers, and others.	system instructions: [The information in this prompt is all you may use to answer any questions. You are not allowed to use any external resources or prior knowledge. When using acronyms, include the full form beside it for the first use.] question: [Summarise all information relevant to law.] context block: [Congress passed and the President signed into law the National Quantum Initiative Act (NQI Act; P.L. 115-368; codified at 15 U.S.C. §§8801 et seq.) in December 2018 to accelerate quantum research and development (R&D) for the economic and national security of the United States and ensure the continued U.S. leadership in quantum information science and its technology applications. Since the enactment of the NQI Act, researchers have made progress in quantum R&D. The authorization of funding for several federal R&D activities under the NQI Act is set to expire at the end of FY2023. In the NQI Act, Congress defined the term quantum information science as “the use of the laws of quantum physics for the storage, transmission, manipulation, computing, or measurement of information.” Quantum computing, one of technology applications of quantum information science, uses a quantum bit, or qubit, as its basic data unit, to harness quantum properties such as superposition and entanglement. By generating and manipulating qubits, a quantum computer is capable of performing certain calculations significantly faster than conventional, non-quantum computers, known as classical computers, leading to new ways to solve some complex problems that were previously unsolvable. Researchers have demonstrated the potential for quantum computing applications in areas such as cryptography, machine learning, and scientific and engineering research, particularly using modeling, optimization, and simulation. The NQI Act is the primary federal law that supports R&D activities in quantum computing. It has been amended by the National Defense Authorization Act (NDAA) for FY2022 (P.L. 117-81) and the CHIPS and Science Act (Division B of P.L. 117-167). The current act contains four titles, directing (1) the President to implement an NQI Program with a 10-year plan to accelerate quantum R&D, invest in and coordinate fundamental federal R&D activities, and partner with industry and universities to advance goals and priorities in the NQI Program; (2) the National Institute of Standards and Technology (NIST) to carry out specified R&D activities and convene a stakeholder consortium to identify the future measurement, standards, cybersecurity, and needs for a robust quantum industry; (3) the National Science Foundation (NSF) to carry out a basic research and education program and award grants to establish Multidisciplinary Centers for Quantum Research and Education; and (4) the Department of Energy (DOE) to administer a number of programs, including a basic research program, National Quantum Information Science Research Centers, a program to accelerate innovation in quantum network infrastructure, and the Quantum User Expansion for Science and Technology program. The authorization of funding for the following activities under the NQI Act is set to expire in September 2023: NSF’s five university-based Quantum Leap Challenge Institutes, DOE’s five national lab-led research centers, and NIST’s R&D activities, including the industry-led Quantum Economic Development Consortium. Since the enactment of the NQI Act in 2018, researchers have made notable advances in quantum computing in three areas: demonstrating that a quantum processor could execute a complex computational task much faster than a classical supercomputer in an experiment; demonstrating the mitigation of calculation errors caused by the loss of information held by qubits—a major outstanding challenge to quantum computing—in an experiment; and scaling up quantum computing processors, thus enhancing their power and potential reliability. Some experts argue that sustained federal R&D investment is necessary to accelerate progress toward practical quantum computing and to maintain the leading role of U.S. researchers and institutions globally. There is less consensus, however, on the specific role the federal government should play in quantum R&D and how resources and support should be specifically targeted and prioritized. Congress faces policymaking in three areas. First, Congress may decide whether and how to reauthorize or expand federal R&D activities and support under the NQI Act. Second, Congress may choose whether to set policy priorities to ensure U.S. leadership in quantum computing, including (1) accelerating the development of practical quantum computers with near-term, useful applications; (2) supporting the development of an accessible, sustainable, and secure supply chain and domestic manufacturing capabilities; and (3) facilitating the development of a quantum-literate workforce. Congress may also consider whether to set policy priorities to protect national security interests in quantum computing by addressing risks; in particular, the anticipated compromise of current cryptographic systems that protect sensitive data and communications among government agencies, financial institutions, health service providers, and others.]	The information in this prompt is all you may use to answer any questions. You are not allowed to use any external resources or prior knowledge. When using acronyms, include the full form beside it for the first use. EVIDENCE: Congress passed and the President signed into law the National Quantum Initiative Act (NQI Act; P.L. 115-368; codified at 15 U.S.C. §§8801 et seq.) in December 2018 to accelerate quantum research and development (R&D) for the economic and national security of the United States and ensure the continued U.S. leadership in quantum information science and its technology applications. Since the enactment of the NQI Act, researchers have made progress in quantum R&D. The authorization of funding for several federal R&D activities under the NQI Act is set to expire at the end of FY2023. In the NQI Act, Congress defined the term quantum information science as “the use of the laws of quantum physics for the storage, transmission, manipulation, computing, or measurement of information.” Quantum computing, one of technology applications of quantum information science, uses a quantum bit, or qubit, as its basic data unit, to harness quantum properties such as superposition and entanglement. By generating and manipulating qubits, a quantum computer is capable of performing certain calculations significantly faster than conventional, non-quantum computers, known as classical computers, leading to new ways to solve some complex problems that were previously unsolvable. Researchers have demonstrated the potential for quantum computing applications in areas such as cryptography, machine learning, and scientific and engineering research, particularly using modeling, optimization, and simulation. The NQI Act is the primary federal law that supports R&D activities in quantum computing. It has been amended by the National Defense Authorization Act (NDAA) for FY2022 (P.L. 117-81) and the CHIPS and Science Act (Division B of P.L. 117-167). The current act contains four titles, directing (1) the President to implement an NQI Program with a 10-year plan to accelerate quantum R&D, invest in and coordinate fundamental federal R&D activities, and partner with industry and universities to advance goals and priorities in the NQI Program; (2) the National Institute of Standards and Technology (NIST) to carry out specified R&D activities and convene a stakeholder consortium to identify the future measurement, standards, cybersecurity, and needs for a robust quantum industry; (3) the National Science Foundation (NSF) to carry out a basic research and education program and award grants to establish Multidisciplinary Centers for Quantum Research and Education; and (4) the Department of Energy (DOE) to administer a number of programs, including a basic research program, National Quantum Information Science Research Centers, a program to accelerate innovation in quantum network infrastructure, and the Quantum User Expansion for Science and Technology program. The authorization of funding for the following activities under the NQI Act is set to expire in September 2023: NSF’s five university-based Quantum Leap Challenge Institutes, DOE’s five national lab-led research centers, and NIST’s R&D activities, including the industry-led Quantum Economic Development Consortium. Since the enactment of the NQI Act in 2018, researchers have made notable advances in quantum computing in three areas: demonstrating that a quantum processor could execute a complex computational task much faster than a classical supercomputer in an experiment; demonstrating the mitigation of calculation errors caused by the loss of information held by qubits—a major outstanding challenge to quantum computing—in an experiment; and scaling up quantum computing processors, thus enhancing their power and potential reliability. Some experts argue that sustained federal R&D investment is necessary to accelerate progress toward practical quantum computing and to maintain the leading role of U.S. researchers and institutions globally. There is less consensus, however, on the specific role the federal government should play in quantum R&D and how resources and support should be specifically targeted and prioritized. Congress faces policymaking in three areas. First, Congress may decide whether and how to reauthorize or expand federal R&D activities and support under the NQI Act. Second, Congress may choose whether to set policy priorities to ensure U.S. leadership in quantum computing, including (1) accelerating the development of practical quantum computers with near-term, useful applications; (2) supporting the development of an accessible, sustainable, and secure supply chain and domestic manufacturing capabilities; and (3) facilitating the development of a quantum-literate workforce. Congress may also consider whether to set policy priorities to protect national security interests in quantum computing by addressing risks; in particular, the anticipated compromise of current cryptographic systems that protect sensitive data and communications among government agencies, financial institutions, health service providers, and others. USER: Summarise all information relevant to law. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	39	6	710	null	158
{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]	The 5G IoT has three layers: the Edge, Network, and Application layer; in which way does the architecture of the 5G IoT help to support complex applications such as the smart home, virtual reality, and industrial IoT? Secondly, explain how this architecture benefits from blockchain for security and data exchange. The next question is addressing the following issues: what are the critical parameters that should be met in order to guarantee the effective work and security of the IoT systems based on 5G technology?	An Insight into IoT IoT or the Internet of Things is a networked digital system of various electronic devices like sensors, activators, receivers, nodes that compute data, etc. By eliminating human involvement, IoT devices have transformed the data collecting and processing system. From top to bottom, IoT devices enhance the development of concepts like smart home, smart vehicle, smart agriculture (Pranto et al. 2021), smart health care, communication, cybersecurity and many more systems (Haque et al. 2021a). They have been used to conduct, monitor, and produce reactions based on the information gathered. People have been thinking of connecting devices to the Internet for a long time. The Internet of Things, on the other hand, enhances and extends network technology based on existing internet technology, allowing computing and smart objects to connect and communicate with one another. The IoT can be broadly defined as any object that communicates, produces, and interchanges data with other objects via the Internet to perform orientation tracing, tracking, intelligent recognition, and management. This process is conducted by various sensors or peripherals such as GPS, thermal sensors, RFID, etc. (Yang et al. 2011). Characteristics of IoT There are many functional and non-functional IoT needs for creating the infrastructure. We will discuss some of the most valuable characteristics of IoT here. Availability To provide customers with facilities wherever and whenever they need them, IoT availability must be implemented at the hardware and software levels. The capacity of IoT systems to give functionality to anybody in any location is referred to as software availability (Mistry et al. 2020a). The nature of computers that are always compatible with IoT features and protocols is referred to as hardware availability. To allow IoT capabilities, protocols like IPv6, 6LoWPAN, RPL, CoAP, and others need to be implemented inside the restricted devices of the single board resource. One technique for achieving high IoT service availability is to ensure the availability of critical hardware and facilities (Bahalul Haque 2019). Mobility Although most utilities are designed to be delivered via Smartphone devices, IoT implementation is hampered by accessibility. A key IoT premise is to keep customers connected to their preferred resources when moving. When mobile devices are relocated from one gateway to another, service interruptions may occur. Caching and tunneling for service continuity allow apps to access IoT data even if the internet is down for a short time. The vast number of smart devices available in IoT systems is usually included in any solid framework for mobility control. Scalability Scalability in the Internet of Things refers to the ability to accept new client equipment, software, and capabilities without compromising the efficiency of existing systems. It is not straightforward to add new processes and manage extra devices, especially when there are several hardware platforms and communication protocols to contend with. IoT applications must be built from the ground up to enable extendable services and operations. Security and Privacy On diverse networks, such as the Internet of Things, ensuring user security and privacy is strict. The fundamental functioning of the Internet of Things is built on data transmission between billions, if not trillions, of Internet-connected items. One great problem in IoT security left out of the standards is the key distribution between devices. The growing number of intelligent objects around us with sensitive data necessitates transparent and simple access control management, such as enabling one vendor to view the data. In contrast, another controls the device Performance The performance of IoT services is difficult to evaluate since it is based on the performance of many components and the underlying technology. The Internet of Things, like other programs, must constantly develop and expand its offerings in order to meet user expectations. IoT also needs to manage the larger amount of information or data created in the ecosystem, ensuring the interoperability and quality of service. Layered Architecture of IoT Various designs have been suggested for IoT worlds. In general, such structures are divided into three categories. There are three types of architecture: three-layer architecture, four-layer architecture, and five-layer architecture. In this chapter, we will look at the three-layered architecture. It is organized keeping mid some specific tasks to accomplish by the system like executing service functions, transmitting data, and connection among service devices. It results in three layers, Application layer, Network/Transmission layer, and Perception/Edge layer. Application Layer In different implementations, this layer may include various services. Smart grids, healthcare, and autonomous automobiles are examples of IoT deployment in smart cities and homes. Because the application layer might serve as a service support middleware, a networking standard, or a cloud computing platform, security considerations vary depending on the application's environment and industry. Network Layer Acting as a bridge, the network layer controls data transfer to subsequent layers. This layer connects to the visual layer. Different smart devices are connected to the network layer following control function protocol (IEEE 802.x) and authentication standards (GPS, and Near-Field Connectivity (NFC)). The transmission of data is highly prone to cyber-attacks. Intelligent intrusion detection key encryption with secured management-based IoT security framework is the most popular along with the latest adoption of blockchain technology. Edge Layer Edge layer manages the IoT devices or sensors like RFID, different actuators, cameras, intensity detectors, moisture and pressure sensors, etc., using gateways in a coordinating function to connect with Researchers have proposed security solutions for this layer based on machine learning, multi-stepped authorization, secure channeling through anti-malware, etc. Requirements for 5G Integrated IoT Architecture 5G-enabled IoT needs special attention for its heterogeneity, advancement, and application. However, there are some requirements that all the architecture should follow (Li et al. 2018b): 5G IoT must ensure a low latency of 1 ms considering the sensitive internet system and medical perspective. The architecture must ensure low energy consumption for low-battery life IoT devices but enough for 5G to transfer data. An advanced application like Virtual Reality or Augmented Reality needs a high speed of 25 Mbps, so the architecture must follow with the future needs. Security must be top-notch, considering massive data transmission at a very high speed. The devices with mobility factors will get priority for the 5G IoT infrastructure. The fundamental 5G IoT architecture consists of five steps in general: sensors, IoT Gateway, 5G-based station, cloud storage, and application (Arsh et al. 2021). These steps can be comprised in IoT layers to bring up a general 5G IoT architecture. Edge Layer of 5G IoT The sensors and gateway of IoT can be comprised of 5G in this layer. For example, sensors for wearable ECG, temperature, smart manufacturing etc. will use this layer to transmit and process information using 5G technology (Shdefat et al. 2021). Network Layer of 5G IoT The network layer will hold the 5G base station and cloud storage to process data using IoT devices. Application Layer of 5G IoT The application layer will provide all the support for the end system like smart home, smart supply chain, etc. (Haque et al. 2021b). Following the above-mentioned general architecture, 5G IoT can support millimeter-wave (Rahimi et al. 2018), D2D communication, nano-chip, wireless software (Huang et al. 2020), mobile edge computing, data analytics cloud computing (Mudigonda et al. 2020), and many more technologies and application. In Fig. 11.1, we have shown a generalized architecture for the 5G integrated IoT ecosystem. Blockchain-Based 5G IoT Blockchain (Haque and Bhushan 2021b) can bring trust and improved security to 5G IoT. It can accelerate data exchange at a lower cost by implementing a cryptographic encryption system to the architecture. The immutability and accountability that blockchain can ensure for the system are marvelous (Hewa et al. 2020). Blockchain integrated 5G IoT can bring revolution to industrial IoT, UnThese layers work together using cloud storage and a 5G network to provide services like education, fire station, transportation, factories, etc.	{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== The 5G IoT has three layers: the Edge, Network, and Application layer; in which way does the architecture of the 5G IoT help to support complex applications such as the smart home, virtual reality, and industrial IoT? Secondly, explain how this architecture benefits from blockchain for security and data exchange. The next question is addressing the following issues: what are the critical parameters that should be met in order to guarantee the effective work and security of the IoT systems based on 5G technology? {passage 0} ========== An Insight into IoT IoT or the Internet of Things is a networked digital system of various electronic devices like sensors, activators, receivers, nodes that compute data, etc. By eliminating human involvement, IoT devices have transformed the data collecting and processing system. From top to bottom, IoT devices enhance the development of concepts like smart home, smart vehicle, smart agriculture (Pranto et al. 2021), smart health care, communication, cybersecurity and many more systems (Haque et al. 2021a). They have been used to conduct, monitor, and produce reactions based on the information gathered. People have been thinking of connecting devices to the Internet for a long time. The Internet of Things, on the other hand, enhances and extends network technology based on existing internet technology, allowing computing and smart objects to connect and communicate with one another. The IoT can be broadly defined as any object that communicates, produces, and interchanges data with other objects via the Internet to perform orientation tracing, tracking, intelligent recognition, and management. This process is conducted by various sensors or peripherals such as GPS, thermal sensors, RFID, etc. (Yang et al. 2011). Characteristics of IoT There are many functional and non-functional IoT needs for creating the infrastructure. We will discuss some of the most valuable characteristics of IoT here. Availability To provide customers with facilities wherever and whenever they need them, IoT availability must be implemented at the hardware and software levels. The capacity of IoT systems to give functionality to anybody in any location is referred to as software availability (Mistry et al. 2020a). The nature of computers that are always compatible with IoT features and protocols is referred to as hardware availability. To allow IoT capabilities, protocols like IPv6, 6LoWPAN, RPL, CoAP, and others need to be implemented inside the restricted devices of the single board resource. One technique for achieving high IoT service availability is to ensure the availability of critical hardware and facilities (Bahalul Haque 2019). Mobility Although most utilities are designed to be delivered via Smartphone devices, IoT implementation is hampered by accessibility. A key IoT premise is to keep customers connected to their preferred resources when moving. When mobile devices are relocated from one gateway to another, service interruptions may occur. Caching and tunneling for service continuity allow apps to access IoT data even if the internet is down for a short time. The vast number of smart devices available in IoT systems is usually included in any solid framework for mobility control. Scalability Scalability in the Internet of Things refers to the ability to accept new client equipment, software, and capabilities without compromising the efficiency of existing systems. It is not straightforward to add new processes and manage extra devices, especially when there are several hardware platforms and communication protocols to contend with. IoT applications must be built from the ground up to enable extendable services and operations. Security and Privacy On diverse networks, such as the Internet of Things, ensuring user security and privacy is strict. The fundamental functioning of the Internet of Things is built on data transmission between billions, if not trillions, of Internet-connected items. One great problem in IoT security left out of the standards is the key distribution between devices. The growing number of intelligent objects around us with sensitive data necessitates transparent and simple access control management, such as enabling one vendor to view the data. In contrast, another controls the device Performance The performance of IoT services is difficult to evaluate since it is based on the performance of many components and the underlying technology. The Internet of Things, like other programs, must constantly develop and expand its offerings in order to meet user expectations. IoT also needs to manage the larger amount of information or data created in the ecosystem, ensuring the interoperability and quality of service. Layered Architecture of IoT Various designs have been suggested for IoT worlds. In general, such structures are divided into three categories. There are three types of architecture: three-layer architecture, four-layer architecture, and five-layer architecture. In this chapter, we will look at the three-layered architecture. It is organized keeping mid some specific tasks to accomplish by the system like executing service functions, transmitting data, and connection among service devices. It results in three layers, Application layer, Network/Transmission layer, and Perception/Edge layer. Application Layer In different implementations, this layer may include various services. Smart grids, healthcare, and autonomous automobiles are examples of IoT deployment in smart cities and homes. Because the application layer might serve as a service support middleware, a networking standard, or a cloud computing platform, security considerations vary depending on the application's environment and industry. Network Layer Acting as a bridge, the network layer controls data transfer to subsequent layers. This layer connects to the visual layer. Different smart devices are connected to the network layer following control function protocol (IEEE 802.x) and authentication standards (GPS, and Near-Field Connectivity (NFC)). The transmission of data is highly prone to cyber-attacks. Intelligent intrusion detection key encryption with secured management-based IoT security framework is the most popular along with the latest adoption of blockchain technology. Edge Layer Edge layer manages the IoT devices or sensors like RFID, different actuators, cameras, intensity detectors, moisture and pressure sensors, etc., using gateways in a coordinating function to connect with Researchers have proposed security solutions for this layer based on machine learning, multi-stepped authorization, secure channeling through anti-malware, etc. Requirements for 5G Integrated IoT Architecture 5G-enabled IoT needs special attention for its heterogeneity, advancement, and application. However, there are some requirements that all the architecture should follow (Li et al. 2018b): 5G IoT must ensure a low latency of 1 ms considering the sensitive internet system and medical perspective. The architecture must ensure low energy consumption for low-battery life IoT devices but enough for 5G to transfer data. An advanced application like Virtual Reality or Augmented Reality needs a high speed of 25 Mbps, so the architecture must follow with the future needs. Security must be top-notch, considering massive data transmission at a very high speed. The devices with mobility factors will get priority for the 5G IoT infrastructure. The fundamental 5G IoT architecture consists of five steps in general: sensors, IoT Gateway, 5G-based station, cloud storage, and application (Arsh et al. 2021). These steps can be comprised in IoT layers to bring up a general 5G IoT architecture. Edge Layer of 5G IoT The sensors and gateway of IoT can be comprised of 5G in this layer. For example, sensors for wearable ECG, temperature, smart manufacturing etc. will use this layer to transmit and process information using 5G technology (Shdefat et al. 2021). Network Layer of 5G IoT The network layer will hold the 5G base station and cloud storage to process data using IoT devices. Application Layer of 5G IoT The application layer will provide all the support for the end system like smart home, smart supply chain, etc. (Haque et al. 2021b). Following the above-mentioned general architecture, 5G IoT can support millimeter-wave (Rahimi et al. 2018), D2D communication, nano-chip, wireless software (Huang et al. 2020), mobile edge computing, data analytics cloud computing (Mudigonda et al. 2020), and many more technologies and application. In Fig. 11.1, we have shown a generalized architecture for the 5G integrated IoT ecosystem. Blockchain-Based 5G IoT Blockchain (Haque and Bhushan 2021b) can bring trust and improved security to 5G IoT. It can accelerate data exchange at a lower cost by implementing a cryptographic encryption system to the architecture. The immutability and accountability that blockchain can ensure for the system are marvelous (Hewa et al. 2020). Blockchain integrated 5G IoT can bring revolution to industrial IoT, UnThese layers work together using cloud storage and a 5G network to provide services like education, fire station, transportation, factories, etc. https://link.springer.com/chapter/10.1007/978-981-99-3668-7_11	{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document] EVIDENCE: An Insight into IoT IoT or the Internet of Things is a networked digital system of various electronic devices like sensors, activators, receivers, nodes that compute data, etc. By eliminating human involvement, IoT devices have transformed the data collecting and processing system. From top to bottom, IoT devices enhance the development of concepts like smart home, smart vehicle, smart agriculture (Pranto et al. 2021), smart health care, communication, cybersecurity and many more systems (Haque et al. 2021a). They have been used to conduct, monitor, and produce reactions based on the information gathered. People have been thinking of connecting devices to the Internet for a long time. The Internet of Things, on the other hand, enhances and extends network technology based on existing internet technology, allowing computing and smart objects to connect and communicate with one another. The IoT can be broadly defined as any object that communicates, produces, and interchanges data with other objects via the Internet to perform orientation tracing, tracking, intelligent recognition, and management. This process is conducted by various sensors or peripherals such as GPS, thermal sensors, RFID, etc. (Yang et al. 2011). Characteristics of IoT There are many functional and non-functional IoT needs for creating the infrastructure. We will discuss some of the most valuable characteristics of IoT here. Availability To provide customers with facilities wherever and whenever they need them, IoT availability must be implemented at the hardware and software levels. The capacity of IoT systems to give functionality to anybody in any location is referred to as software availability (Mistry et al. 2020a). The nature of computers that are always compatible with IoT features and protocols is referred to as hardware availability. To allow IoT capabilities, protocols like IPv6, 6LoWPAN, RPL, CoAP, and others need to be implemented inside the restricted devices of the single board resource. One technique for achieving high IoT service availability is to ensure the availability of critical hardware and facilities (Bahalul Haque 2019). Mobility Although most utilities are designed to be delivered via Smartphone devices, IoT implementation is hampered by accessibility. A key IoT premise is to keep customers connected to their preferred resources when moving. When mobile devices are relocated from one gateway to another, service interruptions may occur. Caching and tunneling for service continuity allow apps to access IoT data even if the internet is down for a short time. The vast number of smart devices available in IoT systems is usually included in any solid framework for mobility control. Scalability Scalability in the Internet of Things refers to the ability to accept new client equipment, software, and capabilities without compromising the efficiency of existing systems. It is not straightforward to add new processes and manage extra devices, especially when there are several hardware platforms and communication protocols to contend with. IoT applications must be built from the ground up to enable extendable services and operations. Security and Privacy On diverse networks, such as the Internet of Things, ensuring user security and privacy is strict. The fundamental functioning of the Internet of Things is built on data transmission between billions, if not trillions, of Internet-connected items. One great problem in IoT security left out of the standards is the key distribution between devices. The growing number of intelligent objects around us with sensitive data necessitates transparent and simple access control management, such as enabling one vendor to view the data. In contrast, another controls the device Performance The performance of IoT services is difficult to evaluate since it is based on the performance of many components and the underlying technology. The Internet of Things, like other programs, must constantly develop and expand its offerings in order to meet user expectations. IoT also needs to manage the larger amount of information or data created in the ecosystem, ensuring the interoperability and quality of service. Layered Architecture of IoT Various designs have been suggested for IoT worlds. In general, such structures are divided into three categories. There are three types of architecture: three-layer architecture, four-layer architecture, and five-layer architecture. In this chapter, we will look at the three-layered architecture. It is organized keeping mid some specific tasks to accomplish by the system like executing service functions, transmitting data, and connection among service devices. It results in three layers, Application layer, Network/Transmission layer, and Perception/Edge layer. Application Layer In different implementations, this layer may include various services. Smart grids, healthcare, and autonomous automobiles are examples of IoT deployment in smart cities and homes. Because the application layer might serve as a service support middleware, a networking standard, or a cloud computing platform, security considerations vary depending on the application's environment and industry. Network Layer Acting as a bridge, the network layer controls data transfer to subsequent layers. This layer connects to the visual layer. Different smart devices are connected to the network layer following control function protocol (IEEE 802.x) and authentication standards (GPS, and Near-Field Connectivity (NFC)). The transmission of data is highly prone to cyber-attacks. Intelligent intrusion detection key encryption with secured management-based IoT security framework is the most popular along with the latest adoption of blockchain technology. Edge Layer Edge layer manages the IoT devices or sensors like RFID, different actuators, cameras, intensity detectors, moisture and pressure sensors, etc., using gateways in a coordinating function to connect with Researchers have proposed security solutions for this layer based on machine learning, multi-stepped authorization, secure channeling through anti-malware, etc. Requirements for 5G Integrated IoT Architecture 5G-enabled IoT needs special attention for its heterogeneity, advancement, and application. However, there are some requirements that all the architecture should follow (Li et al. 2018b): 5G IoT must ensure a low latency of 1 ms considering the sensitive internet system and medical perspective. The architecture must ensure low energy consumption for low-battery life IoT devices but enough for 5G to transfer data. An advanced application like Virtual Reality or Augmented Reality needs a high speed of 25 Mbps, so the architecture must follow with the future needs. Security must be top-notch, considering massive data transmission at a very high speed. The devices with mobility factors will get priority for the 5G IoT infrastructure. The fundamental 5G IoT architecture consists of five steps in general: sensors, IoT Gateway, 5G-based station, cloud storage, and application (Arsh et al. 2021). These steps can be comprised in IoT layers to bring up a general 5G IoT architecture. Edge Layer of 5G IoT The sensors and gateway of IoT can be comprised of 5G in this layer. For example, sensors for wearable ECG, temperature, smart manufacturing etc. will use this layer to transmit and process information using 5G technology (Shdefat et al. 2021). Network Layer of 5G IoT The network layer will hold the 5G base station and cloud storage to process data using IoT devices. Application Layer of 5G IoT The application layer will provide all the support for the end system like smart home, smart supply chain, etc. (Haque et al. 2021b). Following the above-mentioned general architecture, 5G IoT can support millimeter-wave (Rahimi et al. 2018), D2D communication, nano-chip, wireless software (Huang et al. 2020), mobile edge computing, data analytics cloud computing (Mudigonda et al. 2020), and many more technologies and application. In Fig. 11.1, we have shown a generalized architecture for the 5G integrated IoT ecosystem. Blockchain-Based 5G IoT Blockchain (Haque and Bhushan 2021b) can bring trust and improved security to 5G IoT. It can accelerate data exchange at a lower cost by implementing a cryptographic encryption system to the architecture. The immutability and accountability that blockchain can ensure for the system are marvelous (Hewa et al. 2020). Blockchain integrated 5G IoT can bring revolution to industrial IoT, UnThese layers work together using cloud storage and a 5G network to provide services like education, fire station, transportation, factories, etc. USER: The 5G IoT has three layers: the Edge, Network, and Application layer; in which way does the architecture of the 5G IoT help to support complex applications such as the smart home, virtual reality, and industrial IoT? Secondly, explain how this architecture benefits from blockchain for security and data exchange. The next question is addressing the following issues: what are the critical parameters that should be met in order to guarantee the effective work and security of the IoT systems based on 5G technology? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	26	84	1,293	null	95
You may only respond with information from the text that I give you. Do not use outside information or your knowledge base.	How are mental health services handled with power of attorney?	Except to the extent you state otherwise, this document gives the person you name as your agent the authority to make any and all health care decisions for you in accordance with your wishes, including your religious and moral beliefs, when you are unable to make the decisions for yourself. Because "health care" means any treatment, service, or procedure to maintain, diagnose, or treat your physical or mental condition, your agent has the power to make a broad range of health care decisions for you. Your agent may consent, refuse to consent, or withdraw consent to medical treatment and may make decisions about withdrawing or withholding life- sustaining treatment. Your agent may not consent to voluntary inpatient mental health services, convulsive treatment, psychosurgery, or abortion. A physician must comply with your agent's instructions or allow you to be transferred to another physician. Your agent's authority is effective when your doctor certifies that you lack the competence to make health care decisions. Your agent is obligated to follow your instructions when making decisions on your behalf. Unless you state otherwise, your agent has the same authority to make decisions about your health care as you would have if you were able to make health care decisions for yourself. It is important that you discuss this document with your physician or other health care provider before you sign the document to ensure that you understand the nature and range of decisions that may be made on your behalf. If you do not have a physician, you should talk with someone else who is knowledgeable about these issues and can answer your questions. You do not need a lawyer's assistance to complete this document, but if there is anything in this document that you do not understand, you should ask a lawyer to explain it to you. The person you appoint as agent should be someone you know and trust. The person must be 18 years of age or older or a person under 18 years of age who has had the disabilities of minority removed. If you appoint your health or residential care provider (e.g., your physician or an employee of a home health agency, hospital, nursing facility, or residential care facility, other than a relative), that person has to choose between acting as your agent or as your health or residential care provider; the law does not allow a person to serve as both at the same time. You should inform the person you appoint that you want the person to be your health care agent. You should discuss this document with your agent and your physician and give each a signed copy. You should indicate on the document itself the people and institutions that you intend to have signed copies. Your agent is not liable for health care decisions made in good faith on your behalf. Once you have signed this document, you have the right to make health care decisions for yourself as long as you are able to make those decisions, and treatment cannot be given to you or stopped over your objection. You have the right to revoke the authority granted to your agent by informing your agent or your health or residential care provider orally or in writing or by your execution of a subsequent medical power of attorney. Unless you state otherwise in this document, your appointment of a spouse is revoked if your marriage is dissolved, annulled, or declared void. This document may not be changed or modified. If you want to make changes in this document, you must execute a new medical power of attorney. You may wish to designate an alternate agent in the event that your agent is unwilling, unable, or ineligible to act as your agent. If you designate an alternate agent, the alternate agent has the same authority as the agent to make health care decisions for you. This Power Of Attorney Is Not Valid Unless: (1) You Sign It And Have Your Signature Acknowledged Before A Notary Public; Or (2) You Sign It In The Presence Of Two Competent Adult Witnesses. The Following Persons May Not Act As One Of The Witnesses: (1) the person you have designated as your agent; (2) a person related to you by blood or marriage; (3) a person entitled to any part of your estate after your death under a will or codicil executed by you or by operation of law; (4) your attending physician; (5) an employee of your attending physician; (6) an employee of a health care facility in which you are a patient if the employee is providing direct patient care to you or is an officer, director, partner, or business office employee of the health care facility or of any parent organization of the health care facility; or (7) a person who, at the time this medical power of attorney is executed, has a claim against any part of your estate after your death.	How are mental health services handled with power of attorney? You may only respond with information from the text that I give you. Do not use outside information or your knowledge base. Except to the extent you state otherwise, this document gives the person you name as your agent the authority to make any and all health care decisions for you in accordance with your wishes, including your religious and moral beliefs, when you are unable to make the decisions for yourself. Because "health care" means any treatment, service, or procedure to maintain, diagnose, or treat your physical or mental condition, your agent has the power to make a broad range of health care decisions for you. Your agent may consent, refuse to consent, or withdraw consent to medical treatment and may make decisions about withdrawing or withholding life- sustaining treatment. Your agent may not consent to voluntary inpatient mental health services, convulsive treatment, psychosurgery, or abortion. A physician must comply with your agent's instructions or allow you to be transferred to another physician. Your agent's authority is effective when your doctor certifies that you lack the competence to make health care decisions. Your agent is obligated to follow your instructions when making decisions on your behalf. Unless you state otherwise, your agent has the same authority to make decisions about your health care as you would have if you were able to make health care decisions for yourself. It is important that you discuss this document with your physician or other health care provider before you sign the document to ensure that you understand the nature and range of decisions that may be made on your behalf. If you do not have a physician, you should talk with someone else who is knowledgeable about these issues and can answer your questions. You do not need a lawyer's assistance to complete this document, but if there is anything in this document that you do not understand, you should ask a lawyer to explain it to you. The person you appoint as agent should be someone you know and trust. The person must be 18 years of age or older or a person under 18 years of age who has had the disabilities of minority removed. If you appoint your health or residential care provider (e.g., your physician or an employee of a home health agency, hospital, nursing facility, or residential care facility, other than a relative), that person has to choose between acting as your agent or as your health or residential care provider; the law does not allow a person to serve as both at the same time. You should inform the person you appoint that you want the person to be your health care agent. You should discuss this document with your agent and your physician and give each a signed copy. You should indicate on the document itself the people and institutions that you intend to have signed copies. Your agent is not liable for health care decisions made in good faith on your behalf. Once you have signed this document, you have the right to make health care decisions for yourself as long as you are able to make those decisions, and treatment cannot be given to you or stopped over your objection. You have the right to revoke the authority granted to your agent by informing your agent or your health or residential care provider orally or in writing or by your execution of a subsequent medical power of attorney. Unless you state otherwise in this document, your appointment of a spouse is revoked if your marriage is dissolved, annulled, or declared void. This document may not be changed or modified. If you want to make changes in this document, you must execute a new medical power of attorney. You may wish to designate an alternate agent in the event that your agent is unwilling, unable, or ineligible to act as your agent. If you designate an alternate agent, the alternate agent has the same authority as the agent to make health care decisions for you. This Power Of Attorney Is Not Valid Unless: (1) You Sign It And Have Your Signature Acknowledged Before A Notary Public; Or (2) You Sign It In The Presence Of Two Competent Adult Witnesses. The Following Persons May Not Act As One Of The Witnesses: (1) the person you have designated as your agent; (2) a person related to you by blood or marriage; (3) a person entitled to any part of your estate after your death under a will or codicil executed by you or by operation of law; (4) your attending physician; (5) an employee of your attending physician; (6) an employee of a health care facility in which you are a patient if the employee is providing direct patient care to you or is an officer, director, partner, or business office employee of the health care facility or of any parent organization of the health care facility; or (7) a person who, at the time this medical power of attorney is executed, has a claim against any part of your estate after your death.	You may only respond with information from the text that I give you. Do not use outside information or your knowledge base. EVIDENCE: Except to the extent you state otherwise, this document gives the person you name as your agent the authority to make any and all health care decisions for you in accordance with your wishes, including your religious and moral beliefs, when you are unable to make the decisions for yourself. Because "health care" means any treatment, service, or procedure to maintain, diagnose, or treat your physical or mental condition, your agent has the power to make a broad range of health care decisions for you. Your agent may consent, refuse to consent, or withdraw consent to medical treatment and may make decisions about withdrawing or withholding life- sustaining treatment. Your agent may not consent to voluntary inpatient mental health services, convulsive treatment, psychosurgery, or abortion. A physician must comply with your agent's instructions or allow you to be transferred to another physician. Your agent's authority is effective when your doctor certifies that you lack the competence to make health care decisions. Your agent is obligated to follow your instructions when making decisions on your behalf. Unless you state otherwise, your agent has the same authority to make decisions about your health care as you would have if you were able to make health care decisions for yourself. It is important that you discuss this document with your physician or other health care provider before you sign the document to ensure that you understand the nature and range of decisions that may be made on your behalf. If you do not have a physician, you should talk with someone else who is knowledgeable about these issues and can answer your questions. You do not need a lawyer's assistance to complete this document, but if there is anything in this document that you do not understand, you should ask a lawyer to explain it to you. The person you appoint as agent should be someone you know and trust. The person must be 18 years of age or older or a person under 18 years of age who has had the disabilities of minority removed. If you appoint your health or residential care provider (e.g., your physician or an employee of a home health agency, hospital, nursing facility, or residential care facility, other than a relative), that person has to choose between acting as your agent or as your health or residential care provider; the law does not allow a person to serve as both at the same time. You should inform the person you appoint that you want the person to be your health care agent. You should discuss this document with your agent and your physician and give each a signed copy. You should indicate on the document itself the people and institutions that you intend to have signed copies. Your agent is not liable for health care decisions made in good faith on your behalf. Once you have signed this document, you have the right to make health care decisions for yourself as long as you are able to make those decisions, and treatment cannot be given to you or stopped over your objection. You have the right to revoke the authority granted to your agent by informing your agent or your health or residential care provider orally or in writing or by your execution of a subsequent medical power of attorney. Unless you state otherwise in this document, your appointment of a spouse is revoked if your marriage is dissolved, annulled, or declared void. This document may not be changed or modified. If you want to make changes in this document, you must execute a new medical power of attorney. You may wish to designate an alternate agent in the event that your agent is unwilling, unable, or ineligible to act as your agent. If you designate an alternate agent, the alternate agent has the same authority as the agent to make health care decisions for you. This Power Of Attorney Is Not Valid Unless: (1) You Sign It And Have Your Signature Acknowledged Before A Notary Public; Or (2) You Sign It In The Presence Of Two Competent Adult Witnesses. The Following Persons May Not Act As One Of The Witnesses: (1) the person you have designated as your agent; (2) a person related to you by blood or marriage; (3) a person entitled to any part of your estate after your death under a will or codicil executed by you or by operation of law; (4) your attending physician; (5) an employee of your attending physician; (6) an employee of a health care facility in which you are a patient if the employee is providing direct patient care to you or is an officer, director, partner, or business office employee of the health care facility or of any parent organization of the health care facility; or (7) a person who, at the time this medical power of attorney is executed, has a claim against any part of your estate after your death. USER: How are mental health services handled with power of attorney? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	22	10	826	null	348
Only answer using the text I provide. Answer in four sentences that are no longer than 24 words each.	What are the pros and cons of restitution orders specifically related to victims?	Participation in restorative justice programs is voluntary. As a result, offenders often comply with restitution agreements when they have followed a restorative justice program (Van Hecke & Wemmers, 1992). Offenders who do not accept their responsibility and who are not open to the idea of reparation will not enter a program. Thus, once admitted into a restorative justice program, offenders are prone to accept responsibility for their behaviour and repair the harm caused to the victim and, as a result, the victims of these offenders are likely to receive reparation. In their meta-analysis, Umbreit, Coates and Vos (2001) found that 90% of cases that are addressed through mediation end in an agreement. In most cases, these agreements consisted of a monetary sum, community service, or services rendered directly to the victim, and around 80-90% of the agreements were respected. Several researchers studying restorative justice have also observed a very high rate of satisfaction among participants in victim-offender mediation who frequently perceive the process and the result as fair (Umbreit, Coates & Vos 2001; Wemmers & Canuto 2002; Strang 2002; Wemmers & Cyr 2005; Van Camp 2016). According to Carriere, Malsch, Vermunt and De Keijser (1998), victims are generally more satisfied with restitution when they suffer less psychological damages and when their damages are primarily material. In contrast, other researchers find that restorative justice is particularly satisfying for victims of serious violent crimes and that when these victims participate in restorative justice programs they are usually satisfied with mediation, and the restorative justice process often has a positive impact on their well-being (Strang 20 2002; Strang et al 2006; Van Camp 2015; Wemmers 2016). Besides financial needs, other needs often expressed by victims of crime are the need for recognition and validation (Wemmers, 2017). Victims of serious violent crime generally seek other forms of reparation besides compensation, such as recognition of the wrong done by the offender, which is often very important to the victims (Van Camp & Wemmers 2015; Van Camp 2016). In restorative justice, victims’ needs are important and reparation aims to address the consequences of victimization (Wemmers, 2014; 2017). As such, restorative justice is more flexible than restitution orders and, for this reason, it is better able to adapt to the specific needs of the victim. Restitution is an integral part of victim reparation, and its necessity is well recognized by the UN as well as in the Canadian Victims’ Bill of Rights. In Canada, the Criminal Code highlights restitution orders and their application. However, before the introduction of the Victims’ Bill of Rights, restitution orders were a seldom-used measure in the Canadian criminal justice system: Only 2.3% of cases where the offender was found guilty included a restitution order. In order to encourage and facilitate requests by victims for restitution, a standard form was introduced in 2015. Restitution includes numerous advantages, but also has important limitations. It lessens the consequences of the crime for the victim, can reinstate their confidence in the criminal justice system, and can increase denunciation (Hoskins, Care & Ruback, 2015). Nevertheless, Canadian criminal law gives priority to the offender’s rehabilitation and social reintegration. As such, the needs of the victim are secondary. An important obstacle observed across the different models presented, is the conflict between criminal law and civil law. This legal distinction makes it so that judges are often reluctant to issue a restitution order and, if they do so, damages must be easy to determine, which leads to the inapplicability of restitution for emotional or psychological injury. Although lawyers place great importance on this distinction, it is perceived by victims as artificial and is often misunderstood (Helby, Van Dongen & Lindenberg, 2014). Even if restitution is ordered by a criminal court, it is the offender’s civil obligation. The restitution order as well as the civil party pose difficulties for victims with regards to the collection of their money. Civil law is complex and victims lack information on the procedures to undertake in order to obtain restitution. We have seen that the state can implement services to facilitate the collection of restitution. For example, the state can treat the order as a fine and take responsibility for its collection. The state can even advance money to the victim and then use subrogation in order to recover the money from the offender. Studies are nevertheless necessary to evaluate the effects of these types of services on victims and their impact on the effectiveness of restitution. Victim reparation is wider than restitution. Restorative justice programs do not suffer from the same limitations as restitution orders. They give an important place to the victim and can recognize all their needs including recognition, validation, as well as their financial needs. Hence, they are not limited by the offender’s financial insolvency. Restitution remains, after all, a right clearly defined in the Canadian Victims’ Bill of Rights, and significant effort must be deployed in order to ensure its effective application. The information presented in this article clearly points to a lack of data on the implementation and effectiveness of restitution orders. It also highlights the necessity to give more attention to the needs of victims of crime, as well as address the obstacles that hinder the satisfaction of victims’ needs, in order to maximize the benefits of this penal measure for victims, offenders and society as a whole.	Only answer using the text I provide. Answer in four sentences that are no longer than 24 words each. Participation in restorative justice programs is voluntary. As a result, offenders often comply with restitution agreements when they have followed a restorative justice program (Van Hecke & Wemmers, 1992). Offenders who do not accept their responsibility and who are not open to the idea of reparation will not enter a program. Thus, once admitted into a restorative justice program, offenders are prone to accept responsibility for their behaviour and repair the harm caused to the victim and, as a result, the victims of these offenders are likely to receive reparation. In their meta-analysis, Umbreit, Coates and Vos (2001) found that 90% of cases that are addressed through mediation end in an agreement. In most cases, these agreements consisted of a monetary sum, community service, or services rendered directly to the victim, and around 80-90% of the agreements were respected. Several researchers studying restorative justice have also observed a very high rate of satisfaction among participants in victim-offender mediation who frequently perceive the process and the result as fair (Umbreit, Coates & Vos 2001; Wemmers & Canuto 2002; Strang 2002; Wemmers & Cyr 2005; Van Camp 2016). According to Carriere, Malsch, Vermunt and De Keijser (1998), victims are generally more satisfied with restitution when they suffer less psychological damages and when their damages are primarily material. In contrast, other researchers find that restorative justice is particularly satisfying for victims of serious violent crimes and that when these victims participate in restorative justice programs they are usually satisfied with mediation, and the restorative justice process often has a positive impact on their well-being (Strang 20 2002; Strang et al 2006; Van Camp 2015; Wemmers 2016). Besides financial needs, other needs often expressed by victims of crime are the need for recognition and validation (Wemmers, 2017). Victims of serious violent crime generally seek other forms of reparation besides compensation, such as recognition of the wrong done by the offender, which is often very important to the victims (Van Camp & Wemmers 2015; Van Camp 2016). In restorative justice, victims’ needs are important and reparation aims to address the consequences of victimization (Wemmers, 2014; 2017). As such, restorative justice is more flexible than restitution orders and, for this reason, it is better able to adapt to the specific needs of the victim. Restitution is an integral part of victim reparation, and its necessity is well recognized by the UN as well as in the Canadian Victims’ Bill of Rights. In Canada, the Criminal Code highlights restitution orders and their application. However, before the introduction of the Victims’ Bill of Rights, restitution orders were a seldom-used measure in the Canadian criminal justice system: Only 2.3% of cases where the offender was found guilty included a restitution order. In order to encourage and facilitate requests by victims for restitution, a standard form was introduced in 2015. Restitution includes numerous advantages, but also has important limitations. It lessens the consequences of the crime for the victim, can reinstate their confidence in the criminal justice system, and can increase denunciation (Hoskins, Care & Ruback, 2015). Nevertheless, Canadian criminal law gives priority to the offender’s rehabilitation and social reintegration. As such, the needs of the victim are secondary. An important obstacle observed across the different models presented, is the conflict between criminal law and civil law. This legal distinction makes it so that judges are often reluctant to issue a restitution order and, if they do so, damages must be easy to determine, which leads to the inapplicability of restitution for emotional or psychological injury. Although lawyers place great importance on this distinction, it is perceived by victims as artificial and is often misunderstood (Helby, Van Dongen & Lindenberg, 2014). Even if restitution is ordered by a criminal court, it is the offender’s civil obligation. The restitution order as well as the civil party pose difficulties for victims with regards to the collection of their money. Civil law is complex and victims lack information on the procedures to undertake in order to obtain restitution. We have seen that the state can implement services to facilitate the collection of restitution. For example, the state can treat the order as a fine and take responsibility for its collection. The state can even advance money to the victim and then use subrogation in order to recover the money from the offender. Studies are nevertheless necessary to evaluate the effects of these types of services on victims and their impact on the effectiveness of restitution. Victim reparation is wider than restitution. Restorative justice programs do not suffer from the same limitations as restitution orders. They give an important place to the victim and can recognize all their needs including recognition, validation, as well as their financial needs. Hence, they are not limited by the offender’s financial insolvency. Restitution remains, after all, a right clearly defined in the Canadian Victims’ Bill of Rights, and significant effort must be deployed in order to ensure its effective application. The information presented in this article clearly points to a lack of data on the implementation and effectiveness of restitution orders. It also highlights the necessity to give more attention to the needs of victims of crime, as well as address the obstacles that hinder the satisfaction of victims’ needs, in order to maximize the benefits of this penal measure for victims, offenders and society as a whole. What are the pros and cons of restitution orders specifically related to victims?	Only answer using the text I provide. Answer in four sentences that are no longer than 24 words each. EVIDENCE: Participation in restorative justice programs is voluntary. As a result, offenders often comply with restitution agreements when they have followed a restorative justice program (Van Hecke & Wemmers, 1992). Offenders who do not accept their responsibility and who are not open to the idea of reparation will not enter a program. Thus, once admitted into a restorative justice program, offenders are prone to accept responsibility for their behaviour and repair the harm caused to the victim and, as a result, the victims of these offenders are likely to receive reparation. In their meta-analysis, Umbreit, Coates and Vos (2001) found that 90% of cases that are addressed through mediation end in an agreement. In most cases, these agreements consisted of a monetary sum, community service, or services rendered directly to the victim, and around 80-90% of the agreements were respected. Several researchers studying restorative justice have also observed a very high rate of satisfaction among participants in victim-offender mediation who frequently perceive the process and the result as fair (Umbreit, Coates & Vos 2001; Wemmers & Canuto 2002; Strang 2002; Wemmers & Cyr 2005; Van Camp 2016). According to Carriere, Malsch, Vermunt and De Keijser (1998), victims are generally more satisfied with restitution when they suffer less psychological damages and when their damages are primarily material. In contrast, other researchers find that restorative justice is particularly satisfying for victims of serious violent crimes and that when these victims participate in restorative justice programs they are usually satisfied with mediation, and the restorative justice process often has a positive impact on their well-being (Strang 20 2002; Strang et al 2006; Van Camp 2015; Wemmers 2016). Besides financial needs, other needs often expressed by victims of crime are the need for recognition and validation (Wemmers, 2017). Victims of serious violent crime generally seek other forms of reparation besides compensation, such as recognition of the wrong done by the offender, which is often very important to the victims (Van Camp & Wemmers 2015; Van Camp 2016). In restorative justice, victims’ needs are important and reparation aims to address the consequences of victimization (Wemmers, 2014; 2017). As such, restorative justice is more flexible than restitution orders and, for this reason, it is better able to adapt to the specific needs of the victim. Restitution is an integral part of victim reparation, and its necessity is well recognized by the UN as well as in the Canadian Victims’ Bill of Rights. In Canada, the Criminal Code highlights restitution orders and their application. However, before the introduction of the Victims’ Bill of Rights, restitution orders were a seldom-used measure in the Canadian criminal justice system: Only 2.3% of cases where the offender was found guilty included a restitution order. In order to encourage and facilitate requests by victims for restitution, a standard form was introduced in 2015. Restitution includes numerous advantages, but also has important limitations. It lessens the consequences of the crime for the victim, can reinstate their confidence in the criminal justice system, and can increase denunciation (Hoskins, Care & Ruback, 2015). Nevertheless, Canadian criminal law gives priority to the offender’s rehabilitation and social reintegration. As such, the needs of the victim are secondary. An important obstacle observed across the different models presented, is the conflict between criminal law and civil law. This legal distinction makes it so that judges are often reluctant to issue a restitution order and, if they do so, damages must be easy to determine, which leads to the inapplicability of restitution for emotional or psychological injury. Although lawyers place great importance on this distinction, it is perceived by victims as artificial and is often misunderstood (Helby, Van Dongen & Lindenberg, 2014). Even if restitution is ordered by a criminal court, it is the offender’s civil obligation. The restitution order as well as the civil party pose difficulties for victims with regards to the collection of their money. Civil law is complex and victims lack information on the procedures to undertake in order to obtain restitution. We have seen that the state can implement services to facilitate the collection of restitution. For example, the state can treat the order as a fine and take responsibility for its collection. The state can even advance money to the victim and then use subrogation in order to recover the money from the offender. Studies are nevertheless necessary to evaluate the effects of these types of services on victims and their impact on the effectiveness of restitution. Victim reparation is wider than restitution. Restorative justice programs do not suffer from the same limitations as restitution orders. They give an important place to the victim and can recognize all their needs including recognition, validation, as well as their financial needs. Hence, they are not limited by the offender’s financial insolvency. Restitution remains, after all, a right clearly defined in the Canadian Victims’ Bill of Rights, and significant effort must be deployed in order to ensure its effective application. The information presented in this article clearly points to a lack of data on the implementation and effectiveness of restitution orders. It also highlights the necessity to give more attention to the needs of victims of crime, as well as address the obstacles that hinder the satisfaction of victims’ needs, in order to maximize the benefits of this penal measure for victims, offenders and society as a whole. USER: What are the pros and cons of restitution orders specifically related to victims? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	19	13	890	null	487
You must rely only on information contained in the prompt/context block to formulate your answer. No outside sources of information can be relied on.	What role do loan commitments play in a bank's liquidity risk?	Credit Risk For most banks, loans are the largest and most obvious source of credit risk. However, there are other pockets of credit risk both on and off the balance sheet, such as the investment portfolio, overdrafts, and letters of credit. Many products, activities, and services, such as derivatives, foreign exchange, and cash management services, also expose a bank to credit risk. The risk of repayment, i.e., the possibility that an obligor will fail to perform as agreed, is either lessened or increased by a bank’s credit risk management practices. A bank’s first defense against excessive credit risk is the initial credit-granting process − sound underwriting standards, an efficient, balanced Loan Portfolio Management 5 Comptroller’s Handbook approval process, and a competent lending staff. Because a bank cannot easily overcome borrowers with questionable capacity or character, these factors exert a strong influence on credit quality. Borrowers whose financial performance is poor or marginal, or whose repayment ability is dependent upon unproven projections can quickly become impaired by personal or external economic stress. Management of credit risk, however, must continue after a loan has been made, for sound initial credit decisions can be undermined by improper loan structuring or inadequate monitoring. Traditionally, banks have focused on oversight of individual loans in managing their overall credit risk. While this focus is important, banks should also view credit risk management in terms of portfolio segments and the entire portfolio. The focus on managing individual credit risk did not avert the credit crises of the 1980s. However, had the portfolio approach to risk management augmented these traditional risk management practices, banks might have at least reduced their losses. Effective management of the loan portfolio’s credit risk requires that the board and management understand and control the bank’s risk profile and its credit culture. To accomplish this, they must have a thorough knowledge of the portfolio’s composition and its inherent risks. They must understand the portfolio’s product mix, industry and geographic concentrations, average risk ratings, and other aggregate characteristics. They must be sure that the policies, processes, and practices implemented to control the risks of individual loans and portfolio segments are sound and that lending personnel adhere to them. Banks engaged in international lending face country risks that domestic lenders do not. Country risk encompasses all of the uncertainties arising from a nation’s economic, social, and political conditions that may affect the payment of foreigners’ debt and equity investments. Country risk includes the possibility of political and social upheaval, nationalization and expropriation of assets, governmental repudiation of external indebtedness, exchange controls, and currency devaluation or depreciation. Unless a nation repudiates its external debt, these developments might not make a loan uncollectible. However, even a delay in collection could weaken the lending bank. Loan Portfolio Management 6 Comptroller’s Handbook Transfer risk, which is a narrower form of country risk, is the possibility that an obligor will not be able to pay because the currency of payment is unavailable. This unavailability may be a matter of government policy. For example, although an individual borrower may be very successful and have sufficient local currency cash flow to pay its foreign (e.g., U.S. dollar) debt, the borrower’s country may not have sufficient U.S. dollars available to permit repayment of the foreign indebtedness. The transfer risk associated with banks’ exposures in foreign countries is evaluated by the Interagency Country Exposure Review Committee (ICERC). For examination purposes, the transfer risk rating assigned to a country by the ICERC applies to all bank assets in that country. However, examiners may classify individual loans and other assets more severely for credit risk reasons. Strategies for managing country risk will be discussed in “Country Risk Management,” a separate booklet in the Comptroller’s Handbook. Interest Rate Risk The level of interest rate risk attributed to the bank’s lending activities depends on the composition of its loan portfolio and the degree to which the terms of its loans (e.g., maturity, rate structure, embedded options) expose the bank’s revenue stream to changes in rates. Pricing and portfolio maturity decisions should be made with an eye to funding costs and maturities. When significant individual credits or portfolio segments are especially sensitive to interest rate risk, they should be periodically stress-tested. If the asset/liability management committee (ALCO), which typically is responsible for managing the bank’s interest rate risk, is to manage all of the bank’s positions, it must have sufficient reports on loan portfolio and pipeline composition and trends. These reports might include a maturing loans report, pipeline report, and rate and repricing report. Banks frequently shift interest rate risk to their borrowers by structuring loans with variable interest rates. Borrowers with marginal repayment capacity may experience financial difficulty if the interest rates on these loans increase. As part of the risk management process, banks should identify borrowers whose loans have heightened sensitivity to interest rate changes Loan Portfolio Management 7 Comptroller’s Handbook and develop strategies to mitigate the risk. One method is to require vulnerable borrowers to purchase interest rate protection or otherwise hedge the risk. The Comptroller’s Handbook booklet “Interest Rate Risk” provides guidance on interest rate risk management. Liquidity Risk Because of the size of the loan portfolio, effective management of liquidity risk requires that there be close ties to, and good information flow from, the lending function. Obviously, loans are a primary use of funds. And while controlling loan growth has always been a large part of liquidity management, historically the loan portfolio has not been viewed as a significant source of funds for liquidity management. Practices are changing, however. Banks can use the loan portfolio as a source of funds by reducing the total dollar volume of loans through sales, securitization, and portfolio run-off. In fact, banks are taking a more active role in managing their loan portfolios. While these activities are often initiated to manage credit risk, they have also improved liquidity. Banks increasingly are originating loans “for sale” or securitization. Consumer loans (mortgages, instalment loans, and credit cards) are routinely originated for immediate securitization. Many larger banks have been expanding their underwriting for the syndicated loan market. Additionally, banks are also expanding the packaging and sale of distressed credits and otherwise undesirable loans. As part of liquidity planning, a bank’s overall liquidity strategy should include the identification of those loans or loan portfolio segments that may be easily converted to cash. A loan’s liquidity hinges on such characteristics as its quality, pricing, scheduled maturities, and conformity to market standards for underwriting. Loans are also a source of liquidity when used as collateral for borrowings. The ease with which a bank can participate or sell loans to other lenders or investors (and the terms on which the bank can do so) will vary with market conditions, the type of loan, and the quality of loan. Information provided for liquidity analysis should include an assessment of these variables under various scenarios. Loan Portfolio Management 8 Comptroller’s Handbook Liquidity is also affected by the amount of the bank’s commitments to lend and the actual amount that borrowers draw against those commitments. A bank should have systems to track commitments and borrower usage. Knowledge of the types of commitments, deals in the pipeline, normal usage levels, and historically high usage levels are important in assessing whether available liquidity will be adequate for normal, seasonal, or emergency needs. Management information systems should distinguish between commitments that the bank is legally obligated to fund and those (guidance or advisory lines) that it is not. Any analysis of a bank’s ability to reduce or cut existing commitments must consider more than its legal obligation to lend. It should also consider reputation risk and the potential for lender-liability actions. The withdrawal or reduction of commitments can have significant ramifications for a bank. From a strategic perspective, any tightening of commitments may adversely affect a bank’s ability to maintain or grow a customer base if it is perceived as an unreliable lender in tight credit markets. A bank’s reputation may also suffer if it is perceived as unwilling to support community credit needs. Given these ancillary risks, bank management must carefully assess the implications of curtailing lending lines.	You must rely only on information contained in the prompt/context block to formulate your answer. No outside sources of information can be relied on. Credit Risk For most banks, loans are the largest and most obvious source of credit risk. However, there are other pockets of credit risk both on and off the balance sheet, such as the investment portfolio, overdrafts, and letters of credit. Many products, activities, and services, such as derivatives, foreign exchange, and cash management services, also expose a bank to credit risk. The risk of repayment, i.e., the possibility that an obligor will fail to perform as agreed, is either lessened or increased by a bank’s credit risk management practices. A bank’s first defense against excessive credit risk is the initial credit-granting process − sound underwriting standards, an efficient, balanced Loan Portfolio Management 5 Comptroller’s Handbook approval process, and a competent lending staff. Because a bank cannot easily overcome borrowers with questionable capacity or character, these factors exert a strong influence on credit quality. Borrowers whose financial performance is poor or marginal, or whose repayment ability is dependent upon unproven projections can quickly become impaired by personal or external economic stress. Management of credit risk, however, must continue after a loan has been made, for sound initial credit decisions can be undermined by improper loan structuring or inadequate monitoring. Traditionally, banks have focused on oversight of individual loans in managing their overall credit risk. While this focus is important, banks should also view credit risk management in terms of portfolio segments and the entire portfolio. The focus on managing individual credit risk did not avert the credit crises of the 1980s. However, had the portfolio approach to risk management augmented these traditional risk management practices, banks might have at least reduced their losses. Effective management of the loan portfolio’s credit risk requires that the board and management understand and control the bank’s risk profile and its credit culture. To accomplish this, they must have a thorough knowledge of the portfolio’s composition and its inherent risks. They must understand the portfolio’s product mix, industry and geographic concentrations, average risk ratings, and other aggregate characteristics. They must be sure that the policies, processes, and practices implemented to control the risks of individual loans and portfolio segments are sound and that lending personnel adhere to them. Banks engaged in international lending face country risks that domestic lenders do not. Country risk encompasses all of the uncertainties arising from a nation’s economic, social, and political conditions that may affect the payment of foreigners’ debt and equity investments. Country risk includes the possibility of political and social upheaval, nationalization and expropriation of assets, governmental repudiation of external indebtedness, exchange controls, and currency devaluation or depreciation. Unless a nation repudiates its external debt, these developments might not make a loan uncollectible. However, even a delay in collection could weaken the lending bank. Loan Portfolio Management 6 Comptroller’s Handbook Transfer risk, which is a narrower form of country risk, is the possibility that an obligor will not be able to pay because the currency of payment is unavailable. This unavailability may be a matter of government policy. For example, although an individual borrower may be very successful and have sufficient local currency cash flow to pay its foreign (e.g., U.S. dollar) debt, the borrower’s country may not have sufficient U.S. dollars available to permit repayment of the foreign indebtedness. The transfer risk associated with banks’ exposures in foreign countries is evaluated by the Interagency Country Exposure Review Committee (ICERC). For examination purposes, the transfer risk rating assigned to a country by the ICERC applies to all bank assets in that country. However, examiners may classify individual loans and other assets more severely for credit risk reasons. Strategies for managing country risk will be discussed in “Country Risk Management,” a separate booklet in the Comptroller’s Handbook. Interest Rate Risk The level of interest rate risk attributed to the bank’s lending activities depends on the composition of its loan portfolio and the degree to which the terms of its loans (e.g., maturity, rate structure, embedded options) expose the bank’s revenue stream to changes in rates. Pricing and portfolio maturity decisions should be made with an eye to funding costs and maturities. When significant individual credits or portfolio segments are especially sensitive to interest rate risk, they should be periodically stress-tested. If the asset/liability management committee (ALCO), which typically is responsible for managing the bank’s interest rate risk, is to manage all of the bank’s positions, it must have sufficient reports on loan portfolio and pipeline composition and trends. These reports might include a maturing loans report, pipeline report, and rate and repricing report. Banks frequently shift interest rate risk to their borrowers by structuring loans with variable interest rates. Borrowers with marginal repayment capacity may experience financial difficulty if the interest rates on these loans increase. As part of the risk management process, banks should identify borrowers whose loans have heightened sensitivity to interest rate changes Loan Portfolio Management 7 Comptroller’s Handbook and develop strategies to mitigate the risk. One method is to require vulnerable borrowers to purchase interest rate protection or otherwise hedge the risk. The Comptroller’s Handbook booklet “Interest Rate Risk” provides guidance on interest rate risk management. Liquidity Risk Because of the size of the loan portfolio, effective management of liquidity risk requires that there be close ties to, and good information flow from, the lending function. Obviously, loans are a primary use of funds. And while controlling loan growth has always been a large part of liquidity management, historically the loan portfolio has not been viewed as a significant source of funds for liquidity management. Practices are changing, however. Banks can use the loan portfolio as a source of funds by reducing the total dollar volume of loans through sales, securitization, and portfolio run-off. In fact, banks are taking a more active role in managing their loan portfolios. While these activities are often initiated to manage credit risk, they have also improved liquidity. Banks increasingly are originating loans “for sale” or securitization. Consumer loans (mortgages, instalment loans, and credit cards) are routinely originated for immediate securitization. Many larger banks have been expanding their underwriting for the syndicated loan market. Additionally, banks are also expanding the packaging and sale of distressed credits and otherwise undesirable loans. As part of liquidity planning, a bank’s overall liquidity strategy should include the identification of those loans or loan portfolio segments that may be easily converted to cash. A loan’s liquidity hinges on such characteristics as its quality, pricing, scheduled maturities, and conformity to market standards for underwriting. Loans are also a source of liquidity when used as collateral for borrowings. The ease with which a bank can participate or sell loans to other lenders or investors (and the terms on which the bank can do so) will vary with market conditions, the type of loan, and the quality of loan. Information provided for liquidity analysis should include an assessment of these variables under various scenarios. Loan Portfolio Management 8 Comptroller’s Handbook Liquidity is also affected by the amount of the bank’s commitments to lend and the actual amount that borrowers draw against those commitments. A bank should have systems to track commitments and borrower usage. Knowledge of the types of commitments, deals in the pipeline, normal usage levels, and historically high usage levels are important in assessing whether available liquidity will be adequate for normal, seasonal, or emergency needs. Management information systems should distinguish between commitments that the bank is legally obligated to fund and those (guidance or advisory lines) that it is not. Any analysis of a bank’s ability to reduce or cut existing commitments must consider more than its legal obligation to lend. It should also consider reputation risk and the potential for lender-liability actions. The withdrawal or reduction of commitments can have significant ramifications for a bank. From a strategic perspective, any tightening of commitments may adversely affect a bank’s ability to maintain or grow a customer base if it is perceived as an unreliable lender in tight credit markets. A bank’s reputation may also suffer if it is perceived as unwilling to support community credit needs. Given these ancillary risks, bank management must carefully assess the implications of curtailing lending lines. What role do loan commitments play in a bank's liquidity risk?	You must rely only on information contained in the prompt/context block to formulate your answer. No outside sources of information can be relied on. EVIDENCE: Credit Risk For most banks, loans are the largest and most obvious source of credit risk. However, there are other pockets of credit risk both on and off the balance sheet, such as the investment portfolio, overdrafts, and letters of credit. Many products, activities, and services, such as derivatives, foreign exchange, and cash management services, also expose a bank to credit risk. The risk of repayment, i.e., the possibility that an obligor will fail to perform as agreed, is either lessened or increased by a bank’s credit risk management practices. A bank’s first defense against excessive credit risk is the initial credit-granting process − sound underwriting standards, an efficient, balanced Loan Portfolio Management 5 Comptroller’s Handbook approval process, and a competent lending staff. Because a bank cannot easily overcome borrowers with questionable capacity or character, these factors exert a strong influence on credit quality. Borrowers whose financial performance is poor or marginal, or whose repayment ability is dependent upon unproven projections can quickly become impaired by personal or external economic stress. Management of credit risk, however, must continue after a loan has been made, for sound initial credit decisions can be undermined by improper loan structuring or inadequate monitoring. Traditionally, banks have focused on oversight of individual loans in managing their overall credit risk. While this focus is important, banks should also view credit risk management in terms of portfolio segments and the entire portfolio. The focus on managing individual credit risk did not avert the credit crises of the 1980s. However, had the portfolio approach to risk management augmented these traditional risk management practices, banks might have at least reduced their losses. Effective management of the loan portfolio’s credit risk requires that the board and management understand and control the bank’s risk profile and its credit culture. To accomplish this, they must have a thorough knowledge of the portfolio’s composition and its inherent risks. They must understand the portfolio’s product mix, industry and geographic concentrations, average risk ratings, and other aggregate characteristics. They must be sure that the policies, processes, and practices implemented to control the risks of individual loans and portfolio segments are sound and that lending personnel adhere to them. Banks engaged in international lending face country risks that domestic lenders do not. Country risk encompasses all of the uncertainties arising from a nation’s economic, social, and political conditions that may affect the payment of foreigners’ debt and equity investments. Country risk includes the possibility of political and social upheaval, nationalization and expropriation of assets, governmental repudiation of external indebtedness, exchange controls, and currency devaluation or depreciation. Unless a nation repudiates its external debt, these developments might not make a loan uncollectible. However, even a delay in collection could weaken the lending bank. Loan Portfolio Management 6 Comptroller’s Handbook Transfer risk, which is a narrower form of country risk, is the possibility that an obligor will not be able to pay because the currency of payment is unavailable. This unavailability may be a matter of government policy. For example, although an individual borrower may be very successful and have sufficient local currency cash flow to pay its foreign (e.g., U.S. dollar) debt, the borrower’s country may not have sufficient U.S. dollars available to permit repayment of the foreign indebtedness. The transfer risk associated with banks’ exposures in foreign countries is evaluated by the Interagency Country Exposure Review Committee (ICERC). For examination purposes, the transfer risk rating assigned to a country by the ICERC applies to all bank assets in that country. However, examiners may classify individual loans and other assets more severely for credit risk reasons. Strategies for managing country risk will be discussed in “Country Risk Management,” a separate booklet in the Comptroller’s Handbook. Interest Rate Risk The level of interest rate risk attributed to the bank’s lending activities depends on the composition of its loan portfolio and the degree to which the terms of its loans (e.g., maturity, rate structure, embedded options) expose the bank’s revenue stream to changes in rates. Pricing and portfolio maturity decisions should be made with an eye to funding costs and maturities. When significant individual credits or portfolio segments are especially sensitive to interest rate risk, they should be periodically stress-tested. If the asset/liability management committee (ALCO), which typically is responsible for managing the bank’s interest rate risk, is to manage all of the bank’s positions, it must have sufficient reports on loan portfolio and pipeline composition and trends. These reports might include a maturing loans report, pipeline report, and rate and repricing report. Banks frequently shift interest rate risk to their borrowers by structuring loans with variable interest rates. Borrowers with marginal repayment capacity may experience financial difficulty if the interest rates on these loans increase. As part of the risk management process, banks should identify borrowers whose loans have heightened sensitivity to interest rate changes Loan Portfolio Management 7 Comptroller’s Handbook and develop strategies to mitigate the risk. One method is to require vulnerable borrowers to purchase interest rate protection or otherwise hedge the risk. The Comptroller’s Handbook booklet “Interest Rate Risk” provides guidance on interest rate risk management. Liquidity Risk Because of the size of the loan portfolio, effective management of liquidity risk requires that there be close ties to, and good information flow from, the lending function. Obviously, loans are a primary use of funds. And while controlling loan growth has always been a large part of liquidity management, historically the loan portfolio has not been viewed as a significant source of funds for liquidity management. Practices are changing, however. Banks can use the loan portfolio as a source of funds by reducing the total dollar volume of loans through sales, securitization, and portfolio run-off. In fact, banks are taking a more active role in managing their loan portfolios. While these activities are often initiated to manage credit risk, they have also improved liquidity. Banks increasingly are originating loans “for sale” or securitization. Consumer loans (mortgages, instalment loans, and credit cards) are routinely originated for immediate securitization. Many larger banks have been expanding their underwriting for the syndicated loan market. Additionally, banks are also expanding the packaging and sale of distressed credits and otherwise undesirable loans. As part of liquidity planning, a bank’s overall liquidity strategy should include the identification of those loans or loan portfolio segments that may be easily converted to cash. A loan’s liquidity hinges on such characteristics as its quality, pricing, scheduled maturities, and conformity to market standards for underwriting. Loans are also a source of liquidity when used as collateral for borrowings. The ease with which a bank can participate or sell loans to other lenders or investors (and the terms on which the bank can do so) will vary with market conditions, the type of loan, and the quality of loan. Information provided for liquidity analysis should include an assessment of these variables under various scenarios. Loan Portfolio Management 8 Comptroller’s Handbook Liquidity is also affected by the amount of the bank’s commitments to lend and the actual amount that borrowers draw against those commitments. A bank should have systems to track commitments and borrower usage. Knowledge of the types of commitments, deals in the pipeline, normal usage levels, and historically high usage levels are important in assessing whether available liquidity will be adequate for normal, seasonal, or emergency needs. Management information systems should distinguish between commitments that the bank is legally obligated to fund and those (guidance or advisory lines) that it is not. Any analysis of a bank’s ability to reduce or cut existing commitments must consider more than its legal obligation to lend. It should also consider reputation risk and the potential for lender-liability actions. The withdrawal or reduction of commitments can have significant ramifications for a bank. From a strategic perspective, any tightening of commitments may adversely affect a bank’s ability to maintain or grow a customer base if it is perceived as an unreliable lender in tight credit markets. A bank’s reputation may also suffer if it is perceived as unwilling to support community credit needs. Given these ancillary risks, bank management must carefully assess the implications of curtailing lending lines. USER: What role do loan commitments play in a bank's liquidity risk? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	24	11	1,356	null	175
Only use the text that is provided to answer the question. Answer using complete sentences. The answer must be a minimum of 3 sentences.	Based on the given text would Wayne recommend Freedom Mobile?	Freedom Mobile Reviews from Users Freedom mobile reviews from users seem generally positive and assuring. They praise the provider’s ability to provide great offers and excellent service. The operator is also appreciated for offering unique services and promotions to users, every now and then. If you’ve used their services and would like to share a review with others, feel free to share your experience right here! Last 365 days average - 2.2 18 reviews All-time average - 2.6 35 reviews Sasha Mississauga, Ontario 2024-01-03 Horrible customer service You people have no idea what customer service is! Horrible service! I will be complaining! Wayne Toronto, Ontario 2024-02-23 Freedom allowed a sim swap. Freedom has terrible privacy protection. They are incompetent. I was a victim of a sim swap from Freedom. I had my banking and other financial accounts stolen. Freedom will not take any responsibility for my financial losses. They gave a SIM card replacement to a frauster and never requested my consent. Siro J Toronto, Ontario 2024-02-10 A fake mobile network Zero reception in downtown building toronto Sy Toronto, Ontario 2024-01-30 It’s alright Freedom offers cheap plans, but with that you get cheap service. While they offer canada-usa plans their network is a bit wonky. Sometimes you’ll be right beside a tower with full bars and only get around 30 mbps down. Some dropped calls and their reliability indoors isn’t as good as other carriers, although wifi calling is an option. Overall, you get what you pay for.	[Instruction] ======= Only use the text that is provided to answer the question. Answer using complete sentences. The answer must be a minimum of 3 sentences. ---------------- [Passage] ======= Freedom Mobile Reviews from Users Freedom mobile reviews from users seem generally positive and assuring. They praise the provider’s ability to provide great offers and excellent service. The operator is also appreciated for offering unique services and promotions to users, every now and then. If you’ve used their services and would like to share a review with others, feel free to share your experience right here! Last 365 days average - 2.2 18 reviews All-time average - 2.6 35 reviews Sasha Mississauga, Ontario 2024-01-03 Horrible customer service You people have no idea what customer service is! Horrible service! I will be complaining! Wayne Toronto, Ontario 2024-02-23 Freedom allowed a sim swap. Freedom has terrible privacy protection. They are incompetent. I was a victim of a sim swap from Freedom. I had my banking and other financial accounts stolen. Freedom will not take any responsibility for my financial losses. They gave a SIM card replacement to a frauster and never requested my consent. Siro J Toronto, Ontario 2024-02-10 A fake mobile network Zero reception in downtown building toronto Sy Toronto, Ontario 2024-01-30 It’s alright Freedom offers cheap plans, but with that you get cheap service. While they offer canada-usa plans their network is a bit wonky. Sometimes you’ll be right beside a tower with full bars and only get around 30 mbps down. Some dropped calls and their reliability indoors isn’t as good as other carriers, although wifi calling is an option. Overall, you get what you pay for. ---------------- [Query] ======= Based on the given text would Wayne recommend Freedom Mobile?	Only use the text that is provided to answer the question. Answer using complete sentences. The answer must be a minimum of 3 sentences. EVIDENCE: Freedom Mobile Reviews from Users Freedom mobile reviews from users seem generally positive and assuring. They praise the provider’s ability to provide great offers and excellent service. The operator is also appreciated for offering unique services and promotions to users, every now and then. If you’ve used their services and would like to share a review with others, feel free to share your experience right here! Last 365 days average - 2.2 18 reviews All-time average - 2.6 35 reviews Sasha Mississauga, Ontario 2024-01-03 Horrible customer service You people have no idea what customer service is! Horrible service! I will be complaining! Wayne Toronto, Ontario 2024-02-23 Freedom allowed a sim swap. Freedom has terrible privacy protection. They are incompetent. I was a victim of a sim swap from Freedom. I had my banking and other financial accounts stolen. Freedom will not take any responsibility for my financial losses. They gave a SIM card replacement to a frauster and never requested my consent. Siro J Toronto, Ontario 2024-02-10 A fake mobile network Zero reception in downtown building toronto Sy Toronto, Ontario 2024-01-30 It’s alright Freedom offers cheap plans, but with that you get cheap service. While they offer canada-usa plans their network is a bit wonky. Sometimes you’ll be right beside a tower with full bars and only get around 30 mbps down. Some dropped calls and their reliability indoors isn’t as good as other carriers, although wifi calling is an option. Overall, you get what you pay for. USER: Based on the given text would Wayne recommend Freedom Mobile? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	24	10	248	null	341
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]	Given the inherent instability of qubits and the challenges in maintaining quantum coherence, what theoretical advancements or technological breakthroughs would be necessary to achieve fault-tolerant quantum computing on a large scale?	Quantum Computing: What It Is, Why We Want It, and How We're Trying to Get It Quantum mechanics emerged as a branch of physics in the early 1900s to explain nature on the scale of atoms and led to advances such as transistors, lasers, and magnetic resonance imaging. The idea to merge quantum mechanics and information theory arose in the 1970s but garnered little attention until 1982, when physicist Richard Feynman gave a talk in which he reasoned that computing based on classical logic could not tractably process calculations describing quantum phenomena. Computing based on quantum phenomena configured to simulate other quantum phenomena, however, would not be subject to the same bottlenecks. Although this application eventually became the field of quantum simulation, it didn't spark much research activity at the time. In 1994, however, interest in quantum computing rose dramatically when mathematician Peter Shor developed a quantum algorithm, which could find the prime factors of large numbers efficiently. Here, “efficiently” means in a time of practical relevance, which is beyond the capability of state-of-the-art classical algorithms. Although this may seem simply like an oddity, it is impossible to overstate the importance of Shor's insight. The security of nearly every online transaction today relies on an RSA cryptosystem that hinges on the intractability of the factoring problem to classical algorithms. WHAT IS QUANTUM COMPUTING? Quantum and classical computers both try to solve problems, but the way they manipulate data to get answers is fundamentally different. This section provides an explanation of what makes quantum computers unique by introducing two principles of quantum mechanics crucial for their operation, superposition and entanglement. Superposition is the counterintuitive ability of a quantum object, like an electron, to simultaneously exist in multiple “states.” With an electron, one of these states may be the lowest energy level in an atom while another may be the first excited level. If an electron is prepared in a superposition of these two states it has some probability of being in the lower state and some probability of being in the upper. A measurement will destroy this superposition, and only then can it be said that it is in the lower or upper state. Understanding superposition makes it possible to understand the basic component of information in quantum computing, the qubit. In classical computing, bits are transistors that can be off or on, corresponding to the states 0 and 1. In qubits such as electrons, 0 and 1 simply correspond to states like the lower and upper energy levels discussed above. Qubits are distinguished from classical bits, which must always be in the 0 or 1 state, by their ability to be in superpositions with varying probabilities that can be manipulated by quantum operations during computations. Entanglement is a phenomenon in which quantum entities are created and/or manipulated such that none of them can be described without referencing the others. Individual identities are lost. This concept is exceedingly difficult to conceptualize when one considers how entanglement can persist over long distances. A measurement on one member of an entangled pair will immediately determine measurements on its partner, making it appear as if information can travel faster than the speed of light. This apparent action at a distance was so disturbing that even Einstein dubbed it “spooky” (Born 1971, p. 158). The popular press often writes that quantum computers obtain their speedup by trying every possible answer to a problem in parallel. In reality a quantum computer leverages entanglement between qubits and the probabilities associated with superpositions to carry out a series of operations (a quantum algorithm) such that certain probabilities are enhanced (i.e., those of the right answers) and others depressed, even to zero (i.e., those of the wrong answers). When a measurement is made at the end of a computation, the probability of measuring the correct answer should be maximized. The way quantum computers leverage probabilities and entanglement is what makes them so different from classical computers. WHY DO WE WANT IT? The promise of developing a quantum computer sophisticated enough to execute Shor's algorithm for large numbers has been a primary motivator for advancing the field of quantum computation. To develop a broader view of quantum computers, however, it is important to understand that they will likely deliver tremendous speed-ups for only specific types of problems. Researchers are working to both understand which problems are suited for quantum speed-ups and develop algorithms to demonstrate them. In general, it is believed that quantum computers will help immensely with problems related to optimization, which play key roles in everything from defense to financial trading. Multiple additional applications for qubit systems that are not related to computing or simulation also exist and are active areas of research, but they are beyond the scope of this overview. Two of the most prominent areas are (1) quantum sensing and metrology, which leverage the extreme sensitivity of qubits to the environment to realize sensing beyond the classical shot noise limit, and (2) quantum networks and communications, which may lead to revolutionary ways to share information. HOW ARE WE TRYING TO GET IT? Building quantum computers is incredibly difficult. Many candidate qubit systems exist on the scale of single atoms, and the physicists, engineers, and materials scientists who are trying to execute quantum operations on these systems constantly deal with two competing requirements. First, qubits need to be protected from the environment because it can destroy the delicate quantum states needed for computation. The longer a qubit survives in its desired state the longer its “coherence time.” From this perspective, isolation is prized. Second, however, for algorithm execution qubits need to be entangled, shuffled around physical architectures, and controllable on demand. The better these operations can be carried out the higher their “fidelity.” Balancing the required isolation and interaction is difficult, but after decades of research a few systems are emerging as top candidates for large-scale quantum information processing. Superconducting systems, trapped atomic ions, and semiconductors are some of the leading platforms for building a quantum computer. Each has advantages and disadvantages related to coherence, fidelity, and ultimate scalability to large systems. It is clear, however, that all of these platforms will need some type of error correction protocols to be robust enough to carry out meaningful calculations, and how to design and implement these protocols is itself a large area of research. For an overview of quantum computing, with more detail regarding experimental implementations, see Ladd et al. (2010). In this article, “quantum computing” has so far been used as a blanket term describing all computations that utilize quantum phenomena. There are actually multiple types of operational frameworks. Logical, gate-based quantum computing is probably the best recognized. In it, qubits are prepared in initial states and then subject to a series of “gate operations,” like current or laser pulses depending on qubit type. Through these gates the qubits are put in superpositions, entangled, and subjected to logic operations like the AND, OR, and NOT gates of traditional computation. The qubits are then measured and a result obtained. Another framework is measurement-based computation, in which highly entangled qubits serve as the starting point. Then, instead of performing manipulation operations on qubits, single qubit measurements are performed, leaving the targeted single qubit in a definitive state. Based on the result, further measurements are carried out on other qubits and eventually an answer is reached. A third framework is topological computation, in which qubits and operations are based on quasiparticles and their braiding operations. While nascent implementations of the components of topological quantum computers have yet to be demonstrated, the approach is attractive because these systems are theoretically protected against noise, which destroys the coherence of other qubits.	<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> Given the inherent instability of qubits and the challenges in maintaining quantum coherence, what theoretical advancements or technological breakthroughs would be necessary to achieve fault-tolerant quantum computing on a large scale? <TEXT> Quantum Computing: What It Is, Why We Want It, and How We're Trying to Get It Quantum mechanics emerged as a branch of physics in the early 1900s to explain nature on the scale of atoms and led to advances such as transistors, lasers, and magnetic resonance imaging. The idea to merge quantum mechanics and information theory arose in the 1970s but garnered little attention until 1982, when physicist Richard Feynman gave a talk in which he reasoned that computing based on classical logic could not tractably process calculations describing quantum phenomena. Computing based on quantum phenomena configured to simulate other quantum phenomena, however, would not be subject to the same bottlenecks. Although this application eventually became the field of quantum simulation, it didn't spark much research activity at the time. In 1994, however, interest in quantum computing rose dramatically when mathematician Peter Shor developed a quantum algorithm, which could find the prime factors of large numbers efficiently. Here, “efficiently” means in a time of practical relevance, which is beyond the capability of state-of-the-art classical algorithms. Although this may seem simply like an oddity, it is impossible to overstate the importance of Shor's insight. The security of nearly every online transaction today relies on an RSA cryptosystem that hinges on the intractability of the factoring problem to classical algorithms. WHAT IS QUANTUM COMPUTING? Quantum and classical computers both try to solve problems, but the way they manipulate data to get answers is fundamentally different. This section provides an explanation of what makes quantum computers unique by introducing two principles of quantum mechanics crucial for their operation, superposition and entanglement. Superposition is the counterintuitive ability of a quantum object, like an electron, to simultaneously exist in multiple “states.” With an electron, one of these states may be the lowest energy level in an atom while another may be the first excited level. If an electron is prepared in a superposition of these two states it has some probability of being in the lower state and some probability of being in the upper. A measurement will destroy this superposition, and only then can it be said that it is in the lower or upper state. Understanding superposition makes it possible to understand the basic component of information in quantum computing, the qubit. In classical computing, bits are transistors that can be off or on, corresponding to the states 0 and 1. In qubits such as electrons, 0 and 1 simply correspond to states like the lower and upper energy levels discussed above. Qubits are distinguished from classical bits, which must always be in the 0 or 1 state, by their ability to be in superpositions with varying probabilities that can be manipulated by quantum operations during computations. Entanglement is a phenomenon in which quantum entities are created and/or manipulated such that none of them can be described without referencing the others. Individual identities are lost. This concept is exceedingly difficult to conceptualize when one considers how entanglement can persist over long distances. A measurement on one member of an entangled pair will immediately determine measurements on its partner, making it appear as if information can travel faster than the speed of light. This apparent action at a distance was so disturbing that even Einstein dubbed it “spooky” (Born 1971, p. 158). The popular press often writes that quantum computers obtain their speedup by trying every possible answer to a problem in parallel. In reality a quantum computer leverages entanglement between qubits and the probabilities associated with superpositions to carry out a series of operations (a quantum algorithm) such that certain probabilities are enhanced (i.e., those of the right answers) and others depressed, even to zero (i.e., those of the wrong answers). When a measurement is made at the end of a computation, the probability of measuring the correct answer should be maximized. The way quantum computers leverage probabilities and entanglement is what makes them so different from classical computers. WHY DO WE WANT IT? The promise of developing a quantum computer sophisticated enough to execute Shor's algorithm for large numbers has been a primary motivator for advancing the field of quantum computation. To develop a broader view of quantum computers, however, it is important to understand that they will likely deliver tremendous speed-ups for only specific types of problems. Researchers are working to both understand which problems are suited for quantum speed-ups and develop algorithms to demonstrate them. In general, it is believed that quantum computers will help immensely with problems related to optimization, which play key roles in everything from defense to financial trading. Multiple additional applications for qubit systems that are not related to computing or simulation also exist and are active areas of research, but they are beyond the scope of this overview. Two of the most prominent areas are (1) quantum sensing and metrology, which leverage the extreme sensitivity of qubits to the environment to realize sensing beyond the classical shot noise limit, and (2) quantum networks and communications, which may lead to revolutionary ways to share information. HOW ARE WE TRYING TO GET IT? Building quantum computers is incredibly difficult. Many candidate qubit systems exist on the scale of single atoms, and the physicists, engineers, and materials scientists who are trying to execute quantum operations on these systems constantly deal with two competing requirements. First, qubits need to be protected from the environment because it can destroy the delicate quantum states needed for computation. The longer a qubit survives in its desired state the longer its “coherence time.” From this perspective, isolation is prized. Second, however, for algorithm execution qubits need to be entangled, shuffled around physical architectures, and controllable on demand. The better these operations can be carried out the higher their “fidelity.” Balancing the required isolation and interaction is difficult, but after decades of research a few systems are emerging as top candidates for large-scale quantum information processing. Superconducting systems, trapped atomic ions, and semiconductors are some of the leading platforms for building a quantum computer. Each has advantages and disadvantages related to coherence, fidelity, and ultimate scalability to large systems. It is clear, however, that all of these platforms will need some type of error correction protocols to be robust enough to carry out meaningful calculations, and how to design and implement these protocols is itself a large area of research. For an overview of quantum computing, with more detail regarding experimental implementations, see Ladd et al. (2010). In this article, “quantum computing” has so far been used as a blanket term describing all computations that utilize quantum phenomena. There are actually multiple types of operational frameworks. Logical, gate-based quantum computing is probably the best recognized. In it, qubits are prepared in initial states and then subject to a series of “gate operations,” like current or laser pulses depending on qubit type. Through these gates the qubits are put in superpositions, entangled, and subjected to logic operations like the AND, OR, and NOT gates of traditional computation. The qubits are then measured and a result obtained. Another framework is measurement-based computation, in which highly entangled qubits serve as the starting point. Then, instead of performing manipulation operations on qubits, single qubit measurements are performed, leaving the targeted single qubit in a definitive state. Based on the result, further measurements are carried out on other qubits and eventually an answer is reached. A third framework is topological computation, in which qubits and operations are based on quasiparticles and their braiding operations. While nascent implementations of the components of topological quantum computers have yet to be demonstrated, the approach is attractive because these systems are theoretically protected against noise, which destroys the coherence of other qubits. https://www.ncbi.nlm.nih.gov/books/NBK538701/	<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document] EVIDENCE: Quantum Computing: What It Is, Why We Want It, and How We're Trying to Get It Quantum mechanics emerged as a branch of physics in the early 1900s to explain nature on the scale of atoms and led to advances such as transistors, lasers, and magnetic resonance imaging. The idea to merge quantum mechanics and information theory arose in the 1970s but garnered little attention until 1982, when physicist Richard Feynman gave a talk in which he reasoned that computing based on classical logic could not tractably process calculations describing quantum phenomena. Computing based on quantum phenomena configured to simulate other quantum phenomena, however, would not be subject to the same bottlenecks. Although this application eventually became the field of quantum simulation, it didn't spark much research activity at the time. In 1994, however, interest in quantum computing rose dramatically when mathematician Peter Shor developed a quantum algorithm, which could find the prime factors of large numbers efficiently. Here, “efficiently” means in a time of practical relevance, which is beyond the capability of state-of-the-art classical algorithms. Although this may seem simply like an oddity, it is impossible to overstate the importance of Shor's insight. The security of nearly every online transaction today relies on an RSA cryptosystem that hinges on the intractability of the factoring problem to classical algorithms. WHAT IS QUANTUM COMPUTING? Quantum and classical computers both try to solve problems, but the way they manipulate data to get answers is fundamentally different. This section provides an explanation of what makes quantum computers unique by introducing two principles of quantum mechanics crucial for their operation, superposition and entanglement. Superposition is the counterintuitive ability of a quantum object, like an electron, to simultaneously exist in multiple “states.” With an electron, one of these states may be the lowest energy level in an atom while another may be the first excited level. If an electron is prepared in a superposition of these two states it has some probability of being in the lower state and some probability of being in the upper. A measurement will destroy this superposition, and only then can it be said that it is in the lower or upper state. Understanding superposition makes it possible to understand the basic component of information in quantum computing, the qubit. In classical computing, bits are transistors that can be off or on, corresponding to the states 0 and 1. In qubits such as electrons, 0 and 1 simply correspond to states like the lower and upper energy levels discussed above. Qubits are distinguished from classical bits, which must always be in the 0 or 1 state, by their ability to be in superpositions with varying probabilities that can be manipulated by quantum operations during computations. Entanglement is a phenomenon in which quantum entities are created and/or manipulated such that none of them can be described without referencing the others. Individual identities are lost. This concept is exceedingly difficult to conceptualize when one considers how entanglement can persist over long distances. A measurement on one member of an entangled pair will immediately determine measurements on its partner, making it appear as if information can travel faster than the speed of light. This apparent action at a distance was so disturbing that even Einstein dubbed it “spooky” (Born 1971, p. 158). The popular press often writes that quantum computers obtain their speedup by trying every possible answer to a problem in parallel. In reality a quantum computer leverages entanglement between qubits and the probabilities associated with superpositions to carry out a series of operations (a quantum algorithm) such that certain probabilities are enhanced (i.e., those of the right answers) and others depressed, even to zero (i.e., those of the wrong answers). When a measurement is made at the end of a computation, the probability of measuring the correct answer should be maximized. The way quantum computers leverage probabilities and entanglement is what makes them so different from classical computers. WHY DO WE WANT IT? The promise of developing a quantum computer sophisticated enough to execute Shor's algorithm for large numbers has been a primary motivator for advancing the field of quantum computation. To develop a broader view of quantum computers, however, it is important to understand that they will likely deliver tremendous speed-ups for only specific types of problems. Researchers are working to both understand which problems are suited for quantum speed-ups and develop algorithms to demonstrate them. In general, it is believed that quantum computers will help immensely with problems related to optimization, which play key roles in everything from defense to financial trading. Multiple additional applications for qubit systems that are not related to computing or simulation also exist and are active areas of research, but they are beyond the scope of this overview. Two of the most prominent areas are (1) quantum sensing and metrology, which leverage the extreme sensitivity of qubits to the environment to realize sensing beyond the classical shot noise limit, and (2) quantum networks and communications, which may lead to revolutionary ways to share information. HOW ARE WE TRYING TO GET IT? Building quantum computers is incredibly difficult. Many candidate qubit systems exist on the scale of single atoms, and the physicists, engineers, and materials scientists who are trying to execute quantum operations on these systems constantly deal with two competing requirements. First, qubits need to be protected from the environment because it can destroy the delicate quantum states needed for computation. The longer a qubit survives in its desired state the longer its “coherence time.” From this perspective, isolation is prized. Second, however, for algorithm execution qubits need to be entangled, shuffled around physical architectures, and controllable on demand. The better these operations can be carried out the higher their “fidelity.” Balancing the required isolation and interaction is difficult, but after decades of research a few systems are emerging as top candidates for large-scale quantum information processing. Superconducting systems, trapped atomic ions, and semiconductors are some of the leading platforms for building a quantum computer. Each has advantages and disadvantages related to coherence, fidelity, and ultimate scalability to large systems. It is clear, however, that all of these platforms will need some type of error correction protocols to be robust enough to carry out meaningful calculations, and how to design and implement these protocols is itself a large area of research. For an overview of quantum computing, with more detail regarding experimental implementations, see Ladd et al. (2010). In this article, “quantum computing” has so far been used as a blanket term describing all computations that utilize quantum phenomena. There are actually multiple types of operational frameworks. Logical, gate-based quantum computing is probably the best recognized. In it, qubits are prepared in initial states and then subject to a series of “gate operations,” like current or laser pulses depending on qubit type. Through these gates the qubits are put in superpositions, entangled, and subjected to logic operations like the AND, OR, and NOT gates of traditional computation. The qubits are then measured and a result obtained. Another framework is measurement-based computation, in which highly entangled qubits serve as the starting point. Then, instead of performing manipulation operations on qubits, single qubit measurements are performed, leaving the targeted single qubit in a definitive state. Based on the result, further measurements are carried out on other qubits and eventually an answer is reached. A third framework is topological computation, in which qubits and operations are based on quasiparticles and their braiding operations. While nascent implementations of the components of topological quantum computers have yet to be demonstrated, the approach is attractive because these systems are theoretically protected against noise, which destroys the coherence of other qubits. USER: Given the inherent instability of qubits and the challenges in maintaining quantum coherence, what theoretical advancements or technological breakthroughs would be necessary to achieve fault-tolerant quantum computing on a large scale? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	20	31	1,280	null	686
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]	Elon Musk is sending people to space! This is crazy lol. There was a recent exploration where a few non astronauts went up. They're just rich people flexing their money. How experirced is the owner with trips to space? What are some specs from the trip and how did this trip benefit the company?	Tech billionaire returns to Earth after first private spacewalk By MARCIA DUNN Updated 10:38 AM EDT, September 15, 2024 Share CAPE CANAVERAL, Fla. (AP) — A billionaire spacewalker returned to Earth with his crew on Sunday, ending a five-day trip that lifted them higher than anyone has traveled since NASA’s moonwalkers. SpaceX’s capsule splashed down in the Gulf of Mexico near Florida’s Dry Tortugas in the predawn darkness, carrying tech entrepreneur Jared Isaacman, two SpaceX engineers and a former Air Force Thunderbird pilot. They pulled off the first private spacewalk while orbiting nearly 460 miles (740 kilometers) above Earth, higher than the International Space Station and Hubble Space Telescope. Their spacecraft hit a peak altitude of 875 miles (1,408 kilometers) following Tuesday’s liftoff. Isaacman became only the 264th person to perform a spacewalk since the former Soviet Union scored the first in 1965, and SpaceX’s Sarah Gillis the 265th. Until now, all spacewalks were done by professional astronauts. RELATED COVERAGE Image Iran says it successfully launched a satellite in its program criticized by West over missile fears Image Stuck-in-space astronauts reflect on being left behind and adjusting to life in orbit Image Striking Boeing factory workers say they are ready to hold out for a better contract “We are mission complete,” Isaacman radioed as the capsule bobbed in the water, awaiting the recovery team. Within an hour, all four were out of their spacecraft, pumping their fists with joy as they emerged onto the ship’s deck. It was the first time SpaceX aimed for a splashdown near the Dry Tortugas, a cluster of islands 70 miles (113 kilometers) west of Key West. To celebrate the new location, SpaceX employees brought a big, green turtle balloon to Mission Control at company headquarters in Hawthorne, California. The company usually targets closer to the Florida coast, but two weeks of poor weather forecasts prompted SpaceX to look elsewhere. During Thursday’s commercial spacewalk, the Dragon capsule’s hatch was open barely a half-hour. Isaacman emerged only up to his waist to briefly test SpaceX’s brand new spacesuit followed by Gillis, who was knee high as she flexed her arms and legs for several minutes. Gillis, a classically trained violinist, also held a performance in orbit earlier in the week. Image This image made from SpaceX video shows the four-member crew including tech entrepreneur Jared Isaacman, third left, seated in its capsule as they wait to get off the capsule after it landed in the Gulf of Mexico near Florida’s Dry Tortugas early Sunday, Sept. 15, 2024. (SpaceX via AP) The spacewalk lasted less than two hours, considerably shorter than those at the International Space Station. Most of that time was needed to depressurize the entire capsule and then restore the cabin air. Even SpaceX’s Anna Menon and Scott “Kidd” Poteet, who remained strapped in, wore spacesuits. SpaceX considers the brief exercise a starting point to test spacesuit technology for future, longer missions to Mars. This was Isaacman’s second chartered flight with SpaceX, with two more still ahead under his personally financed space exploration program named Polaris after the North Star. He paid an undisclosed sum for his first spaceflight in 2021, taking along contest winners and a pediatric cancer survivor while raising more than $250 million for St. Jude Children’s Research Hospital. For the just completed so-called Polaris Dawn mission, the founder and CEO of the Shift4 credit card-processing company shared the cost with SpaceX. Isaacman won’t divulge how much he spent. ___ The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.	<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> Elon Musk is sending people to space! This is crazy lol. There was a recent exploration where a few non astronauts went up. They're just rich people flexing their money. How experirced is the owner with trips to space? What are some specs from the trip and how did this trip benefit the company? <TEXT> Tech billionaire returns to Earth after first private spacewalk By MARCIA DUNN Updated 10:38 AM EDT, September 15, 2024 Share CAPE CANAVERAL, Fla. (AP) — A billionaire spacewalker returned to Earth with his crew on Sunday, ending a five-day trip that lifted them higher than anyone has traveled since NASA’s moonwalkers. SpaceX’s capsule splashed down in the Gulf of Mexico near Florida’s Dry Tortugas in the predawn darkness, carrying tech entrepreneur Jared Isaacman, two SpaceX engineers and a former Air Force Thunderbird pilot. They pulled off the first private spacewalk while orbiting nearly 460 miles (740 kilometers) above Earth, higher than the International Space Station and Hubble Space Telescope. Their spacecraft hit a peak altitude of 875 miles (1,408 kilometers) following Tuesday’s liftoff. Isaacman became only the 264th person to perform a spacewalk since the former Soviet Union scored the first in 1965, and SpaceX’s Sarah Gillis the 265th. Until now, all spacewalks were done by professional astronauts. RELATED COVERAGE Image Iran says it successfully launched a satellite in its program criticized by West over missile fears Image Stuck-in-space astronauts reflect on being left behind and adjusting to life in orbit Image Striking Boeing factory workers say they are ready to hold out for a better contract “We are mission complete,” Isaacman radioed as the capsule bobbed in the water, awaiting the recovery team. Within an hour, all four were out of their spacecraft, pumping their fists with joy as they emerged onto the ship’s deck. It was the first time SpaceX aimed for a splashdown near the Dry Tortugas, a cluster of islands 70 miles (113 kilometers) west of Key West. To celebrate the new location, SpaceX employees brought a big, green turtle balloon to Mission Control at company headquarters in Hawthorne, California. The company usually targets closer to the Florida coast, but two weeks of poor weather forecasts prompted SpaceX to look elsewhere. During Thursday’s commercial spacewalk, the Dragon capsule’s hatch was open barely a half-hour. Isaacman emerged only up to his waist to briefly test SpaceX’s brand new spacesuit followed by Gillis, who was knee high as she flexed her arms and legs for several minutes. Gillis, a classically trained violinist, also held a performance in orbit earlier in the week. Image This image made from SpaceX video shows the four-member crew including tech entrepreneur Jared Isaacman, third left, seated in its capsule as they wait to get off the capsule after it landed in the Gulf of Mexico near Florida’s Dry Tortugas early Sunday, Sept. 15, 2024. (SpaceX via AP) The spacewalk lasted less than two hours, considerably shorter than those at the International Space Station. Most of that time was needed to depressurize the entire capsule and then restore the cabin air. Even SpaceX’s Anna Menon and Scott “Kidd” Poteet, who remained strapped in, wore spacesuits. SpaceX considers the brief exercise a starting point to test spacesuit technology for future, longer missions to Mars. This was Isaacman’s second chartered flight with SpaceX, with two more still ahead under his personally financed space exploration program named Polaris after the North Star. He paid an undisclosed sum for his first spaceflight in 2021, taking along contest winners and a pediatric cancer survivor while raising more than $250 million for St. Jude Children’s Research Hospital. For the just completed so-called Polaris Dawn mission, the founder and CEO of the Shift4 credit card-processing company shared the cost with SpaceX. Isaacman won’t divulge how much he spent. ___ The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content. https://apnews.com/article/spacex-private-spacewalk-polaris-dawn-e5635c75b15b2f298e426b4992bcde86	<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document] EVIDENCE: Tech billionaire returns to Earth after first private spacewalk By MARCIA DUNN Updated 10:38 AM EDT, September 15, 2024 Share CAPE CANAVERAL, Fla. (AP) — A billionaire spacewalker returned to Earth with his crew on Sunday, ending a five-day trip that lifted them higher than anyone has traveled since NASA’s moonwalkers. SpaceX’s capsule splashed down in the Gulf of Mexico near Florida’s Dry Tortugas in the predawn darkness, carrying tech entrepreneur Jared Isaacman, two SpaceX engineers and a former Air Force Thunderbird pilot. They pulled off the first private spacewalk while orbiting nearly 460 miles (740 kilometers) above Earth, higher than the International Space Station and Hubble Space Telescope. Their spacecraft hit a peak altitude of 875 miles (1,408 kilometers) following Tuesday’s liftoff. Isaacman became only the 264th person to perform a spacewalk since the former Soviet Union scored the first in 1965, and SpaceX’s Sarah Gillis the 265th. Until now, all spacewalks were done by professional astronauts. RELATED COVERAGE Image Iran says it successfully launched a satellite in its program criticized by West over missile fears Image Stuck-in-space astronauts reflect on being left behind and adjusting to life in orbit Image Striking Boeing factory workers say they are ready to hold out for a better contract “We are mission complete,” Isaacman radioed as the capsule bobbed in the water, awaiting the recovery team. Within an hour, all four were out of their spacecraft, pumping their fists with joy as they emerged onto the ship’s deck. It was the first time SpaceX aimed for a splashdown near the Dry Tortugas, a cluster of islands 70 miles (113 kilometers) west of Key West. To celebrate the new location, SpaceX employees brought a big, green turtle balloon to Mission Control at company headquarters in Hawthorne, California. The company usually targets closer to the Florida coast, but two weeks of poor weather forecasts prompted SpaceX to look elsewhere. During Thursday’s commercial spacewalk, the Dragon capsule’s hatch was open barely a half-hour. Isaacman emerged only up to his waist to briefly test SpaceX’s brand new spacesuit followed by Gillis, who was knee high as she flexed her arms and legs for several minutes. Gillis, a classically trained violinist, also held a performance in orbit earlier in the week. Image This image made from SpaceX video shows the four-member crew including tech entrepreneur Jared Isaacman, third left, seated in its capsule as they wait to get off the capsule after it landed in the Gulf of Mexico near Florida’s Dry Tortugas early Sunday, Sept. 15, 2024. (SpaceX via AP) The spacewalk lasted less than two hours, considerably shorter than those at the International Space Station. Most of that time was needed to depressurize the entire capsule and then restore the cabin air. Even SpaceX’s Anna Menon and Scott “Kidd” Poteet, who remained strapped in, wore spacesuits. SpaceX considers the brief exercise a starting point to test spacesuit technology for future, longer missions to Mars. This was Isaacman’s second chartered flight with SpaceX, with two more still ahead under his personally financed space exploration program named Polaris after the North Star. He paid an undisclosed sum for his first spaceflight in 2021, taking along contest winners and a pediatric cancer survivor while raising more than $250 million for St. Jude Children’s Research Hospital. For the just completed so-called Polaris Dawn mission, the founder and CEO of the Shift4 credit card-processing company shared the cost with SpaceX. Isaacman won’t divulge how much he spent. ___ The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content. USER: Elon Musk is sending people to space! This is crazy lol. There was a recent exploration where a few non astronauts went up. They're just rich people flexing their money. How experirced is the owner with trips to space? What are some specs from the trip and how did this trip benefit the company? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	20	54	606	null	186
In a 3-5 sentence paragraph based solely on the provided context block, answer the user's question. Outside knowledge is strictly prohibited.	What are the benefits and/or drawbacks of this acquisition?	Contact: Corporate Communications, USJ Co. 81-6-6465-3333 US MEDIA GIANT, COMCAST NBCUNIVERSAL TO PURCHASE 51% OWNERSHIP OF USJ CO., LTD. OSAKA (Sept. 28, 2015) – USJ Co., Ltd., the operating company of Universal Studios Japan, announced today that Comcast NBCUniversal agreed to purchase 51% of ownership of USJ from the current shareholders. This acquisition will show the strong commitment of Comcast NBCUniversal to grow and evolve Universal Studios Japan and as we work with NBCUniversal and its Universal Parks & Resorts division, the entire group’s global strategy in theme park business will accelerate. Also today, Glenn Gumpel, who served as Chief Executive Officer of USJ since 2004, announced to step down from the current position effective when the transaction closes. Universal Parks & Resorts has named Jean-Louis Bonnier as the new Chief Executive Officer. Glenn Gumpel said, “Universal Studios Japan will continue to progress along with its basic policies such as the successful marketing strategy which has boosted the attendance these recent years and look forward to even further growth utilizing a financial strength and a great platform Comcast NBCUniversal will give.” About Universal Studios Japan Bring You the Best of the Worldas a theme park where its guests can have the world’s best experiences and create the world’s best memories, Universal Studios Japan offers the world-class entertainment such as authentic attractions and shows, based on not only Hollywood blockbusters but also very popular world class entertainment brands, and a variety of seasonal events entertain its guests to the fullest fun. In recent years, Universal Studios Japan has constantly offered new entertainment one after another such as Universal Wonederland area where family guests enjoy meeting with popular characters, Universal Cool Japan event offering attractions themed on world-renowned Japanese entertainment brands, and The Wizarding World of Harry Potter which has been gathering attention of both domestic and international guests. These efforts resulted in not only a record-high attendance made in FY 2014 but also positioning of the Park as a prominent entertainment and leisure landmark drawing much greater number of guests from distant areas in Japan as well as overseas. About Comcast: Comcast Corporation (Nasdaq: CMCSA, CMCSK) is a global media and technology company with two primary businesses, Comcast Cable and NBCUniversal. Comcast Cable is one of the nation's largest video, high-speed Internet and phone providers to residential customers under the XFINITY brand and also provides these services to businesses. About NBCUniversal: NBCUniversal owns and operates a valuable portfolio of news and entertainment television networks, a premier motion picture company, significant television production operations, a leading television stations group, world-renowned theme parks, and a suite of leading Internet-based businesses. NBCUniversal is a subsidiary of Comcast Corporation. About Universal Parks & Resorts: Universal Parks & Resorts, a unit of Comcast NBCUniversal, offers guests around the globe today’s most relevant and popular entertainment experiences. With three-time Academy Award winner Steven Spielberg as creative consultant, its theme parks are known for immersive experiences that feature some of the world’s most thrilling and technologically advanced film- and television-based attractions. Comcast NBCUniversal wholly owns Universal Studios Hollywood, which includes Universal CityWalk Hollywood. It also owns Universal Orlando Resort, a world-class destination resort featuring two theme parks (Universal Studios Florida and Universal’s Islands of Adventure), four resort hotels, and Universal CityWalk Orlando. Comcast NBCUniversal also has license agreements with Universal Studios Japan in Osaka, Japan and Universal Studios Singapore at Resorts World Sentosa, Singapore. In addition, Comcast NBCUniversal has recently announced plans for a theme park in Beijing and an indoor theme park to be developed as part of the Galactica Park project in Moscow. ＊＊＊ Universal Studios Japan aims for the world’s best entertainment, a place where memories that lasts a lifetime are made. Please call the information center （Tel : 0570-20-0606） for any general information in regards to Universal Studios Japan. The Official Universal Studios Japan website can be accessed via computer, cell phone and smart phone. ＊＊＊	Context Block: Contact: Corporate Communications, USJ Co. 81-6-6465-3333 US MEDIA GIANT, COMCAST NBCUNIVERSAL TO PURCHASE 51% OWNERSHIP OF USJ CO., LTD. OSAKA (Sept. 28, 2015) – USJ Co., Ltd., the operating company of Universal Studios Japan, announced today that Comcast NBCUniversal agreed to purchase 51% of ownership of USJ from the current shareholders. This acquisition will show the strong commitment of Comcast NBCUniversal to grow and evolve Universal Studios Japan and as we work with NBCUniversal and its Universal Parks & Resorts division, the entire group’s global strategy in theme park business will accelerate. Also today, Glenn Gumpel, who served as Chief Executive Officer of USJ since 2004, announced to step down from the current position effective when the transaction closes. Universal Parks & Resorts has named Jean-Louis Bonnier as the new Chief Executive Officer. Glenn Gumpel said, “Universal Studios Japan will continue to progress along with its basic policies such as the successful marketing strategy which has boosted the attendance these recent years and look forward to even further growth utilizing a financial strength and a great platform Comcast NBCUniversal will give.” About Universal Studios Japan Bring You the Best of the Worldas a theme park where its guests can have the world’s best experiences and create the world’s best memories, Universal Studios Japan offers the world-class entertainment such as authentic attractions and shows, based on not only Hollywood blockbusters but also very popular world class entertainment brands, and a variety of seasonal events entertain its guests to the fullest fun. In recent years, Universal Studios Japan has constantly offered new entertainment one after another such as Universal Wonederland area where family guests enjoy meeting with popular characters, Universal Cool Japan event offering attractions themed on world-renowned Japanese entertainment brands, and The Wizarding World of Harry Potter which has been gathering attention of both domestic and international guests. These efforts resulted in not only a record-high attendance made in FY 2014 but also positioning of the Park as a prominent entertainment and leisure landmark drawing much greater number of guests from distant areas in Japan as well as overseas. About Comcast: Comcast Corporation (Nasdaq: CMCSA, CMCSK) is a global media and technology company with two primary businesses, Comcast Cable and NBCUniversal. Comcast Cable is one of the nation's largest video, high-speed Internet and phone providers to residential customers under the XFINITY brand and also provides these services to businesses. About NBCUniversal: NBCUniversal owns and operates a valuable portfolio of news and entertainment television networks, a premier motion picture company, significant television production operations, a leading television stations group, world-renowned theme parks, and a suite of leading Internet-based businesses. NBCUniversal is a subsidiary of Comcast Corporation. About Universal Parks & Resorts: Universal Parks & Resorts, a unit of Comcast NBCUniversal, offers guests around the globe today’s most relevant and popular entertainment experiences. With three-time Academy Award winner Steven Spielberg as creative consultant, its theme parks are known for immersive experiences that feature some of the world’s most thrilling and technologically advanced film- and television-based attractions. Comcast NBCUniversal wholly owns Universal Studios Hollywood, which includes Universal CityWalk Hollywood. It also owns Universal Orlando Resort, a world-class destination resort featuring two theme parks (Universal Studios Florida and Universal’s Islands of Adventure), four resort hotels, and Universal CityWalk Orlando. Comcast NBCUniversal also has license agreements with Universal Studios Japan in Osaka, Japan and Universal Studios Singapore at Resorts World Sentosa, Singapore. In addition, Comcast NBCUniversal has recently announced plans for a theme park in Beijing and an indoor theme park to be developed as part of the Galactica Park project in Moscow. ＊＊＊ Universal Studios Japan aims for the world’s best entertainment, a place where memories that lasts a lifetime are made. Please call the information center （Tel : 0570-20-0606） for any general information in regards to Universal Studios Japan. The Official Universal Studios Japan website can be accessed via computer, cell phone and smart phone. ＊＊＊ System Instructions: In a 3-5 sentence paragraph based solely on the provided context block, answer the user's question. Outside knowledge is strictly prohibited. Question: Can you explain the relationship between all the companies mentioned here in simple terms, including subsidiaries, etc.?	In a 3-5 sentence paragraph based solely on the provided context block, answer the user's question. Outside knowledge is strictly prohibited. EVIDENCE: Contact: Corporate Communications, USJ Co. 81-6-6465-3333 US MEDIA GIANT, COMCAST NBCUNIVERSAL TO PURCHASE 51% OWNERSHIP OF USJ CO., LTD. OSAKA (Sept. 28, 2015) – USJ Co., Ltd., the operating company of Universal Studios Japan, announced today that Comcast NBCUniversal agreed to purchase 51% of ownership of USJ from the current shareholders. This acquisition will show the strong commitment of Comcast NBCUniversal to grow and evolve Universal Studios Japan and as we work with NBCUniversal and its Universal Parks & Resorts division, the entire group’s global strategy in theme park business will accelerate. Also today, Glenn Gumpel, who served as Chief Executive Officer of USJ since 2004, announced to step down from the current position effective when the transaction closes. Universal Parks & Resorts has named Jean-Louis Bonnier as the new Chief Executive Officer. Glenn Gumpel said, “Universal Studios Japan will continue to progress along with its basic policies such as the successful marketing strategy which has boosted the attendance these recent years and look forward to even further growth utilizing a financial strength and a great platform Comcast NBCUniversal will give.” About Universal Studios Japan Bring You the Best of the Worldas a theme park where its guests can have the world’s best experiences and create the world’s best memories, Universal Studios Japan offers the world-class entertainment such as authentic attractions and shows, based on not only Hollywood blockbusters but also very popular world class entertainment brands, and a variety of seasonal events entertain its guests to the fullest fun. In recent years, Universal Studios Japan has constantly offered new entertainment one after another such as Universal Wonederland area where family guests enjoy meeting with popular characters, Universal Cool Japan event offering attractions themed on world-renowned Japanese entertainment brands, and The Wizarding World of Harry Potter which has been gathering attention of both domestic and international guests. These efforts resulted in not only a record-high attendance made in FY 2014 but also positioning of the Park as a prominent entertainment and leisure landmark drawing much greater number of guests from distant areas in Japan as well as overseas. About Comcast: Comcast Corporation (Nasdaq: CMCSA, CMCSK) is a global media and technology company with two primary businesses, Comcast Cable and NBCUniversal. Comcast Cable is one of the nation's largest video, high-speed Internet and phone providers to residential customers under the XFINITY brand and also provides these services to businesses. About NBCUniversal: NBCUniversal owns and operates a valuable portfolio of news and entertainment television networks, a premier motion picture company, significant television production operations, a leading television stations group, world-renowned theme parks, and a suite of leading Internet-based businesses. NBCUniversal is a subsidiary of Comcast Corporation. About Universal Parks & Resorts: Universal Parks & Resorts, a unit of Comcast NBCUniversal, offers guests around the globe today’s most relevant and popular entertainment experiences. With three-time Academy Award winner Steven Spielberg as creative consultant, its theme parks are known for immersive experiences that feature some of the world’s most thrilling and technologically advanced film- and television-based attractions. Comcast NBCUniversal wholly owns Universal Studios Hollywood, which includes Universal CityWalk Hollywood. It also owns Universal Orlando Resort, a world-class destination resort featuring two theme parks (Universal Studios Florida and Universal’s Islands of Adventure), four resort hotels, and Universal CityWalk Orlando. Comcast NBCUniversal also has license agreements with Universal Studios Japan in Osaka, Japan and Universal Studios Singapore at Resorts World Sentosa, Singapore. In addition, Comcast NBCUniversal has recently announced plans for a theme park in Beijing and an indoor theme park to be developed as part of the Galactica Park project in Moscow. ＊＊＊ Universal Studios Japan aims for the world’s best entertainment, a place where memories that lasts a lifetime are made. Please call the information center （Tel : 0570-20-0606） for any general information in regards to Universal Studios Japan. The Official Universal Studios Japan website can be accessed via computer, cell phone and smart phone. ＊＊＊ USER: What are the benefits and/or drawbacks of this acquisition? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	21	9	656	null	815
Provide your response solely on the information provided in the text of the prompt. Do not use any outside information, resources or prior knowledge. Make your response exactly 300 words.	What are the key factors in competition between video streaming services?	Video streaming services that use a subscription- or transaction-based system can compete by offering content at lower prices than their competitors. Streaming services that offer live TV can be cheaper than packages offered by MVPDs, depending on the channels the customer subscribes to. Some MVPDs have responded by offering cheaper plans with fewer channels and by improving their set-top boxes to offer some streaming services, such as Netflix.7 Some streaming services that offer live TV advertise their services by promising no hidden fees, such as equipment rentals and cancellation fees, and no annual contracts.8 Most streaming services that offer live TV do not require an annual subscription; subscribers can sign up on a month-to-month basis instead. While the lack of a long-term commitment can be appealing to some consumers, it also means that prices can suddenly increase.9 For example, on June 30, 2020, YouTube TVadded eight new channels and increased its price from $50 to $65 per month, effective immediately for new subscribers; for its current subscribers, the changes went into effect on July 30, 2020.10 On average, the price for streaming services that offer live TV is higher than those that offer only video-on-demand (Table 2). This may be partially due to cost differences—it tends to be costly to license the rights to air a television network. 11 To attract more users, a streaming service that offers live TV may try to expand the number of networks offered on its service, but this in turn increases the cost of running the service. In contrast, a streaming service that offers video-ondemand licenses at least some movies and shows that have been previously shown elsewhere, which tends to lower the cost of licensing this content. Differences in prices across streaming services that offer only video-on-demand tend to be fairly small. This may be partially due to their relatively low prices, which make it difficult to lower prices further. Thus, in addition to competing with prices, streaming services may seek to offer exclusive access to popular movies and TV shows to attract new subscribers. When the first streaming services launched in the late 2000s, they offered movies and shows that had been previously shown elsewhere. For example, when Netflix launched its streaming service in 2007, it offered about 1,000 television shows and movies, licensed from NBC Universal, Sony Pictures, MGM, and others; it did not offer original content. 12 A few years later, some streaming services started commissioning movies and shows from television or film studios. This made streaming services less dependent on licensing agreements with television networks and allowed them to offer original programming, which increased the importance of content. 13 In 2013, Netflix debuted its first original series, House of Cards, and became the first streaming service to win a Television Academy Emmy Award.14 Original programs from other streaming services have won television awards as well, such as Hulu’s Handmaid’s Tale. 15 In 2020, Netflix received 160 Emmy nominations, breaking the record for the greatest number of nominations of any network, studio, or streaming platform.16 Nevertheless, streaming services continue to license previously broadcast movies and shows from television networks and film studios to complement their original content. Some streaming services, particularly those that offer live TV, advertise themselves as an alternative to MVPDs. However, streaming services oftentimes rely on the same content creators as television networks, such as sports leagues and television and movie studios. 17 Television networks and movie theaters show a single program at a time, which can create incentives to select the program with the greatest profit potential for each time slot. In contrast, streaming services offer multiple programs for users to choose from. Thus, streaming services can feature content that appeals to various groups of users rather than to the public at large. This may increase competition for video content and provide new opportunities for content creators.18 Some companies that own studios and television networks offer their own video streaming services. This can create incentives for these studios to license fewer shows and movies to other streaming services, reserving popular content for their own streaming services instead. For example, AT&T, which owns Warner Brothers Studio, stopped licensing certain shows—such as Friends, The Wire, and The Sopranos—to streaming services owned by other companies, offering these shows exclusively on its streaming services HBO and HBO Max.19 Similarly, Comcast is offering some of its NBCUniversal shows, such as The Office and Parks and Recreation, exclusively on its streaming service Peacock;20 Walt Disney Co. announced that The Simpsons would be offered exclusively on its streaming service Disney+.21 Streaming services operated by companies that also own film studios and television networks may have an advantage over their competitors. A company may provide its streaming service exclusive access to its studio’s programming, or may choose to license the programming to its streaming competitors for a fee. This means some streaming services are able to restrict access to content, which could make it more difficult for new competitors to enter the video streaming market. Entrants may need to devote significant resources to produce or license content before offering their streaming services to customers.	System instructions: Provide your response solely on the information provided in the text of the prompt. Do not use any outside information, resources or prior knowledge. Make your response exactly 300 words. Question: What are the key factors in competition between video streaming services? Context Block: Video streaming services that use a subscription- or transaction-based system can compete by offering content at lower prices than their competitors. Streaming services that offer live TV can be cheaper than packages offered by MVPDs, depending on the channels the customer subscribes to. Some MVPDs have responded by offering cheaper plans with fewer channels and by improving their set-top boxes to offer some streaming services, such as Netflix.7 Some streaming services that offer live TV advertise their services by promising no hidden fees, such as equipment rentals and cancellation fees, and no annual contracts.8 Most streaming services that offer live TV do not require an annual subscription; subscribers can sign up on a month-to-month basis instead. While the lack of a long-term commitment can be appealing to some consumers, it also means that prices can suddenly increase.9 For example, on June 30, 2020, YouTube TVadded eight new channels and increased its price from $50 to $65 per month, effective immediately for new subscribers; for its current subscribers, the changes went into effect on July 30, 2020.10 On average, the price for streaming services that offer live TV is higher than those that offer only video-on-demand (Table 2). This may be partially due to cost differences—it tends to be costly to license the rights to air a television network. 11 To attract more users, a streaming service that offers live TV may try to expand the number of networks offered on its service, but this in turn increases the cost of running the service. In contrast, a streaming service that offers video-ondemand licenses at least some movies and shows that have been previously shown elsewhere, which tends to lower the cost of licensing this content. Differences in prices across streaming services that offer only video-on-demand tend to be fairly small. This may be partially due to their relatively low prices, which make it difficult to lower prices further. Thus, in addition to competing with prices, streaming services may seek to offer exclusive access to popular movies and TV shows to attract new subscribers. When the first streaming services launched in the late 2000s, they offered movies and shows that had been previously shown elsewhere. For example, when Netflix launched its streaming service in 2007, it offered about 1,000 television shows and movies, licensed from NBC Universal, Sony Pictures, MGM, and others; it did not offer original content. 12 A few years later, some streaming services started commissioning movies and shows from television or film studios. This made streaming services less dependent on licensing agreements with television networks and allowed them to offer original programming, which increased the importance of content. 13 In 2013, Netflix debuted its first original series, House of Cards, and became the first streaming service to win a Television Academy Emmy Award.14 Original programs from other streaming services have won television awards as well, such as Hulu’s Handmaid’s Tale. 15 In 2020, Netflix received 160 Emmy nominations, breaking the record for the greatest number of nominations of any network, studio, or streaming platform.16 Nevertheless, streaming services continue to license previously broadcast movies and shows from television networks and film studios to complement their original content. Some streaming services, particularly those that offer live TV, advertise themselves as an alternative to MVPDs. However, streaming services oftentimes rely on the same content creators as television networks, such as sports leagues and television and movie studios. 17 Television networks and movie theaters show a single program at a time, which can create incentives to select the program with the greatest profit potential for each time slot. In contrast, streaming services offer multiple programs for users to choose from. Thus, streaming services can feature content that appeals to various groups of users rather than to the public at large. This may increase competition for video content and provide new opportunities for content creators.18 Some companies that own studios and television networks offer their own video streaming services. This can create incentives for these studios to license fewer shows and movies to other streaming services, reserving popular content for their own streaming services instead. For example, AT&T, which owns Warner Brothers Studio, stopped licensing certain shows—such as Friends, The Wire, and The Sopranos—to streaming services owned by other companies, offering these shows exclusively on its streaming services HBO and HBO Max.19 Similarly, Comcast is offering some of its NBCUniversal shows, such as The Office and Parks and Recreation, exclusively on its streaming service Peacock;20 Walt Disney Co. announced that The Simpsons would be offered exclusively on its streaming service Disney+.21 Streaming services operated by companies that also own film studios and television networks may have an advantage over their competitors. A company may provide its streaming service exclusive access to its studio’s programming, or may choose to license the programming to its streaming competitors for a fee. This means some streaming services are able to restrict access to content, which could make it more difficult for new competitors to enter the video streaming market. Entrants may need to devote significant resources to produce or license content before offering their streaming services to customers.	Provide your response solely on the information provided in the text of the prompt. Do not use any outside information, resources or prior knowledge. Make your response exactly 300 words. EVIDENCE: Video streaming services that use a subscription- or transaction-based system can compete by offering content at lower prices than their competitors. Streaming services that offer live TV can be cheaper than packages offered by MVPDs, depending on the channels the customer subscribes to. Some MVPDs have responded by offering cheaper plans with fewer channels and by improving their set-top boxes to offer some streaming services, such as Netflix.7 Some streaming services that offer live TV advertise their services by promising no hidden fees, such as equipment rentals and cancellation fees, and no annual contracts.8 Most streaming services that offer live TV do not require an annual subscription; subscribers can sign up on a month-to-month basis instead. While the lack of a long-term commitment can be appealing to some consumers, it also means that prices can suddenly increase.9 For example, on June 30, 2020, YouTube TVadded eight new channels and increased its price from $50 to $65 per month, effective immediately for new subscribers; for its current subscribers, the changes went into effect on July 30, 2020.10 On average, the price for streaming services that offer live TV is higher than those that offer only video-on-demand (Table 2). This may be partially due to cost differences—it tends to be costly to license the rights to air a television network. 11 To attract more users, a streaming service that offers live TV may try to expand the number of networks offered on its service, but this in turn increases the cost of running the service. In contrast, a streaming service that offers video-ondemand licenses at least some movies and shows that have been previously shown elsewhere, which tends to lower the cost of licensing this content. Differences in prices across streaming services that offer only video-on-demand tend to be fairly small. This may be partially due to their relatively low prices, which make it difficult to lower prices further. Thus, in addition to competing with prices, streaming services may seek to offer exclusive access to popular movies and TV shows to attract new subscribers. When the first streaming services launched in the late 2000s, they offered movies and shows that had been previously shown elsewhere. For example, when Netflix launched its streaming service in 2007, it offered about 1,000 television shows and movies, licensed from NBC Universal, Sony Pictures, MGM, and others; it did not offer original content. 12 A few years later, some streaming services started commissioning movies and shows from television or film studios. This made streaming services less dependent on licensing agreements with television networks and allowed them to offer original programming, which increased the importance of content. 13 In 2013, Netflix debuted its first original series, House of Cards, and became the first streaming service to win a Television Academy Emmy Award.14 Original programs from other streaming services have won television awards as well, such as Hulu’s Handmaid’s Tale. 15 In 2020, Netflix received 160 Emmy nominations, breaking the record for the greatest number of nominations of any network, studio, or streaming platform.16 Nevertheless, streaming services continue to license previously broadcast movies and shows from television networks and film studios to complement their original content. Some streaming services, particularly those that offer live TV, advertise themselves as an alternative to MVPDs. However, streaming services oftentimes rely on the same content creators as television networks, such as sports leagues and television and movie studios. 17 Television networks and movie theaters show a single program at a time, which can create incentives to select the program with the greatest profit potential for each time slot. In contrast, streaming services offer multiple programs for users to choose from. Thus, streaming services can feature content that appeals to various groups of users rather than to the public at large. This may increase competition for video content and provide new opportunities for content creators.18 Some companies that own studios and television networks offer their own video streaming services. This can create incentives for these studios to license fewer shows and movies to other streaming services, reserving popular content for their own streaming services instead. For example, AT&T, which owns Warner Brothers Studio, stopped licensing certain shows—such as Friends, The Wire, and The Sopranos—to streaming services owned by other companies, offering these shows exclusively on its streaming services HBO and HBO Max.19 Similarly, Comcast is offering some of its NBCUniversal shows, such as The Office and Parks and Recreation, exclusively on its streaming service Peacock;20 Walt Disney Co. announced that The Simpsons would be offered exclusively on its streaming service Disney+.21 Streaming services operated by companies that also own film studios and television networks may have an advantage over their competitors. A company may provide its streaming service exclusive access to its studio’s programming, or may choose to license the programming to its streaming competitors for a fee. This means some streaming services are able to restrict access to content, which could make it more difficult for new competitors to enter the video streaming market. Entrants may need to devote significant resources to produce or license content before offering their streaming services to customers. USER: What are the key factors in competition between video streaming services? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	30	11	850	null	263
This task requires you to answer only using the information provided in the prompt. No other information or resources is allowed to be used to formulate your answer.	In what ways are smaller firms disadvantaged in the global market?	[1]—“Leveraging” Resources The primary business advantage of granting a license is “leveraging” business resources. By adding its licensees’ resources for particular business operations to its own, a licensor can address markets that it otherwise could not hope to serve. For example, small firms and start-up companies often do not have enough salespeople or offices to serve nationwide, let alone worldwide, markets. By granting others the right to market and distribute their products, they can penetrate geographic or products markets otherwise completely beyond their reach. This occurred, for example, when International Business Machines Corporation chose Microsoft Corporation’s “MS-DOS” operating system software as the platform upon which to build the “PC-DOS” operating system for IBM’s personal computer. Overnight, Microsoft obtained the benefit of IBM’s massive marketing and sales in forces distributing its products. Although the effect is seldom so dramatic as in this example, “leveraging” of resources is one of the primary advantages of granting licenses. The ability to leverage resources is restricted by limits on the patent rights. The patent exhaustion doctrine, in particular, restricts the ability of the patentee to control sales beyond the first sale of a patented product, or a product embodying a patented process.11 Because of this rule, a patent holder cannot exercise unlimited rights over an invention once embodiments of the invention have been sold.12 Rather, if he sells devices embodying the invention, or permits others to sell such devices, he will have limited control over what the buyers do with those devices because they take the items purchased free of the patent claims.13 In the sphere of copyright, a similar question is whether a rights holder can rely on digital rights management systems to protect against not just copyright infringement, but also other, non-infringing access to copyrighted works.14 Circumvention to permit use beyond the scope of a license may violate the protections for access controls (because it permits unauthorized access), even if it does not cause infringement of copyright (because the users had a license, even though the circumvention allows them to use the software beyond the scope of the license).15 Even while sensitive military or intelligence technology is subjected to secrecy orders by the United States government,16 it is important to seek licensees while patent applications are sequestered.17 If the patent applicant does not do so, it may have no basis for an otherwise valid claim for compensation from the United States government for the adverse effects of a secrecy order.18 [2]—Broadening Geographic Markets As the world becomes a “global village,” product markets that used to be regional or national are rapidly becoming worldwide. Few except the largest firms, however, have the personnel or resources to address worldwide markets successfully. One reason is that most products require some “translation” for foreign markets. Labels and instructions may need translation into foreign languages, goods may require physical modification to comply with local laws and regulations, and advertising and marketing programs may have to be adjusted to satisfy local customs and tastes. If a firm wishes to enter foreign markets but does not have ready marketing and distribution channels in foreign countries, it has only four alternatives. First, it can set up foreign branches, which may subject it to direct taxation abroad. Second, it may set up separate subsidiaries or affiliates in foreign countries. This may avoid direct foreign taxation of the parent company, although the foreign subsidiary will be subject to foreign income tax. Yet whether a branch or subsidiary, establishing of a foreign office requires time, energy, and money in order to complete the necessary legal work, put management and physical plant in place, and hire and train appropriate personnel. The third alternative for firms wishing to expand into foreign markets is a joint venture. If a joint venture is taxed as a separate entity, as is often the case,19 the tax consequences of this alternative are similar to those of establishing a foreign subsidiary. However, formation of a joint venture also involves resolving difficult questions of control, management, and communication that often consume considerable time and resources. If the joint venture is more than a shell—if it will have separate physical plant, employees, and a separate existence—its formation may be as complex as the establishment of a new business enterprise in the foreign country. The fourth alternative for expansion into foreign markets is, of course, licensing. By licensing a foreign entity to help exploit its intellectual property, a firm can take advantage of a preexisting organization, with personnel in place and established channels, resources, and procedures for production, marketing, and distribution. The firm need not establish any new entity because the licensee normally uses existing personnel and resources, or at least an existing management and business structure, to perform the delegated operations. By licensing a foreign concern to exploit its intellectual property in foreign markets, a firm also can use the foreign concern’s familiarity with foreign markets, customs, and needs. Because licensing takes advantage of these preexisting resources and capabilities, it is often the fastest route to the foreign marketplace. This advantage of licensing, however, is not limited to the international sphere. A firm in one state or region of the United States that wishes to expand its markets into another state or region has the same four alternatives as a firm wishing to expand abroad. 20 Very often the firm can achieve the most rapid penetration into new geographic markets simply by granting licenses to a firm already there. [3]—Broadening Product Markets Just as licensing can broaden geographic markets, it can broaden product markets. A firm may have the resources to exploit its intellectual property through one product, but its intellectual property may be applicable to other products or services. The video industry is an excellent example. There is now a tremendous market for entertainment programs for home use. Yet independent producers of movies and television shows often do not have the resources for mass production and distribution. To take advantage of this market, they license their intellectual property—namely, the copyrights in their movies and television shows—to firms that manufacture and distribute the videos. In the biotechnology industry, research firms have developed a number of monoclonal antibodies to be used outside the body as testing and diagnostic tools. Because the process of regulatory review is relatively simple for products used outside the body, these firms can take those products to market quickly. To exploit their technology fully, however, they may wish to develop drugs and biologicals for internal use. The approval process for these products takes much longer and requires much greater expense, as well as clinical expertise and familiarity with the regulatory process. Lacking the requisite resources, smaller biotechnology firms often license their technology to large drug companies for that purpose. 21 Licensing for the purpose of expanding product markets, however, has disadvantages. By granting others the right to use its intellectual property to develop new products, a firm may lose control over those new products. 22 Where a party authorizes another to sell the invention, buyers will be protected by first sale, even if the seller fails to pay the agreed royalties to the patent owner. 22.1 Any other rule would make the buyer of goods or services subject to disputes over which the buyer has neither control nor knowledge. That uncertainty would in turn add transaction costs to such sales. So the rule aids both patentees and ultimate buyers, by facilitating transactions. Unless it has access to improvements made by its licensees, it may quickly find itself left in a backwater of technology, at least insofar as the new product market is concerned. 23 It also may incur some risk of liability for damage caused by defects in its licensee’s products, 24 or even for breach of contract 25 or miscellaneous torts. 26 Nevertheless, for many firms, this sort of licensing is an important source of additional revenue. With appropriate provision for cooperation in the licensing agreement, a firm may stay in touch with the exploitation of its intellectual property and at the same time exploit that property in market areas that it could never hope to penetrate using only its own resources. The patent exhaustion doctrine may prevent a patentee from controlling patent markets beyond the first market which a patented product enters.	This task requires you to answer only using the information provided in the prompt. No other information or resources is allowed to be used to formulate your answer. In what ways are smaller firms disadvantaged in the global market? [1]—“Leveraging” Resources The primary business advantage of granting a license is “leveraging” business resources. By adding its licensees’ resources for particular business operations to its own, a licensor can address markets that it otherwise could not hope to serve. For example, small firms and start-up companies often do not have enough salespeople or offices to serve nationwide, let alone worldwide, markets. By granting others the right to market and distribute their products, they can penetrate geographic or products markets otherwise completely beyond their reach. This occurred, for example, when International Business Machines Corporation chose Microsoft Corporation’s “MS-DOS” operating system software as the platform upon which to build the “PC-DOS” operating system for IBM’s personal computer. Overnight, Microsoft obtained the benefit of IBM’s massive marketing and sales in forces distributing its products. Although the effect is seldom so dramatic as in this example, “leveraging” of resources is one of the primary advantages of granting licenses. The ability to leverage resources is restricted by limits on the patent rights. The patent exhaustion doctrine, in particular, restricts the ability of the patentee to control sales beyond the first sale of a patented product, or a product embodying a patented process.11 Because of this rule, a patent holder cannot exercise unlimited rights over an invention once embodiments of the invention have been sold.12 Rather, if he sells devices embodying the invention, or permits others to sell such devices, he will have limited control over what the buyers do with those devices because they take the items purchased free of the patent claims.13 In the sphere of copyright, a similar question is whether a rights holder can rely on digital rights management systems to protect against not just copyright infringement, but also other, non-infringing access to copyrighted works.14 Circumvention to permit use beyond the scope of a license may violate the protections for access controls (because it permits unauthorized access), even if it does not cause infringement of copyright (because the users had a license, even though the circumvention allows them to use the software beyond the scope of the license).15 Even while sensitive military or intelligence technology is subjected to secrecy orders by the United States government,16 it is important to seek licensees while patent applications are sequestered.17 If the patent applicant does not do so, it may have no basis for an otherwise valid claim for compensation from the United States government for the adverse effects of a secrecy order.18 [2]—Broadening Geographic Markets As the world becomes a “global village,” product markets that used to be regional or national are rapidly becoming worldwide. Few except the largest firms, however, have the personnel or resources to address worldwide markets successfully. One reason is that most products require some “translation” for foreign markets. Labels and instructions may need translation into foreign languages, goods may require physical modification to comply with local laws and regulations, and advertising and marketing programs may have to be adjusted to satisfy local customs and tastes. If a firm wishes to enter foreign markets but does not have ready marketing and distribution channels in foreign countries, it has only four alternatives. First, it can set up foreign branches, which may subject it to direct taxation abroad. Second, it may set up separate subsidiaries or affiliates in foreign countries. This may avoid direct foreign taxation of the parent company, although the foreign subsidiary will be subject to foreign income tax. Yet whether a branch or subsidiary, establishing of a foreign office requires time, energy, and money in order to complete the necessary legal work, put management and physical plant in place, and hire and train appropriate personnel. The third alternative for firms wishing to expand into foreign markets is a joint venture. If a joint venture is taxed as a separate entity, as is often the case,19 the tax consequences of this alternative are similar to those of establishing a foreign subsidiary. However, formation of a joint venture also involves resolving difficult questions of control, management, and communication that often consume considerable time and resources. If the joint venture is more than a shell—if it will have separate physical plant, employees, and a separate existence—its formation may be as complex as the establishment of a new business enterprise in the foreign country. The fourth alternative for expansion into foreign markets is, of course, licensing. By licensing a foreign entity to help exploit its intellectual property, a firm can take advantage of a preexisting organization, with personnel in place and established channels, resources, and procedures for production, marketing, and distribution. The firm need not establish any new entity because the licensee normally uses existing personnel and resources, or at least an existing management and business structure, to perform the delegated operations. By licensing a foreign concern to exploit its intellectual property in foreign markets, a firm also can use the foreign concern’s familiarity with foreign markets, customs, and needs. Because licensing takes advantage of these preexisting resources and capabilities, it is often the fastest route to the foreign marketplace. This advantage of licensing, however, is not limited to the international sphere. A firm in one state or region of the United States that wishes to expand its markets into another state or region has the same four alternatives as a firm wishing to expand abroad. 20 Very often the firm can achieve the most rapid penetration into new geographic markets simply by granting licenses to a firm already there. [3]—Broadening Product Markets Just as licensing can broaden geographic markets, it can broaden product markets. A firm may have the resources to exploit its intellectual property through one product, but its intellectual property may be applicable to other products or services. The video industry is an excellent example. There is now a tremendous market for entertainment programs for home use. Yet independent producers of movies and television shows often do not have the resources for mass production and distribution. To take advantage of this market, they license their intellectual property—namely, the copyrights in their movies and television shows—to firms that manufacture and distribute the videos. In the biotechnology industry, research firms have developed a number of monoclonal antibodies to be used outside the body as testing and diagnostic tools. Because the process of regulatory review is relatively simple for products used outside the body, these firms can take those products to market quickly. To exploit their technology fully, however, they may wish to develop drugs and biologicals for internal use. The approval process for these products takes much longer and requires much greater expense, as well as clinical expertise and familiarity with the regulatory process. Lacking the requisite resources, smaller biotechnology firms often license their technology to large drug companies for that purpose. 21 Licensing for the purpose of expanding product markets, however, has disadvantages. By granting others the right to use its intellectual property to develop new products, a firm may lose control over those new products. 22 Where a party authorizes another to sell the invention, buyers will be protected by first sale, even if the seller fails to pay the agreed royalties to the patent owner. 22.1 Any other rule would make the buyer of goods or services subject to disputes over which the buyer has neither control nor knowledge. That uncertainty would in turn add transaction costs to such sales. So the rule aids both patentees and ultimate buyers, by facilitating transactions. Unless it has access to improvements made by its licensees, it may quickly find itself left in a backwater of technology, at least insofar as the new product market is concerned. 23 It also may incur some risk of liability for damage caused by defects in its licensee’s products, 24 or even for breach of contract 25 or miscellaneous torts. 26 Nevertheless, for many firms, this sort of licensing is an important source of additional revenue. With appropriate provision for cooperation in the licensing agreement, a firm may stay in touch with the exploitation of its intellectual property and at the same time exploit that property in market areas that it could never hope to penetrate using only its own resources. The patent exhaustion doctrine may prevent a patentee from controlling patent markets beyond the first market which a patented product enters.	This task requires you to answer only using the information provided in the prompt. No other information or resources is allowed to be used to formulate your answer. EVIDENCE: [1]—“Leveraging” Resources The primary business advantage of granting a license is “leveraging” business resources. By adding its licensees’ resources for particular business operations to its own, a licensor can address markets that it otherwise could not hope to serve. For example, small firms and start-up companies often do not have enough salespeople or offices to serve nationwide, let alone worldwide, markets. By granting others the right to market and distribute their products, they can penetrate geographic or products markets otherwise completely beyond their reach. This occurred, for example, when International Business Machines Corporation chose Microsoft Corporation’s “MS-DOS” operating system software as the platform upon which to build the “PC-DOS” operating system for IBM’s personal computer. Overnight, Microsoft obtained the benefit of IBM’s massive marketing and sales in forces distributing its products. Although the effect is seldom so dramatic as in this example, “leveraging” of resources is one of the primary advantages of granting licenses. The ability to leverage resources is restricted by limits on the patent rights. The patent exhaustion doctrine, in particular, restricts the ability of the patentee to control sales beyond the first sale of a patented product, or a product embodying a patented process.11 Because of this rule, a patent holder cannot exercise unlimited rights over an invention once embodiments of the invention have been sold.12 Rather, if he sells devices embodying the invention, or permits others to sell such devices, he will have limited control over what the buyers do with those devices because they take the items purchased free of the patent claims.13 In the sphere of copyright, a similar question is whether a rights holder can rely on digital rights management systems to protect against not just copyright infringement, but also other, non-infringing access to copyrighted works.14 Circumvention to permit use beyond the scope of a license may violate the protections for access controls (because it permits unauthorized access), even if it does not cause infringement of copyright (because the users had a license, even though the circumvention allows them to use the software beyond the scope of the license).15 Even while sensitive military or intelligence technology is subjected to secrecy orders by the United States government,16 it is important to seek licensees while patent applications are sequestered.17 If the patent applicant does not do so, it may have no basis for an otherwise valid claim for compensation from the United States government for the adverse effects of a secrecy order.18 [2]—Broadening Geographic Markets As the world becomes a “global village,” product markets that used to be regional or national are rapidly becoming worldwide. Few except the largest firms, however, have the personnel or resources to address worldwide markets successfully. One reason is that most products require some “translation” for foreign markets. Labels and instructions may need translation into foreign languages, goods may require physical modification to comply with local laws and regulations, and advertising and marketing programs may have to be adjusted to satisfy local customs and tastes. If a firm wishes to enter foreign markets but does not have ready marketing and distribution channels in foreign countries, it has only four alternatives. First, it can set up foreign branches, which may subject it to direct taxation abroad. Second, it may set up separate subsidiaries or affiliates in foreign countries. This may avoid direct foreign taxation of the parent company, although the foreign subsidiary will be subject to foreign income tax. Yet whether a branch or subsidiary, establishing of a foreign office requires time, energy, and money in order to complete the necessary legal work, put management and physical plant in place, and hire and train appropriate personnel. The third alternative for firms wishing to expand into foreign markets is a joint venture. If a joint venture is taxed as a separate entity, as is often the case,19 the tax consequences of this alternative are similar to those of establishing a foreign subsidiary. However, formation of a joint venture also involves resolving difficult questions of control, management, and communication that often consume considerable time and resources. If the joint venture is more than a shell—if it will have separate physical plant, employees, and a separate existence—its formation may be as complex as the establishment of a new business enterprise in the foreign country. The fourth alternative for expansion into foreign markets is, of course, licensing. By licensing a foreign entity to help exploit its intellectual property, a firm can take advantage of a preexisting organization, with personnel in place and established channels, resources, and procedures for production, marketing, and distribution. The firm need not establish any new entity because the licensee normally uses existing personnel and resources, or at least an existing management and business structure, to perform the delegated operations. By licensing a foreign concern to exploit its intellectual property in foreign markets, a firm also can use the foreign concern’s familiarity with foreign markets, customs, and needs. Because licensing takes advantage of these preexisting resources and capabilities, it is often the fastest route to the foreign marketplace. This advantage of licensing, however, is not limited to the international sphere. A firm in one state or region of the United States that wishes to expand its markets into another state or region has the same four alternatives as a firm wishing to expand abroad. 20 Very often the firm can achieve the most rapid penetration into new geographic markets simply by granting licenses to a firm already there. [3]—Broadening Product Markets Just as licensing can broaden geographic markets, it can broaden product markets. A firm may have the resources to exploit its intellectual property through one product, but its intellectual property may be applicable to other products or services. The video industry is an excellent example. There is now a tremendous market for entertainment programs for home use. Yet independent producers of movies and television shows often do not have the resources for mass production and distribution. To take advantage of this market, they license their intellectual property—namely, the copyrights in their movies and television shows—to firms that manufacture and distribute the videos. In the biotechnology industry, research firms have developed a number of monoclonal antibodies to be used outside the body as testing and diagnostic tools. Because the process of regulatory review is relatively simple for products used outside the body, these firms can take those products to market quickly. To exploit their technology fully, however, they may wish to develop drugs and biologicals for internal use. The approval process for these products takes much longer and requires much greater expense, as well as clinical expertise and familiarity with the regulatory process. Lacking the requisite resources, smaller biotechnology firms often license their technology to large drug companies for that purpose. 21 Licensing for the purpose of expanding product markets, however, has disadvantages. By granting others the right to use its intellectual property to develop new products, a firm may lose control over those new products. 22 Where a party authorizes another to sell the invention, buyers will be protected by first sale, even if the seller fails to pay the agreed royalties to the patent owner. 22.1 Any other rule would make the buyer of goods or services subject to disputes over which the buyer has neither control nor knowledge. That uncertainty would in turn add transaction costs to such sales. So the rule aids both patentees and ultimate buyers, by facilitating transactions. Unless it has access to improvements made by its licensees, it may quickly find itself left in a backwater of technology, at least insofar as the new product market is concerned. 23 It also may incur some risk of liability for damage caused by defects in its licensee’s products, 24 or even for breach of contract 25 or miscellaneous torts. 26 Nevertheless, for many firms, this sort of licensing is an important source of additional revenue. With appropriate provision for cooperation in the licensing agreement, a firm may stay in touch with the exploitation of its intellectual property and at the same time exploit that property in market areas that it could never hope to penetrate using only its own resources. The patent exhaustion doctrine may prevent a patentee from controlling patent markets beyond the first market which a patented product enters. USER: In what ways are smaller firms disadvantaged in the global market? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	28	11	1,374	null	411
Any information that you draw to answer any questions must come only from the information found in the prompt. Under no circumstances are you allowed rely on any information from any source other than the information in the prompt. If the answer requires a series of steps, list them in a numbered list format.	How many beeps would be heard if a user wants to activate right-handed operation, increase the cursor speed to 2, activate double click, and turn the buzzer off on a new device?	There are a number of settings to allow you to configure OPTIMA Joystick to your exact requirements. These are all programmed using Learn Mode and are stored in an internal, non-volatile memory so they are automatically recalled each time you use the unit, even if you swap computers. To make changes to the settings, you must first go into Learn Mode. Press and hold the middle button until a warbling tone is heard. The unit is now in Learn Mode and is able to accept changes to the settings, as follows: Learn Mode Features • Plug and Play USB and PS/2 operation and requires no drivers. • PC, Mac and Chromebook compatible. • Switchable to Gaming output for full compatibility with Xbox Adaptive Controller • Light touch joystick movement. • User-selectable cursor speed settings. • Drag lock and double click features. • Sockets to operate left and right click from remote switches. • Robust construction and ergonomic design. • Industry-standard mounting option. • Optional left-handed operation. Cursor Speed To change the speed setting while in Learn Mode, press the middle button briefly. Each time you do so, the unit emits a number of beeps, between 1 and 4. One beep indicates the lowest speed and 4 the highest. The speed of the cursor changes immediately, allowing you to experiment until the best setting is found. Left-Handed Operation The left and right buttons may be swapped around, which is particularly useful for left-landed users. To change this setting, press the left button while in Learn Mode. One beep indicates the unit is set to standard ‘right-handed’ mode, whereas two beeps indicates ‘left-handed’ operation. Double Click Right-click may be substituted with Double-Click, which is useful for users who have difficulty in double-clicking quickly enough for the computer to recognise. To change this setting, press the right button briefly while in Learn Mode. One beep indicates the unit is set to standard ‘right-click’ mode, whereas two beeps indicates ‘Double-Click’ operation. Buzzer On/Off OPTIMA Joystick is fitted with a buzzer which gives an audible indication of operations such as drag lock and unlock, double-click, entering Learn Mode etc. When OPTIMA Joystick is used in a classroom setting, where there may be many units in close proximity, it may be beneficial to turn off the buzzer. To achieve this, press and hold the right button while in Learn Mode, until two long beeps are heard. The buzzer is now disabled, although it will still operate while in Learn Mode. Repeating the above operation will re-enable it. All of the above settings may be changed as often as required while in Learn Mode, allowing you to experiment with the settings until the best configuration is found. Once you are happy with the settings, they may be stored in the non-volatile memory by pressing and holding the middle button once again, until the warbling tone is heard. Normal operation then resumes. Note that if both left-handed operation and Double-Click are selected, the buttons will function as Double-Click, Drag and Left Click, reading from left to right. Also note that the function of the sockets for external switches reproduces the function of the internal buttons, according to the above settings. The unit automatically leaves Learn Mode, and any changes are discarded, if the settings remain unchanged for more than a minute.	Any information that you draw to answer any questions must come only from the information found in the prompt. Under no circumstances are you allowed rely on any information from any source other than the information in the prompt. If the answer requires a series of steps, list them in a numbered list format. There are a number of settings to allow you to configure OPTIMA Joystick to your exact requirements. These are all programmed using Learn Mode and are stored in an internal, non-volatile memory so they are automatically recalled each time you use the unit, even if you swap computers. To make changes to the settings, you must first go into Learn Mode. Press and hold the middle button until a warbling tone is heard. The unit is now in Learn Mode and is able to accept changes to the settings, as follows: Learn Mode Features • Plug and Play USB and PS/2 operation and requires no drivers. • PC, Mac and Chromebook compatible. • Switchable to Gaming output for full compatibility with Xbox Adaptive Controller • Light touch joystick movement. • User-selectable cursor speed settings. • Drag lock and double click features. • Sockets to operate left and right click from remote switches. • Robust construction and ergonomic design. • Industry-standard mounting option. • Optional left-handed operation. Cursor Speed To change the speed setting while in Learn Mode, press the middle button briefly. Each time you do so, the unit emits a number of beeps, between 1 and 4. One beep indicates the lowest speed and 4 the highest. The speed of the cursor changes immediately, allowing you to experiment until the best setting is found. Left-Handed Operation The left and right buttons may be swapped around, which is particularly useful for left-landed users. To change this setting, press the left button while in Learn Mode. One beep indicates the unit is set to standard ‘right-handed’ mode, whereas two beeps indicates ‘left-handed’ operation. Double Click Right-click may be substituted with Double-Click, which is useful for users who have difficulty in double-clicking quickly enough for the computer to recognise. To change this setting, press the right button briefly while in Learn Mode. One beep indicates the unit is set to standard ‘right-click’ mode, whereas two beeps indicates ‘Double-Click’ operation. Buzzer On/Off OPTIMA Joystick is fitted with a buzzer which gives an audible indication of operations such as drag lock and unlock, double-click, entering Learn Mode etc. When OPTIMA Joystick is used in a classroom setting, where there may be many units in close proximity, it may be beneficial to turn off the buzzer. To achieve this, press and hold the right button while in Learn Mode, until two long beeps are heard. The buzzer is now disabled, although it will still operate while in Learn Mode. Repeating the above operation will re-enable it. All of the above settings may be changed as often as required while in Learn Mode, allowing you to experiment with the settings until the best configuration is found. Once you are happy with the settings, they may be stored in the non-volatile memory by pressing and holding the middle button once again, until the warbling tone is heard. Normal operation then resumes. Note that if both left-handed operation and Double-Click are selected, the buttons will function as Double-Click, Drag and Left Click, reading from left to right. Also note that the function of the sockets for external switches reproduces the function of the internal buttons, according to the above settings. The unit automatically leaves Learn Mode, and any changes are discarded, if the settings remain unchanged for more than a minute. How many sounds would be heard if a user wants to activate right-handed operation, increase the cursor speed to 2, activate double click, and turn the buzzer off on a new device?	Any information that you draw to answer any questions must come only from the information found in the prompt. Under no circumstances are you allowed rely on any information from any source other than the information in the prompt. If the answer requires a series of steps, list them in a numbered list format. EVIDENCE: There are a number of settings to allow you to configure OPTIMA Joystick to your exact requirements. These are all programmed using Learn Mode and are stored in an internal, non-volatile memory so they are automatically recalled each time you use the unit, even if you swap computers. To make changes to the settings, you must first go into Learn Mode. Press and hold the middle button until a warbling tone is heard. The unit is now in Learn Mode and is able to accept changes to the settings, as follows: Learn Mode Features • Plug and Play USB and PS/2 operation and requires no drivers. • PC, Mac and Chromebook compatible. • Switchable to Gaming output for full compatibility with Xbox Adaptive Controller • Light touch joystick movement. • User-selectable cursor speed settings. • Drag lock and double click features. • Sockets to operate left and right click from remote switches. • Robust construction and ergonomic design. • Industry-standard mounting option. • Optional left-handed operation. Cursor Speed To change the speed setting while in Learn Mode, press the middle button briefly. Each time you do so, the unit emits a number of beeps, between 1 and 4. One beep indicates the lowest speed and 4 the highest. The speed of the cursor changes immediately, allowing you to experiment until the best setting is found. Left-Handed Operation The left and right buttons may be swapped around, which is particularly useful for left-landed users. To change this setting, press the left button while in Learn Mode. One beep indicates the unit is set to standard ‘right-handed’ mode, whereas two beeps indicates ‘left-handed’ operation. Double Click Right-click may be substituted with Double-Click, which is useful for users who have difficulty in double-clicking quickly enough for the computer to recognise. To change this setting, press the right button briefly while in Learn Mode. One beep indicates the unit is set to standard ‘right-click’ mode, whereas two beeps indicates ‘Double-Click’ operation. Buzzer On/Off OPTIMA Joystick is fitted with a buzzer which gives an audible indication of operations such as drag lock and unlock, double-click, entering Learn Mode etc. When OPTIMA Joystick is used in a classroom setting, where there may be many units in close proximity, it may be beneficial to turn off the buzzer. To achieve this, press and hold the right button while in Learn Mode, until two long beeps are heard. The buzzer is now disabled, although it will still operate while in Learn Mode. Repeating the above operation will re-enable it. All of the above settings may be changed as often as required while in Learn Mode, allowing you to experiment with the settings until the best configuration is found. Once you are happy with the settings, they may be stored in the non-volatile memory by pressing and holding the middle button once again, until the warbling tone is heard. Normal operation then resumes. Note that if both left-handed operation and Double-Click are selected, the buttons will function as Double-Click, Drag and Left Click, reading from left to right. Also note that the function of the sockets for external switches reproduces the function of the internal buttons, according to the above settings. The unit automatically leaves Learn Mode, and any changes are discarded, if the settings remain unchanged for more than a minute. USER: How many beeps would be heard if a user wants to activate right-handed operation, increase the cursor speed to 2, activate double click, and turn the buzzer off on a new device? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	54	32	553	null	257
You can only use the provided text for information in your response. Answer in under 150 words.	How can I charge the patient?	Electronic Claim Submission via Clearinghouse DentaQuest works directly with Emdeon (1-888-255-7293), Tesia 1-800-724-7240, EDI Health Group 1-800-576-6412, Secure EDI 1-877-466-9656 and Mercury Data Exchange 1-866-633-1090, for claim submissions to DentaQuest. You can contact your software vendor and make certain that they have DentaQuest listed as the payer and claim mailing address on your electronic claim. Your software vendor will be able to provide you with any information you may need to ensure that submitted claims are forwarded to DentaQuest. DentaQuest’s Payor ID is CX014. 27.5 HIPAA Compliant 837DFile For Providers who are unable to submit electronically via the Internet or a clearinghouse, DentaQuest will work directly with the Provider to receive their claims electronically via a HIPAA compliant 837D or 837P file from the Provider’s practice management system. 27.6 NPI Requirements for Submission of Electronic Claims In accordance with the HIPAA guidelines, DentaQuest has adopted the following NPI standards in order to simplify the submission of claims from all of our providers, conform to industry required standards and increase the accuracy and efficiency of claims administered by DentaQuest. • Providers must register for the appropriate NPI classification at the following website https://nppes.cms.hhs.gov/NPPES/Welcome.do and provide this information to DentaQuest in its entirety. • All providers must register for an Individual NPI. You may also be required to register for a group NPI (or as part of a group) dependant upon your designation. • When submitting claims to DentaQuest you must submit all forms of NPI properly and in their entirety for claims to be accepted and processed accurately. If you registered as part of a group, your claims must be submitted with both the Group and Individual NPI’s. These numbers are not interchangeable and could cause your claims to be returned to you as non-compliant. • If you are presently submitting claims to DentaQuest through a clearinghouse or through a direct integration you need to review your integration to assure that it is in compliance with the revised HIPAA compliant 837D format. This information can be found on the 837D Companion Guide located on the Provider Web Portal. 27.7 Paper Claim Submission • Claims must be submitted on 2018, 2019, or later ADA approved claim forms. • Member name, identification number, and date of birth must be listed on all claims submitted. If the Member identification number is missing or miscoded on the claim form, the patient cannot be identified. This could result in the claim being returned to the submitting Provider office, causing a delay in payment. • The paper claim must contain an acceptable provider signature. • The Provider and office location information must be clearly identified on the claim. Frequently, if only the dentist signature is used for identification, the dentist’s name cannot be clearly identified. Please include either a typed dentist (practice) name or the DentaQuest Provider identificationnumber. • The paper claim form must contain a valid provider NPI (National Provider Identification) number. In the event of not having this box on the claim form, the NPI must still be included on the form. The ADA claim form only supplies 2 fields to enter NPI. On paper claims, the Type 2 NPI identifies the payee, and may be submitted in conjunction with a Type 1 NPI to identify the dentist who provided the treatment. For example, on a standard ADA Dental Claim Form, the treating dentist’s NPI is entered in field 54 and the billing entity’s NPI is entered in field49. • The date of service must be provided on the claim form for each service line submitted. • Approved ADA dental codes as published in the current CDT book or as defined in this manual must be used to define all services. • List all quadrants, tooth numbers and surfaces for dental codes that necessitate identification (extractions, root canals, amalgams and resin fillings). Missing tooth and surface identification codes can result in the delay or denial of claim payment. Affix the proper postage when mailing bulk documentation. DentaQuest does not accept postage due mail. This mail will be returned to the sender and will result in delay of payment. Claims should be mailed to the following address: DentaQuest- Claims PO Box 2906 Milwaukee, WI 53201-2906 For questions, providers may contact DentaQuest Provider Services at 844.776.8740. 27.8 Coordination of Benefits (COB) Medicaid is the payer of last resort. Providers should ask Members if they have other dental insurance coverage at the time of their appointment. When Medicaid is the secondary insurance carrier, a copy of the primary carrier's Explanation of Benefits (EOB) must be submitted with the claim. For electronic claim submissions, the payment made by the primary carrier must be indicated in the appropriate COB field. When a primary carrier's payment meets or exceeds the Medicaid fee schedule, DentaQuest will consider the claim paid in full and no further payment will be made on the claim. 27.9 Member Billing Restrictions Providers may not bill Members directly for Covered Services. DentaQuest reimburses only those services that are medically necessary and a Covered benefit in the respective program the Member is enrolled in. Medicaid Members do not have co-payments. Member Acknowledgement Statement A Provider may bill a Member for a claim denied as not being medically necessary or not a part of a Covered service if both of the following conditions are met: • A specific service or item is provided at the request of the client • If the Provider obtains a written waiver from the Member prior to rendering such service. The Member Acknowledgment Statement reads as follows: “I understand that, in the opinion of (Provider’s name), the services or items that I have requested to be provided to me on (dates of service) may not be covered under the Texas Medicaid Assistance Program as being reasonable and medically necessary for my care. I understand that DentaQuest through its contract with Superior and HHSC determines the medical necessity of the services or items that I request and receive. I also understand that I am responsible for payment of the services or items I request and receive if these services or items are determined not to be reasonable and medically necessary for my care.” 27.10 Private Pay Form (Non-Covered Services Disclosure Form) There are instances when the dentist may bill the Member. For example, if the Provider accepts the Member as a private pay patient and informs the Member at the time of service that the Member will be responsible for payment for all services. In this situation, it is recommended that the Provider use a Private Pay Form. It is suggested that the Provider use the Member Acknowledgement Statement listed above as the Private Pay Form, or use the DentaQuest Non-Covered Services Disclosure Form. Without written, signed documentation that the Member has been properly notified of their private pay status, the Provider could not ask for payment from a Member.	Electronic Claim Submission via Clearinghouse DentaQuest works directly with Emdeon (1-888-255-7293), Tesia 1-800-724-7240, EDI Health Group 1-800-576-6412, Secure EDI 1-877-466-9656 and Mercury Data Exchange 1-866-633-1090, for claim submissions to DentaQuest. You can contact your software vendor and make certain that they have DentaQuest listed as the payer and claim mailing address on your electronic claim. Your software vendor will be able to provide you with any information you may need to ensure that submitted claims are forwarded to DentaQuest. DentaQuest’s Payor ID is CX014. 27.5 HIPAA Compliant 837DFile For Providers who are unable to submit electronically via the Internet or a clearinghouse, DentaQuest will work directly with the Provider to receive their claims electronically via a HIPAA compliant 837D or 837P file from the Provider’s practice management system. 27.6 NPI Requirements for Submission of Electronic Claims In accordance with the HIPAA guidelines, DentaQuest has adopted the following NPI standards in order to simplify the submission of claims from all of our providers, conform to industry required standards and increase the accuracy and efficiency of claims administered by DentaQuest. • Providers must register for the appropriate NPI classification at the following website https://nppes.cms.hhs.gov/NPPES/Welcome.do and provide this information to DentaQuest in its entirety. • All providers must register for an Individual NPI. You may also be required to register for a group NPI (or as part of a group) dependant upon your designation. • When submitting claims to DentaQuest you must submit all forms of NPI properly and in their entirety for claims to be accepted and processed accurately. If you registered as part of a group, your claims must be submitted with both the Group and Individual NPI’s. These numbers are not interchangeable and could cause your claims to be returned to you as non-compliant. • If you are presently submitting claims to DentaQuest through a clearinghouse or through a direct integration you need to review your integration to assure that it is in compliance with the revised HIPAA compliant 837D format. This information can be found on the 837D Companion Guide located on the Provider Web Portal. 27.7 Paper Claim Submission • Claims must be submitted on 2018, 2019, or later ADA approved claim forms. • Member name, identification number, and date of birth must be listed on all claims submitted. If the Member identification number is missing or miscoded on the claim form, the patient cannot be identified. This could result in the claim being returned to the submitting Provider office, causing a delay in payment. • The paper claim must contain an acceptable provider signature. • The Provider and office location information must be clearly identified on the claim. Frequently, if only the dentist signature is used for identification, the dentist’s name cannot be clearly identified. Please include either a typed dentist (practice) name or the DentaQuest Provider identificationnumber. • The paper claim form must contain a valid provider NPI (National Provider Identification) number. In the event of not having this box on the claim form, the NPI must still be included on the form. The ADA claim form only supplies 2 fields to enter NPI. On paper claims, the Type 2 NPI identifies the payee, and may be submitted in conjunction with a Type 1 NPI to identify the dentist who provided the treatment. For example, on a standard ADA Dental Claim Form, the treating dentist’s NPI is entered in field 54 and the billing entity’s NPI is entered in field49. • The date of service must be provided on the claim form for each service line submitted. • Approved ADA dental codes as published in the current CDT book or as defined in this manual must be used to define all services. • List all quadrants, tooth numbers and surfaces for dental codes that necessitate identification (extractions, root canals, amalgams and resin fillings). Missing tooth and surface identification codes can result in the delay or denial of claim payment. Affix the proper postage when mailing bulk documentation. DentaQuest does not accept postage due mail. This mail will be returned to the sender and will result in delay of payment. Claims should be mailed to the following address: DentaQuest- Claims PO Box 2906 Milwaukee, WI 53201-2906 For questions, providers may contact DentaQuest Provider Services at 844.776.8740. 27.8 Coordination of Benefits (COB) Medicaid is the payer of last resort. Providers should ask Members if they have other dental insurance coverage at the time of their appointment. When Medicaid is the secondary insurance carrier, a copy of the primary carrier's Explanation of Benefits (EOB) must be submitted with the claim. For electronic claim submissions, the payment made by the primary carrier must be indicated in the appropriate COB field. When a primary carrier's payment meets or exceeds the Medicaid fee schedule, DentaQuest will consider the claim paid in full and no further payment will be made on the claim. 27.9 Member Billing Restrictions Providers may not bill Members directly for Covered Services. DentaQuest reimburses only those services that are medically necessary and a Covered benefit in the respective program the Member is enrolled in. Medicaid Members do not have co-payments. Member Acknowledgement Statement A Provider may bill a Member for a claim denied as not being medically necessary or not a part of a Covered service if both of the following conditions are met: • A specific service or item is provided at the request of the client • If the Provider obtains a written waiver from the Member prior to rendering such service. The Member Acknowledgment Statement reads as follows: “I understand that, in the opinion of (Provider’s name), the services or items that I have requested to be provided to me on (dates of service) may not be covered under the Texas Medicaid Assistance Program as being reasonable and medically necessary for my care. I understand that DentaQuest through its contract with Superior and HHSC determines the medical necessity of the services or items that I request and receive. I also understand that I am responsible for payment of the services or items I request and receive if these services or items are determined not to be reasonable and medically necessary for my care.” 27.10 Private Pay Form (Non-Covered Services Disclosure Form) There are instances when the dentist may bill the Member. For example, if the Provider accepts the Member as a private pay patient and informs the Member at the time of service that the Member will be responsible for payment for all services. In this situation, it is recommended that the Provider use a Private Pay Form. It is suggested that the Provider use the Member Acknowledgement Statement listed above as the Private Pay Form, or use the DentaQuest Non-Covered Services Disclosure Form. Without written, signed documentation that the Member has been properly notified of their private pay status, the Provider could not ask for payment from a Member. How can I charge the patient? You can only use the provided text for information in your response. Answer in under 150 words.	You can only use the provided text for information in your response. Answer in under 150 words. EVIDENCE: Electronic Claim Submission via Clearinghouse DentaQuest works directly with Emdeon (1-888-255-7293), Tesia 1-800-724-7240, EDI Health Group 1-800-576-6412, Secure EDI 1-877-466-9656 and Mercury Data Exchange 1-866-633-1090, for claim submissions to DentaQuest. You can contact your software vendor and make certain that they have DentaQuest listed as the payer and claim mailing address on your electronic claim. Your software vendor will be able to provide you with any information you may need to ensure that submitted claims are forwarded to DentaQuest. DentaQuest’s Payor ID is CX014. 27.5 HIPAA Compliant 837DFile For Providers who are unable to submit electronically via the Internet or a clearinghouse, DentaQuest will work directly with the Provider to receive their claims electronically via a HIPAA compliant 837D or 837P file from the Provider’s practice management system. 27.6 NPI Requirements for Submission of Electronic Claims In accordance with the HIPAA guidelines, DentaQuest has adopted the following NPI standards in order to simplify the submission of claims from all of our providers, conform to industry required standards and increase the accuracy and efficiency of claims administered by DentaQuest. • Providers must register for the appropriate NPI classification at the following website https://nppes.cms.hhs.gov/NPPES/Welcome.do and provide this information to DentaQuest in its entirety. • All providers must register for an Individual NPI. You may also be required to register for a group NPI (or as part of a group) dependant upon your designation. • When submitting claims to DentaQuest you must submit all forms of NPI properly and in their entirety for claims to be accepted and processed accurately. If you registered as part of a group, your claims must be submitted with both the Group and Individual NPI’s. These numbers are not interchangeable and could cause your claims to be returned to you as non-compliant. • If you are presently submitting claims to DentaQuest through a clearinghouse or through a direct integration you need to review your integration to assure that it is in compliance with the revised HIPAA compliant 837D format. This information can be found on the 837D Companion Guide located on the Provider Web Portal. 27.7 Paper Claim Submission • Claims must be submitted on 2018, 2019, or later ADA approved claim forms. • Member name, identification number, and date of birth must be listed on all claims submitted. If the Member identification number is missing or miscoded on the claim form, the patient cannot be identified. This could result in the claim being returned to the submitting Provider office, causing a delay in payment. • The paper claim must contain an acceptable provider signature. • The Provider and office location information must be clearly identified on the claim. Frequently, if only the dentist signature is used for identification, the dentist’s name cannot be clearly identified. Please include either a typed dentist (practice) name or the DentaQuest Provider identificationnumber. • The paper claim form must contain a valid provider NPI (National Provider Identification) number. In the event of not having this box on the claim form, the NPI must still be included on the form. The ADA claim form only supplies 2 fields to enter NPI. On paper claims, the Type 2 NPI identifies the payee, and may be submitted in conjunction with a Type 1 NPI to identify the dentist who provided the treatment. For example, on a standard ADA Dental Claim Form, the treating dentist’s NPI is entered in field 54 and the billing entity’s NPI is entered in field49. • The date of service must be provided on the claim form for each service line submitted. • Approved ADA dental codes as published in the current CDT book or as defined in this manual must be used to define all services. • List all quadrants, tooth numbers and surfaces for dental codes that necessitate identification (extractions, root canals, amalgams and resin fillings). Missing tooth and surface identification codes can result in the delay or denial of claim payment. Affix the proper postage when mailing bulk documentation. DentaQuest does not accept postage due mail. This mail will be returned to the sender and will result in delay of payment. Claims should be mailed to the following address: DentaQuest- Claims PO Box 2906 Milwaukee, WI 53201-2906 For questions, providers may contact DentaQuest Provider Services at 844.776.8740. 27.8 Coordination of Benefits (COB) Medicaid is the payer of last resort. Providers should ask Members if they have other dental insurance coverage at the time of their appointment. When Medicaid is the secondary insurance carrier, a copy of the primary carrier's Explanation of Benefits (EOB) must be submitted with the claim. For electronic claim submissions, the payment made by the primary carrier must be indicated in the appropriate COB field. When a primary carrier's payment meets or exceeds the Medicaid fee schedule, DentaQuest will consider the claim paid in full and no further payment will be made on the claim. 27.9 Member Billing Restrictions Providers may not bill Members directly for Covered Services. DentaQuest reimburses only those services that are medically necessary and a Covered benefit in the respective program the Member is enrolled in. Medicaid Members do not have co-payments. Member Acknowledgement Statement A Provider may bill a Member for a claim denied as not being medically necessary or not a part of a Covered service if both of the following conditions are met: • A specific service or item is provided at the request of the client • If the Provider obtains a written waiver from the Member prior to rendering such service. The Member Acknowledgment Statement reads as follows: “I understand that, in the opinion of (Provider’s name), the services or items that I have requested to be provided to me on (dates of service) may not be covered under the Texas Medicaid Assistance Program as being reasonable and medically necessary for my care. I understand that DentaQuest through its contract with Superior and HHSC determines the medical necessity of the services or items that I request and receive. I also understand that I am responsible for payment of the services or items I request and receive if these services or items are determined not to be reasonable and medically necessary for my care.” 27.10 Private Pay Form (Non-Covered Services Disclosure Form) There are instances when the dentist may bill the Member. For example, if the Provider accepts the Member as a private pay patient and informs the Member at the time of service that the Member will be responsible for payment for all services. In this situation, it is recommended that the Provider use a Private Pay Form. It is suggested that the Provider use the Member Acknowledgement Statement listed above as the Private Pay Form, or use the DentaQuest Non-Covered Services Disclosure Form. Without written, signed documentation that the Member has been properly notified of their private pay status, the Provider could not ask for payment from a Member. USER: How can I charge the patient? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	true	17	6	1,144	null	692
Any information used should come solely from the provided text. Use no outside information or prior knowledge in your response.	Provide one example of how the change in scheduling would impact low-income people.	Legal Consequences of Rescheduling Marijuana Updated May 1, 2024 On April 30, 2024, news outlets reported that the Drug Enforcement Administration (DEA) planned to move marijuana from Schedule I to Schedule III under the Controlled Substances Act (CSA). The planned change followed an August 2023 recommendation from the Department of Health and Human Services (HHS) that DEA reschedule marijuana from Schedule I to Schedule III. Any change to the status of marijuana via the DEA rulemaking process would not take effect immediately. According to reports, the proposal will be reviewed by the White House Office of Management and Budget and will then be subject to public comment. A previous CRS Insight outlined policy considerations related to rescheduling marijuana. This Legal Sidebar provides additional information on the legal consequences of the possible move of marijuana from Schedule I to Schedule III. Current Legal Status of Cannabis Under the CSA Cannabis and its derivatives generally fall within one of two categories under federal law: marijuana or hemp. Unless an exception applies, the CSA classifies the cannabis plant and its derivatives as marijuana (some provisions of the statute use an alternative spelling, “marihuana”). The CSA definition of marijuana excludes (1) products that meet the legal definition of hemp and (2) the mature stalks of the cannabis plant; the sterilized seeds of the plant; and fibers, oils, and other products made from the stalks and seeds. Marijuana is a Schedule I controlled substance under the CSA. Federal law defines hemp as the cannabis plant or any part of that plant with a delta-9 tetrahydrocannabinol (THC) concentration of no more than 0.3%. The non-psychoactive compound cannabidiol (CBD) falls within the legal definition of hemp. Hemp is not a controlled substance under the CSA. Substances become subject to the CSA through placement in one of five lists, known as Schedules I through V. Congress placed marijuana in Schedule I in 1970 when it enacted the CSA. A lower schedule number carries greater restrictions under the CSA, with controlled substances in Schedule I subject to the most stringent controls. Schedule I controlled substances have no currently accepted medical use. It is illegal to produce, dispense, or possess such substances except in the context of federally approved Congressional Research Service https://crsreports.congress.gov LSB11105 Congressional Research Service 2 scientific studies, subject to CSA regulatory requirements designed to prevent abuse and diversion. Unauthorized activities involving Schedule I controlled substances are federal crimes that may give rise to large fines and significant jail time. DEA is required to set annual production quotas for Schedule I controlled substances manufactured for use in approved research. In addition to the general regulatory framework that applies due to marijuana’s Schedule I status, some provisions of the CSA apply specifically to marijuana. For instance, 21 U.S.C. § 841 imposes mandatory minimum prison sentences for persons convicted of criminal CSA violations involving set quantities of specific controlled substances, including marijuana. In addition, 21 U.S.C. § 823 creates special registration requirements for those who manufacture marijuana for research purposes. In sharp contrast to the stringent federal control of marijuana, in recent decades nearly all the states have changed their laws to permit the use of marijuana (or other cannabis products) for medical purposes. In addition, twenty-four states and the District of Columbia have passed laws removing certain state criminal prohibitions on recreational marijuana use by adults. As the Supreme Court has recognized, states cannot actually legalize marijuana because the states cannot change federal law, and the Constitution’s Supremacy Clause dictates that federal law takes precedence over conflicting state laws. So long as marijuana is a Schedule I controlled substance under the CSA, all unauthorized activities involving marijuana are federal crimes anywhere in the United States, including in states that have purported to legalize medical or recreational marijuana. Nonetheless, Congress has granted the states some leeway to allow the distribution and use of medical marijuana. In each budget cycle since FY2014, Congress has passed an appropriations rider barring the Department of Justice (DOJ) from using taxpayer funds to prevent states from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” Courts have interpreted the appropriations rider to prohibit federal prosecution of state-legal activities involving medical marijuana. However, it poses no bar to federal prosecution of activities involving recreational marijuana. Moreover, the rider does not remove criminal liability; it merely limits enforcement of the CSA in certain circumstances while the rider remains in effect. While official DOJ policy has varied somewhat across Administrations, recent presidential Administrations have not prioritized prosecution of state-legal activities involving marijuana. Even absent criminal prosecution or conviction, individuals and organizations engaged in marijuanarelated activities in violation of the CSA—including participants in the state-legal marijuana industry— may face collateral consequences arising from the federal prohibition of marijuana. Other federal laws impose legal consequences based on criminal activity, including violations of the CSA. For example, a financial institution handling income from a marijuana business may violate federal anti-money laundering laws. Likewise, Section 280E of the Internal Revenue Code renders marijuana businesses ineligible for certain federal tax deductions. The presence of income from a marijuana-related business may also prevent a bankruptcy court from confirming a bankruptcy plan (though courts have split on the issue). For individuals, participation in the state-legal marijuana industry may have adverse immigration consequences. Violations of the CSA may also affect individuals’ ability to receive certain federal government benefits. In addition, federal law prohibits gun ownership and possession by any person who is an “unlawful user of or addicted to any controlled substance,” with no exception for users of state-legal medical marijuana. Legal Consequences If Marijuana Moved to Schedule III Moving marijuana from Schedule I to Schedule III, without other legal changes, would not bring the state-legal medical or recreational marijuana industry into compliance with federal controlled substances law. With respect to medical marijuana, a key difference between placement in Schedule I and Schedule III is that substances in Schedule III have an accepted medical use and may lawfully be dispensed by Congressional Research Service 3 prescription, while substances in Schedule I cannot. However, prescription drugs must be approved by the Food and Drug Administration (FDA). Although FDA has approved some drugs derived from or related to cannabis, marijuana itself is not an FDA-approved drug. Moreover, if one or more marijuana products obtained FDA approval, manufacturers and distributors would need to register with DEA and comply with regulatory requirements that apply to Schedule III substances in order to handle those products. Users of medical marijuana would need to obtain valid prescriptions for the substance from medical providers, subject to federal legal requirements that differ from existing state regulatory requirements for medical marijuana. Rescheduling marijuana would not affect the medical marijuana appropriations rider. Thus, so long as the current rider remains in effect, participants in the state-legal medical marijuana industry who comply with state law would be shielded from federal prosecution. If the rider were to lapse or be repealed, these persons would again be subject to prosecution at the discretion of DOJ. With respect to the manufacture, distribution, and possession of recreational marijuana, if marijuana were moved to Schedule III, such activities would remain illegal under federal law and potentially subject to federal prosecution regardless of their status under state law. Some criminal penalties for CSA violations depend on the schedule in which a substance is classified. If marijuana were moved to Schedule III, applicable penalties for some offenses would be reduced. However, CSA penalties that apply to activities involving marijuana specifically, such as the quantitybased mandatory minimum sentences discussed above, would not change as a result of rescheduling. DEA is not required to set annual production quotas for Schedule III controlled substances. The prohibition on business deductions in Section 280E of the Internal Revenue Code applies to any trade or business that “consists of trafficking in controlled substances (within the meaning of schedule I and II of the Controlled Substances Act) which is prohibited by Federal law or the law of any State in which such trade or business is conducted.” Because the provision applies only to activities involving substances in Schedule I or II, moving marijuana from Schedule I to Schedule III would allow marijuana businesses to deduct business expenses on federal tax filings. Other collateral legal consequences would continue to attach to unauthorized marijuana-related activities. Considerations for Congress Either Congress or the executive branch has the authority to change the status of marijuana under the CSA. Congress can change the status of a controlled substance through legislation, while the CSA empowers DEA to make scheduling decisions through the notice-and-comment rulemaking process. When considering whether to schedule or reschedule a controlled substance, DEA is bound by HHS’s recommendations on scientific and medical matters. However, DEA has stated that it has “final authority to schedule, reschedule, or deschedule a drug under the Controlled Substances Act.” A proposal from the 118th Congress would provide for congressional review of DEA rescheduling decisions related to marijuana. If Congress wishes to change the legal status of marijuana, it has broad authority to do so before or after DEA makes any final scheduling decision. Several proposals from the 118th Congress would remove marijuana from control under the CSA or move the substance to a less restrictive schedule. If Congress moved marijuana to Schedule III by legislation, it could simultaneously consider whether to change some of the legal consequences of Schedule III status described above. Congress could also legislate to move marijuana to another CSA schedule, which would subject it to controls more or less stringent than those that apply to Schedule III controlled substances. Rescheduling or descheduling marijuana under the CSA could raise additional legal questions. For instance, FDA regulates certain cannabis products under the Federal Food, Drug, and Cosmetic Act, so Congressional Research Service 4 LSB11105 · VERSION 2 · UPDATED Congress might also consider whether to alter that regulatory regime or create some alternative regulatory framework. In addition, relaxing the CSA’s restrictions on marijuana could implicate the United States’ international treaty obligations. While most recent proposals would relax federal regulation of marijuana, Congress could also seek to impose more stringent controls. One proposal from the 118th Congress would withhold certain federal funds from states in which the purchase or public possession of marijuana for recreational purposes is lawful. A proposal from the 117th Congress would have prohibited the use of benefits under the Temporary Assistance for Needy Families block grant at any store that offers marijuana for sale. Other proposals from the 117th Congress sought to address the issues of workplace impairment or driving under the influence of marijuana and other substances.	Any information used should come solely from the provided text. Use no outside information or prior knowledge in your response. Legal Consequences of Rescheduling Marijuana Updated May 1, 2024 On April 30, 2024, news outlets reported that the Drug Enforcement Administration (DEA) planned to move marijuana from Schedule I to Schedule III under the Controlled Substances Act (CSA). The planned change followed an August 2023 recommendation from the Department of Health and Human Services (HHS) that DEA reschedule marijuana from Schedule I to Schedule III. Any change to the status of marijuana via the DEA rulemaking process would not take effect immediately. According to reports, the proposal will be reviewed by the White House Office of Management and Budget and will then be subject to public comment. A previous CRS Insight outlined policy considerations related to rescheduling marijuana. This Legal Sidebar provides additional information on the legal consequences of the possible move of marijuana from Schedule I to Schedule III. Current Legal Status of Cannabis Under the CSA Cannabis and its derivatives generally fall within one of two categories under federal law: marijuana or hemp. Unless an exception applies, the CSA classifies the cannabis plant and its derivatives as marijuana (some provisions of the statute use an alternative spelling, “marihuana”). The CSA definition of marijuana excludes (1) products that meet the legal definition of hemp and (2) the mature stalks of the cannabis plant; the sterilized seeds of the plant; and fibers, oils, and other products made from the stalks and seeds. Marijuana is a Schedule I controlled substance under the CSA. Federal law defines hemp as the cannabis plant or any part of that plant with a delta-9 tetrahydrocannabinol (THC) concentration of no more than 0.3%. The non-psychoactive compound cannabidiol (CBD) falls within the legal definition of hemp. Hemp is not a controlled substance under the CSA. Substances become subject to the CSA through placement in one of five lists, known as Schedules I through V. Congress placed marijuana in Schedule I in 1970 when it enacted the CSA. A lower schedule number carries greater restrictions under the CSA, with controlled substances in Schedule I subject to the most stringent controls. Schedule I controlled substances have no currently accepted medical use. It is illegal to produce, dispense, or possess such substances except in the context of federally approved Congressional Research Service https://crsreports.congress.gov LSB11105 Congressional Research Service 2 scientific studies, subject to CSA regulatory requirements designed to prevent abuse and diversion. Unauthorized activities involving Schedule I controlled substances are federal crimes that may give rise to large fines and significant jail time. DEA is required to set annual production quotas for Schedule I controlled substances manufactured for use in approved research. In addition to the general regulatory framework that applies due to marijuana’s Schedule I status, some provisions of the CSA apply specifically to marijuana. For instance, 21 U.S.C. § 841 imposes mandatory minimum prison sentences for persons convicted of criminal CSA violations involving set quantities of specific controlled substances, including marijuana. In addition, 21 U.S.C. § 823 creates special registration requirements for those who manufacture marijuana for research purposes. In sharp contrast to the stringent federal control of marijuana, in recent decades nearly all the states have changed their laws to permit the use of marijuana (or other cannabis products) for medical purposes. In addition, twenty-four states and the District of Columbia have passed laws removing certain state criminal prohibitions on recreational marijuana use by adults. As the Supreme Court has recognized, states cannot actually legalize marijuana because the states cannot change federal law, and the Constitution’s Supremacy Clause dictates that federal law takes precedence over conflicting state laws. So long as marijuana is a Schedule I controlled substance under the CSA, all unauthorized activities involving marijuana are federal crimes anywhere in the United States, including in states that have purported to legalize medical or recreational marijuana. Nonetheless, Congress has granted the states some leeway to allow the distribution and use of medical marijuana. In each budget cycle since FY2014, Congress has passed an appropriations rider barring the Department of Justice (DOJ) from using taxpayer funds to prevent states from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” Courts have interpreted the appropriations rider to prohibit federal prosecution of state-legal activities involving medical marijuana. However, it poses no bar to federal prosecution of activities involving recreational marijuana. Moreover, the rider does not remove criminal liability; it merely limits enforcement of the CSA in certain circumstances while the rider remains in effect. While official DOJ policy has varied somewhat across Administrations, recent presidential Administrations have not prioritized prosecution of state-legal activities involving marijuana. Even absent criminal prosecution or conviction, individuals and organizations engaged in marijuanarelated activities in violation of the CSA—including participants in the state-legal marijuana industry— may face collateral consequences arising from the federal prohibition of marijuana. Other federal laws impose legal consequences based on criminal activity, including violations of the CSA. For example, a financial institution handling income from a marijuana business may violate federal anti-money laundering laws. Likewise, Section 280E of the Internal Revenue Code renders marijuana businesses ineligible for certain federal tax deductions. The presence of income from a marijuana-related business may also prevent a bankruptcy court from confirming a bankruptcy plan (though courts have split on the issue). For individuals, participation in the state-legal marijuana industry may have adverse immigration consequences. Violations of the CSA may also affect individuals’ ability to receive certain federal government benefits. In addition, federal law prohibits gun ownership and possession by any person who is an “unlawful user of or addicted to any controlled substance,” with no exception for users of state-legal medical marijuana. Legal Consequences If Marijuana Moved to Schedule III Moving marijuana from Schedule I to Schedule III, without other legal changes, would not bring the state-legal medical or recreational marijuana industry into compliance with federal controlled substances law. With respect to medical marijuana, a key difference between placement in Schedule I and Schedule III is that substances in Schedule III have an accepted medical use and may lawfully be dispensed by Congressional Research Service 3 prescription, while substances in Schedule I cannot. However, prescription drugs must be approved by the Food and Drug Administration (FDA). Although FDA has approved some drugs derived from or related to cannabis, marijuana itself is not an FDA-approved drug. Moreover, if one or more marijuana products obtained FDA approval, manufacturers and distributors would need to register with DEA and comply with regulatory requirements that apply to Schedule III substances in order to handle those products. Users of medical marijuana would need to obtain valid prescriptions for the substance from medical providers, subject to federal legal requirements that differ from existing state regulatory requirements for medical marijuana. Rescheduling marijuana would not affect the medical marijuana appropriations rider. Thus, so long as the current rider remains in effect, participants in the state-legal medical marijuana industry who comply with state law would be shielded from federal prosecution. If the rider were to lapse or be repealed, these persons would again be subject to prosecution at the discretion of DOJ. With respect to the manufacture, distribution, and possession of recreational marijuana, if marijuana were moved to Schedule III, such activities would remain illegal under federal law and potentially subject to federal prosecution regardless of their status under state law. Some criminal penalties for CSA violations depend on the schedule in which a substance is classified. If marijuana were moved to Schedule III, applicable penalties for some offenses would be reduced. However, CSA penalties that apply to activities involving marijuana specifically, such as the quantitybased mandatory minimum sentences discussed above, would not change as a result of rescheduling. DEA is not required to set annual production quotas for Schedule III controlled substances. The prohibition on business deductions in Section 280E of the Internal Revenue Code applies to any trade or business that “consists of trafficking in controlled substances (within the meaning of schedule I and II of the Controlled Substances Act) which is prohibited by Federal law or the law of any State in which such trade or business is conducted.” Because the provision applies only to activities involving substances in Schedule I or II, moving marijuana from Schedule I to Schedule III would allow marijuana businesses to deduct business expenses on federal tax filings. Other collateral legal consequences would continue to attach to unauthorized marijuana-related activities. Considerations for Congress Either Congress or the executive branch has the authority to change the status of marijuana under the CSA. Congress can change the status of a controlled substance through legislation, while the CSA empowers DEA to make scheduling decisions through the notice-and-comment rulemaking process. When considering whether to schedule or reschedule a controlled substance, DEA is bound by HHS’s recommendations on scientific and medical matters. However, DEA has stated that it has “final authority to schedule, reschedule, or deschedule a drug under the Controlled Substances Act.” A proposal from the 118th Congress would provide for congressional review of DEA rescheduling decisions related to marijuana. If Congress wishes to change the legal status of marijuana, it has broad authority to do so before or after DEA makes any final scheduling decision. Several proposals from the 118th Congress would remove marijuana from control under the CSA or move the substance to a less restrictive schedule. If Congress moved marijuana to Schedule III by legislation, it could simultaneously consider whether to change some of the legal consequences of Schedule III status described above. Congress could also legislate to move marijuana to another CSA schedule, which would subject it to controls more or less stringent than those that apply to Schedule III controlled substances. Rescheduling or descheduling marijuana under the CSA could raise additional legal questions. For instance, FDA regulates certain cannabis products under the Federal Food, Drug, and Cosmetic Act, so Congressional Research Service 4 LSB11105 · VERSION 2 · UPDATED Congress might also consider whether to alter that regulatory regime or create some alternative regulatory framework. In addition, relaxing the CSA’s restrictions on marijuana could implicate the United States’ international treaty obligations. While most recent proposals would relax federal regulation of marijuana, Congress could also seek to impose more stringent controls. One proposal from the 118th Congress would withhold certain federal funds from states in which the purchase or public possession of marijuana for recreational purposes is lawful. A proposal from the 117th Congress would have prohibited the use of benefits under the Temporary Assistance for Needy Families block grant at any store that offers marijuana for sale. Other proposals from the 117th Congress sought to address the issues of workplace impairment or driving under the influence of marijuana and other substances. Provide one example of how the change in scheduling would impact low-income people.	Any information used should come solely from the provided text. Use no outside information or prior knowledge in your response. EVIDENCE: Legal Consequences of Rescheduling Marijuana Updated May 1, 2024 On April 30, 2024, news outlets reported that the Drug Enforcement Administration (DEA) planned to move marijuana from Schedule I to Schedule III under the Controlled Substances Act (CSA). The planned change followed an August 2023 recommendation from the Department of Health and Human Services (HHS) that DEA reschedule marijuana from Schedule I to Schedule III. Any change to the status of marijuana via the DEA rulemaking process would not take effect immediately. According to reports, the proposal will be reviewed by the White House Office of Management and Budget and will then be subject to public comment. A previous CRS Insight outlined policy considerations related to rescheduling marijuana. This Legal Sidebar provides additional information on the legal consequences of the possible move of marijuana from Schedule I to Schedule III. Current Legal Status of Cannabis Under the CSA Cannabis and its derivatives generally fall within one of two categories under federal law: marijuana or hemp. Unless an exception applies, the CSA classifies the cannabis plant and its derivatives as marijuana (some provisions of the statute use an alternative spelling, “marihuana”). The CSA definition of marijuana excludes (1) products that meet the legal definition of hemp and (2) the mature stalks of the cannabis plant; the sterilized seeds of the plant; and fibers, oils, and other products made from the stalks and seeds. Marijuana is a Schedule I controlled substance under the CSA. Federal law defines hemp as the cannabis plant or any part of that plant with a delta-9 tetrahydrocannabinol (THC) concentration of no more than 0.3%. The non-psychoactive compound cannabidiol (CBD) falls within the legal definition of hemp. Hemp is not a controlled substance under the CSA. Substances become subject to the CSA through placement in one of five lists, known as Schedules I through V. Congress placed marijuana in Schedule I in 1970 when it enacted the CSA. A lower schedule number carries greater restrictions under the CSA, with controlled substances in Schedule I subject to the most stringent controls. Schedule I controlled substances have no currently accepted medical use. It is illegal to produce, dispense, or possess such substances except in the context of federally approved Congressional Research Service https://crsreports.congress.gov LSB11105 Congressional Research Service 2 scientific studies, subject to CSA regulatory requirements designed to prevent abuse and diversion. Unauthorized activities involving Schedule I controlled substances are federal crimes that may give rise to large fines and significant jail time. DEA is required to set annual production quotas for Schedule I controlled substances manufactured for use in approved research. In addition to the general regulatory framework that applies due to marijuana’s Schedule I status, some provisions of the CSA apply specifically to marijuana. For instance, 21 U.S.C. § 841 imposes mandatory minimum prison sentences for persons convicted of criminal CSA violations involving set quantities of specific controlled substances, including marijuana. In addition, 21 U.S.C. § 823 creates special registration requirements for those who manufacture marijuana for research purposes. In sharp contrast to the stringent federal control of marijuana, in recent decades nearly all the states have changed their laws to permit the use of marijuana (or other cannabis products) for medical purposes. In addition, twenty-four states and the District of Columbia have passed laws removing certain state criminal prohibitions on recreational marijuana use by adults. As the Supreme Court has recognized, states cannot actually legalize marijuana because the states cannot change federal law, and the Constitution’s Supremacy Clause dictates that federal law takes precedence over conflicting state laws. So long as marijuana is a Schedule I controlled substance under the CSA, all unauthorized activities involving marijuana are federal crimes anywhere in the United States, including in states that have purported to legalize medical or recreational marijuana. Nonetheless, Congress has granted the states some leeway to allow the distribution and use of medical marijuana. In each budget cycle since FY2014, Congress has passed an appropriations rider barring the Department of Justice (DOJ) from using taxpayer funds to prevent states from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” Courts have interpreted the appropriations rider to prohibit federal prosecution of state-legal activities involving medical marijuana. However, it poses no bar to federal prosecution of activities involving recreational marijuana. Moreover, the rider does not remove criminal liability; it merely limits enforcement of the CSA in certain circumstances while the rider remains in effect. While official DOJ policy has varied somewhat across Administrations, recent presidential Administrations have not prioritized prosecution of state-legal activities involving marijuana. Even absent criminal prosecution or conviction, individuals and organizations engaged in marijuanarelated activities in violation of the CSA—including participants in the state-legal marijuana industry— may face collateral consequences arising from the federal prohibition of marijuana. Other federal laws impose legal consequences based on criminal activity, including violations of the CSA. For example, a financial institution handling income from a marijuana business may violate federal anti-money laundering laws. Likewise, Section 280E of the Internal Revenue Code renders marijuana businesses ineligible for certain federal tax deductions. The presence of income from a marijuana-related business may also prevent a bankruptcy court from confirming a bankruptcy plan (though courts have split on the issue). For individuals, participation in the state-legal marijuana industry may have adverse immigration consequences. Violations of the CSA may also affect individuals’ ability to receive certain federal government benefits. In addition, federal law prohibits gun ownership and possession by any person who is an “unlawful user of or addicted to any controlled substance,” with no exception for users of state-legal medical marijuana. Legal Consequences If Marijuana Moved to Schedule III Moving marijuana from Schedule I to Schedule III, without other legal changes, would not bring the state-legal medical or recreational marijuana industry into compliance with federal controlled substances law. With respect to medical marijuana, a key difference between placement in Schedule I and Schedule III is that substances in Schedule III have an accepted medical use and may lawfully be dispensed by Congressional Research Service 3 prescription, while substances in Schedule I cannot. However, prescription drugs must be approved by the Food and Drug Administration (FDA). Although FDA has approved some drugs derived from or related to cannabis, marijuana itself is not an FDA-approved drug. Moreover, if one or more marijuana products obtained FDA approval, manufacturers and distributors would need to register with DEA and comply with regulatory requirements that apply to Schedule III substances in order to handle those products. Users of medical marijuana would need to obtain valid prescriptions for the substance from medical providers, subject to federal legal requirements that differ from existing state regulatory requirements for medical marijuana. Rescheduling marijuana would not affect the medical marijuana appropriations rider. Thus, so long as the current rider remains in effect, participants in the state-legal medical marijuana industry who comply with state law would be shielded from federal prosecution. If the rider were to lapse or be repealed, these persons would again be subject to prosecution at the discretion of DOJ. With respect to the manufacture, distribution, and possession of recreational marijuana, if marijuana were moved to Schedule III, such activities would remain illegal under federal law and potentially subject to federal prosecution regardless of their status under state law. Some criminal penalties for CSA violations depend on the schedule in which a substance is classified. If marijuana were moved to Schedule III, applicable penalties for some offenses would be reduced. However, CSA penalties that apply to activities involving marijuana specifically, such as the quantitybased mandatory minimum sentences discussed above, would not change as a result of rescheduling. DEA is not required to set annual production quotas for Schedule III controlled substances. The prohibition on business deductions in Section 280E of the Internal Revenue Code applies to any trade or business that “consists of trafficking in controlled substances (within the meaning of schedule I and II of the Controlled Substances Act) which is prohibited by Federal law or the law of any State in which such trade or business is conducted.” Because the provision applies only to activities involving substances in Schedule I or II, moving marijuana from Schedule I to Schedule III would allow marijuana businesses to deduct business expenses on federal tax filings. Other collateral legal consequences would continue to attach to unauthorized marijuana-related activities. Considerations for Congress Either Congress or the executive branch has the authority to change the status of marijuana under the CSA. Congress can change the status of a controlled substance through legislation, while the CSA empowers DEA to make scheduling decisions through the notice-and-comment rulemaking process. When considering whether to schedule or reschedule a controlled substance, DEA is bound by HHS’s recommendations on scientific and medical matters. However, DEA has stated that it has “final authority to schedule, reschedule, or deschedule a drug under the Controlled Substances Act.” A proposal from the 118th Congress would provide for congressional review of DEA rescheduling decisions related to marijuana. If Congress wishes to change the legal status of marijuana, it has broad authority to do so before or after DEA makes any final scheduling decision. Several proposals from the 118th Congress would remove marijuana from control under the CSA or move the substance to a less restrictive schedule. If Congress moved marijuana to Schedule III by legislation, it could simultaneously consider whether to change some of the legal consequences of Schedule III status described above. Congress could also legislate to move marijuana to another CSA schedule, which would subject it to controls more or less stringent than those that apply to Schedule III controlled substances. Rescheduling or descheduling marijuana under the CSA could raise additional legal questions. For instance, FDA regulates certain cannabis products under the Federal Food, Drug, and Cosmetic Act, so Congressional Research Service 4 LSB11105 · VERSION 2 · UPDATED Congress might also consider whether to alter that regulatory regime or create some alternative regulatory framework. In addition, relaxing the CSA’s restrictions on marijuana could implicate the United States’ international treaty obligations. While most recent proposals would relax federal regulation of marijuana, Congress could also seek to impose more stringent controls. One proposal from the 118th Congress would withhold certain federal funds from states in which the purchase or public possession of marijuana for recreational purposes is lawful. A proposal from the 117th Congress would have prohibited the use of benefits under the Temporary Assistance for Needy Families block grant at any store that offers marijuana for sale. Other proposals from the 117th Congress sought to address the issues of workplace impairment or driving under the influence of marijuana and other substances. USER: Provide one example of how the change in scheduling would impact low-income people. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	true	20	13	1,769	null	316
Limit your response to presenting information contained within the text provided above - You are not permitted to use external resources.	What actually is the federal debt?	Deficits, Debt, and Interest The annual differences between revenue (i.e., taxes and fees) that the government collects and outlays (i.e., spending) result in the budget deficit (or surplus). Annual budget deficits or surpluses determine, over time, the level of publicly held federal debt and affect the level of interest payments to finance the debt. Budget Deficits Between FY2009 and FY2012, annual budgets as a percentage of GDP were sharply higher than deficits in any period since FY1945.27 The unified budget deficit in FY2015 was $439 billion, or 2.5% of GDP—the lowest level since FY2007. The unified deficit, according to some budget experts, gives an incomplete view of the government’s fiscal conditions because it includes off- budget surpluses.28 Excluding off-budget items (Social Security benefits paid net of Social Security payroll taxes collected and the U.S. Postal Service’s net balance), the on-budget FY2015 federal deficit was $466 billion. Budget Deficit for FY2016 The January 2016 CBO baseline estimated the FY2016 budget deficit at $544 billion, or 2.9% of GDP. The rise in the estimated budget deficit for FY2016 is the result of increases in spending more than offsetting a smaller rise in revenues. FY2016 outlays are projected to increase to 21.2% of GDP, up from 20.7% of GDP in FY2015; revenues are projected to increase from 18.2% of GDP to 18.3% of GDP over the same period. Federal Debt and Debt Limit Gross federal debt is composed of debt held by the public and intragovernmental debt. Intragovernmental debt is the amount owed by the federal government to other federal agencies, to be paid by the Department of the Treasury, which mostly consists of money contained in trust funds. Debt held by the public is the total amount the federal government has borrowed from the public and remains outstanding. This measure is generally considered to be the most relevant in macroeconomic terms because it is the debt sold in credit markets. Changes in debt held by the public generally track the movements of the annual unified deficits and surpluses.29 Historically, Congress has set a ceiling on federal debt through a legislatively established limit. The debt limit also imposes a form of fiscal accountability that compels Congress, in the form of a vote authorizing a debt limit increase, and the President, by signing the legislation, to take visible action to allow further federal borrowing when nearing the statutory limit. The debt limit by itself has no effect on the borrowing needs of the government.30 The debt limit, however, can hinder the Treasury’s ability to manage the federal government’s finances when the amount of federal debt approaches this ceiling, or when the suspension expires. In those instances, the Treasury has had to take extraordinary measures to meet federal obligations, leading to inconvenience and uncertainty in Treasury operations at times.31 At the end of CY2015 (December 31, 2015), federal debt subject to limit was approximately $18.922 trillion, of which $13.673 trillion was held by the public.32 The debt limit is currently suspended until March 15, 2017. Upon reinstatement, the debt limit will be modified to exactly accommodate any increases in statutory debt subject to limit above the previous limit ($18.1 trillion). At the end of calendar year 2015, total debt subject to limit was $18.9 trillion. Barring advanced legislative action, the debt limit will be reached when reinstated, so long as federal debt remains above the previous limit and continues to rise. Net Interest In FY2015, the United States spent $223 billion, or 1.3% of GDP, on net interest payments on the debt. What the government pays in interest depends on market interest rates as well as on the size and composition of the federal debt. Currently, low interest rates have held net interest payments as a percentage of GDP below the historical average despite increases in borrowing to finance the debt.33 Some economists, however, have expressed concern that federal interest costs could rise once the economy fully recovers, resulting in future strain on the budget. Interest rates are projected to gradually rise in the CBO baseline, resulting in net interest payments of $830 billion (3.0% of GDP) in FY2026. If interest costs rise to this level, they will be higher than the historical average.	Deficits, Debt, and Interest The annual differences between revenue (i.e., taxes and fees) that the government collects and outlays (i.e., spending) result in the budget deficit (or surplus). Annual budget deficits or surpluses determine, over time, the level of publicly held federal debt and affect the level of interest payments to finance the debt. Budget Deficits Between FY2009 and FY2012, annual budgets as a percentage of GDP were sharply higher than deficits in any period since FY1945.27 The unified budget deficit in FY2015 was $439 billion, or 2.5% of GDP—the lowest level since FY2007. The unified deficit, according to some budget experts, gives an incomplete view of the government’s fiscal conditions because it includes off- budget surpluses.28 Excluding off-budget items (Social Security benefits paid net of Social Security payroll taxes collected and the U.S. Postal Service’s net balance), the on-budget FY2015 federal deficit was $466 billion. Budget Deficit for FY2016 The January 2016 CBO baseline estimated the FY2016 budget deficit at $544 billion, or 2.9% of GDP. The rise in the estimated budget deficit for FY2016 is the result of increases in spending more than offsetting a smaller rise in revenues. FY2016 outlays are projected to increase to 21.2% of GDP, up from 20.7% of GDP in FY2015; revenues are projected to increase from 18.2% of GDP to 18.3% of GDP over the same period. Federal Debt and Debt Limit Gross federal debt is composed of debt held by the public and intragovernmental debt. Intragovernmental debt is the amount owed by the federal government to other federal agencies, to be paid by the Department of the Treasury, which mostly consists of money contained in trust funds. Debt held by the public is the total amount the federal government has borrowed from the public and remains outstanding. This measure is generally considered to be the most relevant in macroeconomic terms because it is the debt sold in credit markets. Changes in debt held by the public generally track the movements of the annual unified deficits and surpluses.29 Historically, Congress has set a ceiling on federal debt through a legislatively established limit. The debt limit also imposes a form of fiscal accountability that compels Congress, in the form of a vote authorizing a debt limit increase, and the President, by signing the legislation, to take visible action to allow further federal borrowing when nearing the statutory limit. The debt limit by itself has no effect on the borrowing needs of the government.30 The debt limit, however, can hinder the Treasury’s ability to manage the federal government’s finances when the amount of federal debt approaches this ceiling, or when the suspension expires. In those instances, the Treasury has had to take extraordinary measures to meet federal obligations, leading to inconvenience and uncertainty in Treasury operations at times.31 At the end of CY2015 (December 31, 2015), federal debt subject to limit was approximately $18.922 trillion, of which $13.673 trillion was held by the public.32 The debt limit is currently suspended until March 15, 2017. Upon reinstatement, the debt limit will be modified to exactly accommodate any increases in statutory debt subject to limit above the previous limit ($18.1 trillion). At the end of calendar year 2015, total debt subject to limit was $18.9 trillion. Barring advanced legislative action, the debt limit will be reached when reinstated, so long as federal debt remains above the previous limit and continues to rise. Net Interest In FY2015, the United States spent $223 billion, or 1.3% of GDP, on net interest payments on the debt. What the government pays in interest depends on market interest rates as well as on the size and composition of the federal debt. Currently, low interest rates have held net interest payments as a percentage of GDP below the historical average despite increases in borrowing to finance the debt.33 Some economists, however, have expressed concern that federal interest costs could rise once the economy fully recovers, resulting in future strain on the budget. Interest rates are projected to gradually rise in the CBO baseline, resulting in net interest payments of $830 billion (3.0% of GDP) in FY2026. If interest costs rise to this level, they will be higher than the historical average. Limit your response to presenting information contained within the text provided above - You are not permitted to use external resources. What actually is the federal debt?	Limit your response to presenting information contained within the text provided above - You are not permitted to use external resources. EVIDENCE: Deficits, Debt, and Interest The annual differences between revenue (i.e., taxes and fees) that the government collects and outlays (i.e., spending) result in the budget deficit (or surplus). Annual budget deficits or surpluses determine, over time, the level of publicly held federal debt and affect the level of interest payments to finance the debt. Budget Deficits Between FY2009 and FY2012, annual budgets as a percentage of GDP were sharply higher than deficits in any period since FY1945.27 The unified budget deficit in FY2015 was $439 billion, or 2.5% of GDP—the lowest level since FY2007. The unified deficit, according to some budget experts, gives an incomplete view of the government’s fiscal conditions because it includes off- budget surpluses.28 Excluding off-budget items (Social Security benefits paid net of Social Security payroll taxes collected and the U.S. Postal Service’s net balance), the on-budget FY2015 federal deficit was $466 billion. Budget Deficit for FY2016 The January 2016 CBO baseline estimated the FY2016 budget deficit at $544 billion, or 2.9% of GDP. The rise in the estimated budget deficit for FY2016 is the result of increases in spending more than offsetting a smaller rise in revenues. FY2016 outlays are projected to increase to 21.2% of GDP, up from 20.7% of GDP in FY2015; revenues are projected to increase from 18.2% of GDP to 18.3% of GDP over the same period. Federal Debt and Debt Limit Gross federal debt is composed of debt held by the public and intragovernmental debt. Intragovernmental debt is the amount owed by the federal government to other federal agencies, to be paid by the Department of the Treasury, which mostly consists of money contained in trust funds. Debt held by the public is the total amount the federal government has borrowed from the public and remains outstanding. This measure is generally considered to be the most relevant in macroeconomic terms because it is the debt sold in credit markets. Changes in debt held by the public generally track the movements of the annual unified deficits and surpluses.29 Historically, Congress has set a ceiling on federal debt through a legislatively established limit. The debt limit also imposes a form of fiscal accountability that compels Congress, in the form of a vote authorizing a debt limit increase, and the President, by signing the legislation, to take visible action to allow further federal borrowing when nearing the statutory limit. The debt limit by itself has no effect on the borrowing needs of the government.30 The debt limit, however, can hinder the Treasury’s ability to manage the federal government’s finances when the amount of federal debt approaches this ceiling, or when the suspension expires. In those instances, the Treasury has had to take extraordinary measures to meet federal obligations, leading to inconvenience and uncertainty in Treasury operations at times.31 At the end of CY2015 (December 31, 2015), federal debt subject to limit was approximately $18.922 trillion, of which $13.673 trillion was held by the public.32 The debt limit is currently suspended until March 15, 2017. Upon reinstatement, the debt limit will be modified to exactly accommodate any increases in statutory debt subject to limit above the previous limit ($18.1 trillion). At the end of calendar year 2015, total debt subject to limit was $18.9 trillion. Barring advanced legislative action, the debt limit will be reached when reinstated, so long as federal debt remains above the previous limit and continues to rise. Net Interest In FY2015, the United States spent $223 billion, or 1.3% of GDP, on net interest payments on the debt. What the government pays in interest depends on market interest rates as well as on the size and composition of the federal debt. Currently, low interest rates have held net interest payments as a percentage of GDP below the historical average despite increases in borrowing to finance the debt.33 Some economists, however, have expressed concern that federal interest costs could rise once the economy fully recovers, resulting in future strain on the budget. Interest rates are projected to gradually rise in the CBO baseline, resulting in net interest payments of $830 billion (3.0% of GDP) in FY2026. If interest costs rise to this level, they will be higher than the historical average. USER: What actually is the federal debt? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	21	6	699	null	251
Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]	What are some frequent difficulties that Finance and Accounting (F&A) teams face when dealing with period-end close task? Please provide solutions in bold font.	Why Is Year-End Close Important? This form of annual reporting stands as a resource for organizations when establishing budget, long-term, and short-term goals. With this financial data, organizational leaders can make informed decisions to greatly benefit their company – but it all starts with accurate reporting. There are multiple aspects of year-end close that must be considered when finalizing your company’s financial assets at the end of the fiscal year. The year-end close process includes: Adhering to legal/government regulations Modifying journal entries Preparing financial statements Balancing accounts When accountants have these benchmarks in mind, they can enjoy several benefits associated with a successful year-end close. Benefits of a Successful Year-End Close The year-end close process can help organizations improve and optimize their operations in several ways – not only can it identify areas for improvement throughout the financial process, but it also helps decision-makers determine areas to allocate resources. This ultimately enhances the overall financial performance of the entire business. Accuracy & Compliance The year-end close process ultimately confirms the accuracy of an organization’s financial reporting for the entire fiscal year – giving leaders and decision makers a crystal-clear view of the business’s financial performance and health. Financial data is verified, and accounts are reconciled during this process, ensuring that the company is complying with accounting standards and regulations. Decision-Making & Planning As we’ve discussed, the year-end close process is essential for future financial planning and budgeting. This level of reporting allows leadership to make informed decisions based on reliable data – highlighting potential problems, trends, and areas primed for growth - a huge help when planning for the next year. Now that you know why year-end close is critical for your company, do you know how to do it properly? Let’s talk about it. Best Practices for Year-End Close Businesses must keep accurate financial reporting data for proper planning and decision making, but the year-end close process is known to be both time-consuming and complicated. Lucky for you, BlackLine is on your side - and we’ve listed out the most important steps to take during your year-end close process: Prepare In Advance They say preparation is the key to success, and when we’re talking about closing your financial records at the end of the fiscal year, they couldn’t be more correct. If you operate throughout the year with your year-end close process in mind, you can save a lot of time and stress come the end of Q4. As you manage your financial data throughout the year, keep these tasks in mind: Understanding applicable tax deadlines and implications Analyzing your organization’s tax duties Auditing and verifying financial data (which you should have been doing every step of the way) Taking advantage of the applicable tax credits and tax deductions Analyze Your Company’s Finances Now that you’ve been keeping accurate records and a close eye on your company’s financial data for the entirety of the fiscal year, it’s time to conduct an in-depth financial review. This review should consist of the following tasks: Analyzing revenue and expenses Evaluating asset and liability statements (receivables, payables, loans, and inventory) Discovering and correcting anomalies Through this detailed financial analysis, you will be empowered to identify opportunities for growth and savings in the next year, as well as fix inconsistencies that arise in your organization’s liability and asset accounts before you prepare your financial statements.	Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. What are some frequent difficulties that Finance and Accounting (F&A) teams face when dealing with period-end close task? Please provide solutions in bold font. Why Is Year-End Close Important? This form of annual reporting stands as a resource for organizations when establishing budget, long-term, and short-term goals. With this financial data, organizational leaders can make informed decisions to greatly benefit their company – but it all starts with accurate reporting. There are multiple aspects of year-end close that must be considered when finalizing your company’s financial assets at the end of the fiscal year. The year-end close process includes: Adhering to legal/government regulations Modifying journal entries Preparing financial statements Balancing accounts When accountants have these benchmarks in mind, they can enjoy several benefits associated with a successful year-end close. Benefits of a Successful Year-End Close The year-end close process can help organizations improve and optimize their operations in several ways – not only can it identify areas for improvement throughout the financial process, but it also helps decision-makers determine areas to allocate resources. This ultimately enhances the overall financial performance of the entire business. Accuracy & Compliance The year-end close process ultimately confirms the accuracy of an organization’s financial reporting for the entire fiscal year – giving leaders and decision makers a crystal-clear view of the business’s financial performance and health. Financial data is verified, and accounts are reconciled during this process, ensuring that the company is complying with accounting standards and regulations. Decision-Making & Planning As we’ve discussed, the year-end close process is essential for future financial planning and budgeting. This level of reporting allows leadership to make informed decisions based on reliable data – highlighting potential problems, trends, and areas primed for growth - a huge help when planning for the next year. Now that you know why year-end close is critical for your company, do you know how to do it properly? Let’s talk about it. Best Practices for Year-End Close Businesses must keep accurate financial reporting data for proper planning and decision making, but the year-end close process is known to be both time-consuming and complicated. Lucky for you, BlackLine is on your side - and we’ve listed out the most important steps to take during your year-end close process: Prepare In Advance They say preparation is the key to success, and when we’re talking about closing your financial records at the end of the fiscal year, they couldn’t be more correct. If you operate throughout the year with your year-end close process in mind, you can save a lot of time and stress come the end of Q4. As you manage your financial data throughout the year, keep these tasks in mind: Understanding applicable tax deadlines and implications Analyzing your organization’s tax duties Auditing and verifying financial data (which you should have been doing every step of the way) Taking advantage of the applicable tax credits and tax deductions Analyze Your Company’s Finances Now that you’ve been keeping accurate records and a close eye on your company’s financial data for the entirety of the fiscal year, it’s time to conduct an in-depth financial review. This review should consist of the following tasks: Analyzing revenue and expenses Evaluating asset and liability statements (receivables, payables, loans, and inventory) Discovering and correcting anomalies Through this detailed financial analysis, you will be empowered to identify opportunities for growth and savings in the next year, as well as fix inconsistencies that arise in your organization’s liability and asset accounts before you prepare your financial statements. https://www.blackline.com/blog/closing-the-books-best-practices-for-year-end-close/	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: Why Is Year-End Close Important? This form of annual reporting stands as a resource for organizations when establishing budget, long-term, and short-term goals. With this financial data, organizational leaders can make informed decisions to greatly benefit their company – but it all starts with accurate reporting. There are multiple aspects of year-end close that must be considered when finalizing your company’s financial assets at the end of the fiscal year. The year-end close process includes: Adhering to legal/government regulations Modifying journal entries Preparing financial statements Balancing accounts When accountants have these benchmarks in mind, they can enjoy several benefits associated with a successful year-end close. Benefits of a Successful Year-End Close The year-end close process can help organizations improve and optimize their operations in several ways – not only can it identify areas for improvement throughout the financial process, but it also helps decision-makers determine areas to allocate resources. This ultimately enhances the overall financial performance of the entire business. Accuracy & Compliance The year-end close process ultimately confirms the accuracy of an organization’s financial reporting for the entire fiscal year – giving leaders and decision makers a crystal-clear view of the business’s financial performance and health. Financial data is verified, and accounts are reconciled during this process, ensuring that the company is complying with accounting standards and regulations. Decision-Making & Planning As we’ve discussed, the year-end close process is essential for future financial planning and budgeting. This level of reporting allows leadership to make informed decisions based on reliable data – highlighting potential problems, trends, and areas primed for growth - a huge help when planning for the next year. Now that you know why year-end close is critical for your company, do you know how to do it properly? Let’s talk about it. Best Practices for Year-End Close Businesses must keep accurate financial reporting data for proper planning and decision making, but the year-end close process is known to be both time-consuming and complicated. Lucky for you, BlackLine is on your side - and we’ve listed out the most important steps to take during your year-end close process: Prepare In Advance They say preparation is the key to success, and when we’re talking about closing your financial records at the end of the fiscal year, they couldn’t be more correct. If you operate throughout the year with your year-end close process in mind, you can save a lot of time and stress come the end of Q4. As you manage your financial data throughout the year, keep these tasks in mind: Understanding applicable tax deadlines and implications Analyzing your organization’s tax duties Auditing and verifying financial data (which you should have been doing every step of the way) Taking advantage of the applicable tax credits and tax deductions Analyze Your Company’s Finances Now that you’ve been keeping accurate records and a close eye on your company’s financial data for the entirety of the fiscal year, it’s time to conduct an in-depth financial review. This review should consist of the following tasks: Analyzing revenue and expenses Evaluating asset and liability statements (receivables, payables, loans, and inventory) Discovering and correcting anomalies Through this detailed financial analysis, you will be empowered to identify opportunities for growth and savings in the next year, as well as fix inconsistencies that arise in your organization’s liability and asset accounts before you prepare your financial statements. USER: What are some frequent difficulties that Finance and Accounting (F&A) teams face when dealing with period-end close task? Please provide solutions in bold font. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	24	24	561	null	809
Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here.	What are some effects of overexposure to glucocorticoids?	5756Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Adult & Aging Brain 8Adult & Aging Brain8 memory, which requires a high degree of synaptic plasticity. The loss of thin dendritic spines could impair neuro- nal communication and contribute to cognitive decline. So far, direct evidence of their role in cognitive decline is lacking, and more studies are needed. Finally, the formation of new neurons also declines with age. Although neurogenesis was once believed to halt after birth, we now know of two brain regions that con- tinue to add new neurons through- out life: the olfactory bulbs and the dentate gyrus of the hippocampus. Studies suggest that the rate of neu- rogenesis plummets with age in mice, but recent human studies suggest a more modest decline. It is not yet clear whether neurogenesis apprecia- bly affects cognition in the aging hu- man brain, but mouse studies indicate that strategies that boost neurogenesis can enhance cognitive function. Chemical Changes The amount of neurotransmit- ters and the number of their recep- tors might also decline with age. Several studies have reported that less dopamine is synthesized in the aged brain, and there are fewer re- ceptors to bind the neurotransmitter. Less robust evidence indicates that the amount of serotonin might also decline with age. WHY DOES THE BRAIN AGE? From cortical thinning to the loss of dendritic spines, you’ve seen how the brain ages. But what causes these changes? Many different theories have been advanced to explain why neurons, and cells in general, age. One possibility is that changes in gene expression play a role. Researchers have found that genes important for synaptic plasticity are expressed less in the brains of older people than in the brains of younger adults. The underexpressed genes also showed more signs of damage. Oxidative Stress and DNA Damage DNA damage that accumulates over a lifetime could contribute to aging processes throughout the brain and body, and DNA damage due to oxidative stress has received a great deal of attention. Every cell in your body contains organelles called mitochondria, which function a bit like cellular power plants, carrying out chemical reactions that provide energy for cell use. Some of these metabolic reactions produce harmful byproducts called free radicals, highly reactive molecules which, if left un- checked, can destroy fats and proteins vital to normal cell function and can damage DNA as well. Your body has natural defense mechanisms to neutralize free radi- cals. Unfortunately, these mechanisms decline with age, leaving aging tissues more vulnerable to oxidative damage by the free radicals. Studies of brain cells have shown that damage to their mitochondrial DNA accumulates with age. In addition, the brains of people with mild cognitive impairment and Alzheimer’s disease show more signs of oxidative damage than the brains of healthy people. Studies in rodents also link increased oxidative damage to memory impairments. Your brain is one of the most metabolically active organs, demand- ing around 20 percent of the body’s fuel. Its enormous energy require- ments might make the brain even more vulnerable than other tissues to the metabolic changes that occur in aging. While the brain’s energy demands remain high, its energy supply can no longer keep pace; the brain’s ability to take up and use glu- cose diminishes and mitochondrial metabolism declines. Immune Dysfunction Immune dysfunction often occurs in conjunction with the metabolic changes seen in aging. Microglia, the brain’s resident immune cells, per- form many important jobs: defending against pathogens, cleaning up cellular debris, and helping maintain and re- model synapses. These inflammatory responses are protective, but a pro- longed inflammatory state is harmful to brain health. Microglia become more reactive with age, increasing the inflammatory response in the brain while also damping production of helpful anti-inflammatory molecules. Mouse studies suggest that excessive microglial activity also contributes to cognitive impairments. Impaired Protein Recycling We know that excessive buildup of abnormal proteins in the brain contributes to age-related neurode- generative diseases like Alzheimer’s and Parkinson’s. Buildup of proteins and other cell components can also contribute to cellular degeneration in the healthy brain. Cells normally break down and recycle damaged proteins and molecules, using a pro- cess that is usually efficient but not perfect. Over time, damaged mole- cules can build up in cells and prevent them from functioning normally. Because neurons in the brain are not replaced as often as cells in other parts of the body (for example, bone marrow, intestinal lining, hair folli- cles), brain cells might be even more vulnerable to this buildup of damaged molecules. Also, the cellular ma- chinery involved in breakdown and recycling processes degrades with age, reducing the efficiency of the “waste removal” systems. Finally, remember that changes in the aging brain occur within the context of other changes throughout the body. Researchers speculate that worsening cardiovascular health, for example, could contribute to, or even drive, many changes seen in the aging brain. HEALTHY AGING We have learned how the brain changes with age and why these changes can occur. Now let’s turn our attention to a growing field in neuroscience that explores ways to slow these changes and preserve healthy brain function. Diet and Exercise Strong evidence now suggests that habits and choices that keep your body healthy also benefit your mind. Poor cardiovascular health puts a person at increased risk of age-related cognitive impairment. Diets rich in vegetables, fruits, and whole grains, and low in meat and dairy products, can reduce cardiovascular risk factors linked to cognitive impairment, such as high blood pressure and high levels of LDL cholesterol. Indeed, observa- tional studies have found that people who follow plant-rich diets such as the Mediterranean diet or Dietary Approaches to Stop Hypertension (DASH) are less likely to develop cognitive decline and dementia. Specific nutrients have been linked to improved cognitive performance and lower rates of dementia. Anti- oxidants, such as vitamins C and E, flavonoids, and omega-3 fatty acids have received considerable attention, with observational studies showing that high dietary intake of these compounds is beneficial. However, the results of lifestyle intervention studies using supplements have been more mixed. Finally, caloric restriction — substantially reducing the number of calories eaten without leading to malnutrition — has been linked to Many different theories have been advanced to explain why neurons, and cells in general, age. Synapses begin to weaken as a person ages, which can contribute to normal cognitive decline. Brain Facts society for neuroscience\| Adult & Aging Brain85958 improved cognitive health as well as a longer lifespan. Growing evidence shows that aerobic exercise can improve cognitive function and offset some of the de- clines seen in aging. Numerous studies have found that people who engage in regular physical activity show improved learning, improved mem- ory, and a reduced risk of developing dementia. Physical activity might even slow the progression of Alzheimer’s disease and dementia, and higher levels of physical activity have been linked to improvements in some markers of structural brain health, such as reduced cortical thinning and less shrinkage in the hippocampus. Exercise exerts its neuroprotec- tive effects in the brain by improving neuroplasticity — the brain’s ability to form and reorganize connections be- tween neurons in response to changes in behavior and environment. Scien- tists also believe that exercise increases neurogenesis (the formation of new nerve cells) which, in turn, enhances neuroplasticity. Evidence from rodent studies confirms that exercise increases neurogenesis: Older mice allowed to run on a wheel have higher rates of neurogenesis in the hippocampus than sedentary mice, and they perform bet- ter on learning and memory tests. Ex- ercise can also improve blood flow and increase production of neurotrophic factors that support new neurons and synapses. For humans, starting exercise later in life can be beneficial, but the studies suggest that adopting an exer- cise program earlier in life could yield even more neuroprotective benefits. Mental Stimulation and Social Networks Mental stimulation and large so- cial networks can also improve cogni- tive function in aging. In lab studies, mice housed in cognitively stimulat- ing environments with many oppor- tunities for social interaction perform better on learning and memory tests as they age compared to mice housed in standard cages. Much like physical exercise, cognitive stimulation appears to enhance neuroplasticity by increas- ing neurogenesis and boosting levels of important neurotrophic factors. People who perform cognitive- ly-demanding work or engage in stimulating activities such as reading, solving puzzles, or playing a musical instrument have lower rates of cog- nitive decline with aging. An active social life has also been shown to be beneficial for cognition as we age. Neuroscientists have learned a lot about the aging brain — how it changes, why it changes, and how to maintain healthy cognitive func- tioning as we age. Even so, many questions remain. Answers to those questions could identify new strate- gies for protecting the brain, not only in our later years, but throughout our lives. Exercise has been shown to increase neurogenesis in the adult brain, and can slow the cognitive decline associated with aging. iStock.com/artyme83. Have you ever considered the ups and downs that occur during your day? Speaking literally, you are up and awake during the day and lying down sleeping at night. Speaking figuratively, ups and downs could mean that you experi- ence periods of elevated alertness and arousal compared with your mood when you are tired or relaxed. Asleep, awake, aroused, and relaxed are different brain states, meaning that the brain’s activity is different during each of these peri- ods. Scientists have looked deep inside the brain to understand what sleep is and how rest differs from being alert. This research is especially important for people like doctors, pilots, and shift workers who sometimes must focus and make important decisions with very little sleep. Research on brain states can also help people who have disorders of sleep, attention, and learning. SLEEP How many hours of sleep do you get every night? Most people spend one-third of their lives asleep. While that might appear to be a lot of time spent doing nothing, our brains are active while we rest each night. The activity in our brains during sleep is important for brain health and for solidifying memories. Most people feel tired and un- able to focus if they don’t get enough sleep. In some cases, too little sleep can impair a person’s driving as much as drinking alcohol. The long-term ef- fects of lacking sleep also involve many health risks. Several studies in humans have revealed that sleep-deprived people are at increased risk for a wide range of health issues including diabe- tes, stress, obesity, high blood pres- sure, anxiety, cognitive impairment, and depression. CHAPTER Brain States 9 Brain Facts 6160Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Brain States 9Brain States9 Brain Activity During Sleep Scientists can measure the brain’s electrical activity using electroenceph- alography (EEG). Electrodes attached to the scalp detect and record the net electrical activity of hundreds of thou- sands of cortical nerve cells. When a neuron is active, ions move in and out of the cell, altering the electrical charge across the cell membrane. An EEG de- tects the net electrical charge produced when neurons increase and decrease their activity as a group, in synchrony. The results are “brain waves” — the cyclic rising and falling of brain activ- ity that can be important indicators of brain function. In sleep studies, scien- tists now recognize two main states: slow wave sleep (SWS) and rapid eye movement sleep (REM). SWS gets its name from the high amplitude, low frequency, brain waves in EEG recordings. The high amplitude of slow waves indicates that many cortical neu- rons are switching their activity in a synchronized way from a depolarized (more excitable) state to a hyperpo- larized (less excitable) state and back again. These slow waves appear to be important to sleep function — the longer a person stays awake, the more slow waves they will experience during the SWS state. Slow waves become less frequent the longer the person is asleep. If awakened during SWS, most people recall only frag- mented thoughts, not active dreams. Have you ever seen a cat dream- ing — twitching its whiskers or paws while it sleeps? Dreaming happens mainly during REM sleep, which takes its name from the periodic rapid eye movements people make in this state. Brain activity recorded during REM looks very similar to EEGs recorded while awake. EEG waves during REM sleep have much lower amplitudes than the SWS slow waves, because neuron activity is less synchronized — some nerve cells depolarize while others hyperpolarize, and the “sum” of their electrical states is less positive (or negative) than if they acted in synchro- ny. Paradoxically, the fast, waking-like EEG activity during REM sleep is ac- companied by atonia, a loss of muscle tone causing the body to become tem- porarily paralyzed. The only muscles remaining active are those that enable breathing and control eye movements. Oddly enough, the neurons of our motor cortex fire as rapidly during REM sleep as they do during waking movement — a fact that explains why movements like a kitten’s twitching paws can coincide with dreams. During the night, periods of SWS and REM sleep alternate in 90-minute cycles with 75–80 minutes of SWS followed by 10–15 minutes of REM sleep. This cycle repeats, typically with deeper and longer peri- ods of REM sleep towards morning. To study sleep disorders, researchers often use mice that have sleep struc- tures qualitatively very similar to hu- mans; however, rodents have shorter This chart shows the brain waves of an individual being recorded by an EEG machine during a night’s sleep. As the person falls asleep, the brain waves slow down and become larger. Throughout the night, the individual cycles though sleep stages, including REM sleep, where brain activity is similar to wakefulness. and more frequent sleep episodes lasting 3–30 minutes (sometimes lon- ger). Rodents also sleep more during the day and are more active at night. Compare that to human adults, who are typically more active during the day and have one sleep episode at night lasting about 8 hours. Sleep Regulation How does the brain keep us awake? Wakefulness is main- tained by the brain’s arousal systems, each regulating different aspects of the awake state. Many arousal systems are in the upper brainstem, where neurons connecting with the forebrain use the neurotransmitters acetylcholine, norepinephrine, serotonin, and glutamate to keep us awake. Orexin- producing neurons, located in the hypothalamus, send projections to the brainstem and spinal cord, the thala- mus and basal ganglia, as well as to the forebrain, the amygdala, and dopa- mine-producing neurons. In studies of rats and monkeys, orexin appears to exert excitatory effects on other arousal systems. Orexins (there are two types, both small neuropeptides) increase metabolic rate, and their production can be activated by insulin-induced low blood sugar. Thus, they are involved in energy metabolism. Given these functions, it comes as no surprise that orexin-producing neurons are important for preventing a sudden transition to sleep; their loss causes narcolepsy, as described below. Orexin neurons also connect to hypothalamic neurons containing the neurotransmit- ter histamine, which plays a role in staying awake. The balance of neurotransmitters in the brain is critically important for maintaining certain brain states. For example, the balance of acetylcholine and norepinephrine can affect wheth- er we are awake (high acetylcholine and norepinephrine) or in SWS (low acetylcholine and norepinephrine). During REM, norepinephrine re- mains low while acetylcholine is high, activating the thalamus and neocortex enough for dreaming to occur; in this brain state, forebrain excitation without external sensory stimuli pro- duces dreams. The forebrain becomes excited by signals from the REM sleep generator (special brainstem neurons), leading to rapid eye move- ments and suppression of muscle tone — hallmark signs of REM. During SWS, the brain systems that keep us awake are actively sup- pressed. This active suppression of arousal systems is caused by the ven- trolateral preoptic (VLPO) nucleus, a group of nerve cells in the hypothala- mus. Cells in the VLPO release the in- hibitory neurotransmitters galanin and gamma-aminobutyric acid (GABA), which can suppress the arousal sys- tems. Damage to the VLPO nucleus causes irreversible insomnia. Sleep-Wake Cycle Two main factors drive your body to crave sleep: the time of day or night (circadian system) and how long you have been awake (homeostatic system). The homeostatic and circadian systems are separate and act independently. The circadian timing system is regulated by the suprachiasmatic nucleus, a small group of nerve cells in the hypothalamus that functions as a master clock. These cells express “clock proteins,” which go through a biochemical cycle of about 24 hours, setting the pace for daily cycles of activity, sleep, hormone release, and other bodily functions. The master clock neurons also receive input directly from the retina of the eye. Thus, light can reset the master clock, adjusting it to the outside world’s day/night cycle — this explains how your sleep cycles can shift when you change time zones during travel. In addition, the suprachiasmatic nucleus sends signals through different brain regions, eventually contacting the VLPO and the orexin neurons in the lateral hypothalamus, which directly regulate arousal. What happens in the brain when we don’t get enough sleep? The second system that regulates sleepiness is the The balance of neurotransmitters in the brain is critically important for maintaining certain brain states. 6362Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Brain States 9Brain States9 homeostatic system, which makes you feel sleepy if you stay awake longer than usual. One important sleep factor is a chemical in the brain called adenosine. When you stay awake for a long time, adenosine levels in the brain increase. The increased ade- nosine binds to specific receptors on nerve cells in arousal centers to slow cellular activity and reduce arousal. Adenosine can increase the number of slow waves during SWS. As you get more sleep, adenosine levels fall and slow waves decrease in number. Caf- feine acts as a stimulant by binding to adenosine receptors throughout the brain and preventing their interaction with adenosine. As a result, in the presence of caffeine, fewer receptors are available for the slowing influence of adenosine. People often say they need to “catch up on sleep.” But can you really make up for lost sleep? Normally, the homeostatic and circadian systems act in a complementary fashion to produce a normal 24-hour cycle of sleep and wakefulness. Nonetheless, activating the brain’s arousal system can keep us awake even after a long pe- riod of wakefulness — for example, a late-night study session to prepare for an important exam. In normal circum- stances, the homeostatic system will respond to the loss of sleep by increas- ing the duration of ensuing sleep and increasing the number of slow waves during the SWS episodes. As noted above, this rebound slow wave activity correlates with the previous time spent awake and is mediated by adenosine. Sleep Disorders The most common sleep disorder, and the one most people are familiar with, is insomnia. Some people with insomnia have difficulty falling asleep initially; others fall asleep, then awak- en part way through the night and can’t fall back asleep. Several common disorders, listed below, disrupt sleep and prevent people from getting an adequate amount of sleep. Daytime sleepiness (not narcolep- sy), characterized by excessive feelings of tiredness during the day, has many causes including sleep apnea (see be- low). Increased daytime sleepiness can increase the risk of daytime accidents, especially car accidents. Sleep apnea occurs when the air- way muscles of the throat relax during sleep, to the point of collapse, closing the airway. People with sleep apnea have difficulty breathing and wake up without entering the deeper stages of SWS. This condition can cause high blood pressure and may increase the risk of heart attack. Treatments for sleep apnea focus on reducing airway collapse during sleep; simple changes that may help include losing weight, avoiding alcohol or sedating drugs prior to sleep, and avoiding sleeping on one’s back. However, most people with sleep apnea require breathing machines to keep their airway open. One such device, called a continuous positive airway pressure or “CPAP” machine, uses a small mask that fits over the nose to provide an airstream under pressure during sleep. In some cases, people need surgery to correct their airway anatomy. REM sleep behavior disorder occurs when nerve pathways in the brain that prevent muscle movement during REM sleep do not work. Remember that dreaming happens during REM sleep, so imagine people literally acting out their dreams by getting up and moving around. This can be very disruptive to a normal night’s sleep. The cause of REM be- havior disorder is unknown, but it is more common in people with degen- erative neural disease such as Parkin- son’s, stroke, and types of dementia. The disorder can be treated with drugs for Parkinson’s or with a ben- zodiazepine drug, clonazepam, which enhances the effects of the inhibitory neurotransmitter GABA. FPO Electroencephalography measures brain activity through sensors placed on the head. It can record how the brain reacts to all kinds of stimuli and activities, including sleep. Simon Fraser University. Narcolepsy: An Example of Sleep Disorder Research Narcolepsy is a relatively uncommon sleep disorder — only 1 case per 2,000 people in the United States — in which the brain lacks the special neurons that help control the transition into sleep, so that the regular cycling is disrupted. People with narcolepsy have sleep attacks during the day, causing them to suddenly fall asleep, which is especially dangerous if they are driving. The problem is caused by the loss of orexin neurons in the lateral hypothalamus. People with narcolep- sy tend to enter REM sleep very quickly and may even enter a dream- ing state while still partially awake, a condition known as hypnagogic hallucination. Some people with narcolepsy also have attacks in which they lose muscle tone — similar to what happens in REM sleep, but while they’re awake. These attacks of paralysis, known as cataplexy, can be triggered by emotional experiences and even by hearing a funny joke. Recent research into the mech- anisms of narcolepsy has provided important insights into the processes that control the mysterious transitions between waking, slow wave sleep, and REM sleep states. Orexin (in the lateral hypothalamus) is critical for preventing abnormal transitions into REM sleep during the day. In one study, scientists inactivated the gene for orexin in mice and measured their sleep patterns. They found that mice lacking the orexin gene showed symp- toms of narcolepsy. Similarly, humans with narcolepsy have abnormally low levels of orexin levels in their brain and spinal fluid. Because orexin levels are disrupt- ed in narcolepsy, scientists also began studying neurons that were neighbors to orexin neurons to see what hap- pened if the neighboring neurons were activated in narcoleptic mice. Those neurons contained melanin-concen- trating hormone, and stimulating them (using a technique called opto- genetics) induced sleep — opposite to the effect of stimulating orexin neu- rons. A balance between the activation of orexin neurons and their neighbor- ing neurons could control the tran- sition between waking and sleeping. These findings will be important in developing treatments for narcolepsy. AROUSAL Think about what happens in your body and mind when you speak in front of a crowd — your brain state is very different from when you are asleep. Perhaps you notice changes in your breathing, heart rate, or stomach. Maybe your thoughts are racing or panicked. Or maybe you are energized and excited to perform for your audience. These are exam- ples of the complex brain state called arousal. Rather than merely being awake, arousal involves changes in the body and brain that provide motivations to do an action — teaching a class, speaking in public, or focusing your attention. People experience arousal daily when searching for food while hungry, or when talking with other people (social interaction). Arousal is also important for reproduction and for avoiding danger. The level of arousal varies across a spectrum from low to high. When arousal falls below a certain threshold we can transition from wake to sleep, for example. But under heightened arousal, like intense anxiety, we cannot reach this threshold and we stay awake. Neurotransmitters During arousal, the brain must de- vote resources to specific brain regions, much as an emergency call center redirects resources like ambulances and fire trucks during a fire. Specific types of neurons in the brain regions involved in arousal release multiple neurotransmitters, telling the rest of the brain and the body to be on alert. These neurotransmitters are dopamine (for movement), norepinephrine (for alertness), serotonin (for emotion), and acetylcholine and histamine, which help the brain communicate with the body to increase arousal. Sensory Input While neurotransmitters provide the internal signals for arousal, external signals from the outside world — like the bright lights (visual input) and cheering crowds (auditory input) at a stage performance — can also stimu- late arousal. Sensory input gets sorted in the brain region called the thala- mus. Often called a “sensory clearing house,” the thalamus regulates arous- al, receiving and processing sensory inputs from brain regions important in senses like vision and hearing and relaying these inputs to the cortex. Autonomic Nervous System Once the brain is aroused, what does the body do? The reticular activating system, in the brainstem, co- ordinates signals coming from sensory inputs and neurotransmitters to make sense of events in the brain and pass that information to the rest of the body. The reticular activating system specifically controls the autonomic nervous system, which affects heart rate, blood flow, and breathing. By controlling these automatic body pro- cesses, the reticular activating system 6564Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Brain States 9Brain States9 sets up the physical state of arousal, bringing important resources like oxy- gen and nutrients to parts of the body where they are needed. Together, the changes that happen in the brain and body during arous- al enable us to be alert and focused, which helps us process information quickly. Using this information, we can choose the appropriate emotional response or physical action for a given situation. Sexual Arousal Several complex brain systems and endocrine (hormone) systems contrib- ute to sexual arousal and behaviors, but the brain regions, neurotransmitters, and body systems are similar to those involved in general arousal. The dis- tinguishing factor is that sexual arousal also involves hormones such as estrogen and testosterone, which then activate neurons that release the same neu- rotransmitters that are released during general arousal. Many human and ani- mal studies report interactions between sex hormones and neurotransmitters dopamine, serotonin, GABA, and glutamate. Researchers have also found that brain regions such as the hypo- thalamus, amygdala, and hippocampus contain many estrogen and progester- one receptors, and brain regions that mediate feelings of reward (nucleus accumbens) and emotions like pleasure (amygdala) motivate sexual behaviors. Overall, the primary involvement of sex hormones is a key in defining the brain state of sexual arousal. ATTENTION If you are paying attention right now, there should be detectable changes in your heart rate, breathing, and blood flow. If that sounds familiar, it’s because those same physiological changes occur during arousal, which is necessary for being alert and paying attention. As mentioned previously, the state of arousal calls for reactions to the environment. To make deci- sions about what to do, you need to focus on what’s happening in the environment, especially involving anything relevant to your goals. For example, if your goal is to run away from an angry bear, you need to be alert and pay attention to where you’re running so you don’t trip and fall. Scientists have theorized that the state of arousal speeds processing and improves comprehension of environ- mental details. Otherwise, your brain would need an infinite amount of time and energy to process all of its sensory inputs (sounds, sights, smells, and other feelings), because the environment is always changing. Focus Even with multitasking, it is impossible for the brain to process all its sensory inputs. Instead, people focus their attention on one thing at a time. Attention is a fascinating abil- ity, because it enables you to have so much control and the ability to fine- tune your focus to different locations, times, and topics. Consider the page you are reading right now. Although you can see the whole page, you focus on only one line at a time. Alterna- tively, you can turn your attention to the past — just minutes ago when you were reading about arousal. Or you can ignore the sentences alto- gether and focus on the number of times the word “you” occurs on this page. Scientists recognize two types of attention, which involve different brain processes: voluntary (endog- enous) attention and involuntary (exogenous) attention. Voluntary attention happens when you choose what to focus on — like finding a loved one in a crowd. The frontal and parietal cortices of the brain are active when you control your attention or direct it towards a specific object or location. Involun- tary attention occurs when something in the environment (like a sudden noise or movement) grabs your atten- tion. Involuntary attention is a dis- traction from your chosen goals and, in fact, researchers often use distrac- tor objects in attention experiments. Distractors can be emotional, like pictures of family, or non-emotional images that stand out from other stimuli, like a red circle surrounded by gray squares. Brain regions in the right hemisphere, collectively known as the ventral frontoparietal network, form a system that processes new and interesting stimuli that distract you from the task at hand. Research on at- tention can help us understand visual tasks, learning, child development, and disorders of attention. Disorders of Attention Paying attention for long periods of time, such as a 3-hour lecture, can be difficult for many people. For some people, even focusing for a short time can be hard. Several disorders that affect the ability to pay attention are attention deficit hyperactivity disorder (ADHD), schizophrenia, prosopagnosia, and hemineglect syndrome. It may seem strange to regard schizophrenia as an attention disturbance, but some psychiatric studies suggest that it involves a failure of selective attention. Prosopagnosia, or face blindness, is a cognitive disorder in which a person is unable to recognize faces — even their own family members. The severity of this condition varies, and genetic factors might be involved. Attention disorders have various causes, but we will focus on hemineglect syndrome, caused by damage to the right parietal cortex, a brain region important in involuntary attention. Between 50–82 percent of pa- tients who suffer stroke in the right hemisphere experience hemineglect syndrome, also known as spatial ne- glect and unilateral neglect. In these cases, patients with neglect ignore the left side of their visual field. Some- times they ignore the left side of the body and the left side of individual objects, as well. Diagnosis of hemine- glect syndrome can be done with a pen and paper. For example, patients can be instructed to draw a copy of a picture like a butterfly or a castle, and those patients with hemineglect usually draw only the right half of the picture or leave out details of the left side. Research on patients with hemineglect syndrome contributes to our understanding of rehabilitation after stroke, as well as the role of the right parietal cortex in attention and perception. REST: DEFAULT MODE NETWORK What is the difference between being alert and resting while awake? During times of rest and relaxation, you’re usually avoiding heavy thinking or complicat- ed tasks, and parts of the brain called the default mode network are more active. You may think of the default mode network as a personal lullaby or a playlist that turns on when you are ready to relax. Activity of the default mode network decreases (the lullaby gets quieter) when you start doing or thinking about a demanding task. Human studies using imaging tech- niques such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) have identified which brain regions belong to the default mode network. These brain areas, which are involved in emotion, personality, introspection, and memory, include frontal brain regions (ventromedial prefrontal cortex, dorsomedial prefrontal cortex, and anterior cingulate cortex), as well as the posterior cingulate cortex, lateral parietal cortex, and precuneus. Although the exact role of the default mode network is unclear, the functions of its “participating” brain regions provide hints about its purpose. Studies on emotion have revealed that activity in the ventro- medial PFC is directly related to how anxious a subject feels while performing a task — suggesting that the default mode network may play a role in regulating emotion and mood. Activity in the dorsomedial PFC (a region involved in self-referential or introspective thoughts) increases when a person is at rest and day- dreaming. The dorsomedial PFC is also involved in stream-of-conscious- ness thoughts and thoughts about oneself in the past, present, or future (autobiographical self ). The roles of these regions suggest that the default mode network may also function in self-reflection and our sense of self in time. The posterior brain regions of the default mode network (posterior cin- gulate cortex, lateral parietal cortex, and precuneus) become more active when remembering concrete mem- ories from past experiences. These brain regions are connected with the hippocampus, which is important for learning and forming memories. Both the hippocampus and the default mode network are more active when a person is at rest in the evening and less active when waking up early in the day. These patterns indicate that the default mode network helps to process and remember the events of the day. Future studies using electrical re- cordings from inside the human brain can be paired with fMRI to tell us more about the brain activity patterns of the default mode network and how brain regions coordinate their activity during tasks that utilize the functions of this network. Scientists recognize two types of attention, which involve different brain processes: voluntary attention and involuntary attention. 67Brain Factssociety for neuroscience \| The Body in Balance 10 The cells of your body are immersed in a constantly changing environment. The nutrients that sustain them rise and fall with each meal. Gases, ions, and other solutes flow back and forth between your cells and blood. Chemicals bind to cells and trigger the building and re- lease of proteins. Your cells digest food, get rid of wastes, build new tissues, and destroy old cells. Environmental changes, both internal and external, ripple through your body’s physio- logical systems. One of your brain’s less-visible jobs is to cope with all these changes, keep them within a normal range, and maintain the healthy func- tions of your body. The tendency of your body’s tissues and organ systems to maintain a condi- tion of balance or equilibrium is called homeostasis. Homeostasis depends on active regulation, with dynamic adjustments that keep the environ- ment of your cells and tissues relatively constant. The brain is part of many homeostatic systems, providing signals that coordinate your body’s internal clocks and regulating hormone secre- tion by the endocrine system. These functions often involve a region of the forebrain called the hypothalamus. CIRCADIAN RHYTHMS Almost every cell in your body has an internal clock that tells it when to become active, when to rest, and when to divide. These clocks broker changes in many of the body’s physiological systems over a 24-hour, or circadian, period. For example, the clocks cause faster pulses of peristaltic waves in your gut during the day and make your blood pressure dip at night. But because these clocks are deep inside your body and cannot detect daylight, none of them can tell time CHAPTER The Body in Balance 10 on its own. Instead, daily rhythms are coordinated by the suprachiasmatic nucleus (SCN), a tiny group of neurons in the hypothalamus. Neurons in the SCN act like a met- ronome for the rest of the body, emit- ting a steady stream of action potentials during the day and becoming quiet at night. The shift between active and silent states is controlled by cyclic in- teractions between two sets of proteins encoded by your body’s “clock” genes. Researchers first identified clock genes in the fruit fly Drosophila melanogaster and studied how they keep time; since then, a nearly identical set of genes has been found in mammals. The SCN also tracks what time it is based on signals it receives from photoreceptors in the retina, which keeps its activity in sync with the Earth’s actual day/night cycle. That little nudge is very important be- cause, on their own, clock proteins take slightly more than 24 hours to complete a full cycle. Studies of animals deprived of light have discovered that they go to sleep and wake up a bit later each day. An autonomic neural pathway ties the daily rhythmic activity of the SCN directly to other clocks in the body. Neurons in the SCN stimulate an adjacent region of the brain called the paraventricular nucleus (PVN), which in turn sends signals down a chain of neurons through the spinal cord to the peripheral organs of the body. You’ve al- ready learned how signals in part of this neural pathway stimulate orexin neu- rons to regulate the body’s sleep/wake cycle. Related pathways also govern the secretion of melatonin, a hormone that influences sleep behaviors. Specifically, electrical activity originating in the SCN enters the PVN’s neural network and sends signals up to the pineal gland, a small pinecone-shaped gland embedded between the cerebral hemispheres. The pineal gland secretes melatonin into the bloodstream at night. Melatonin binds to cells in many tissues, and although it has no direct effect on clock gene expression in the SCN, its systemic effects seem to reduce alertness and increase sleepiness. Light exposure trig- gers signals that stop melatonin secre- tion, promoting wakeful behaviors. Together, these signals keep all the body’s clocks synchronized to the same 24-hour cycle. Coordinated body clocks enable your body’s physiological systems to work together at the right times. When your body prepares to wake from sleep, 1) levels of the stress hormone cortisol peak in the blood, releasing sugars from storage and increasing appetite, and 2) core body temperature begins to drift upwards, raising your body’s metabolic rate. These events, synchronized with others, prepare your body for a new day’s activity. Desynchronizing the body’s phys- iological clocks can cause noticeable and sometimes serious health effects. You might have experienced a familiar example of circadian rhythm distur- bance: jet lag. After crossing many time zones in a short time period, a person’s patterns of wakefulness and hunger are out of sync with day and night. Exposure to the local day/night cycle resets the brain and body, but it can take several days to get fully resynchro- nized. Circadian rhythms can also be disturbed by situations like late-shift jobs or blindness, which decouple nor- mal daylight signals from wake/sleep cycles. Long-term circadian disruptions are associated with health problems including weight gain, increased rates of insomnia, depression, and cancers. HORMONES, HOMEOSTASIS, AND BEHAVIOR Neurons can quickly deliver the brain’s messages to precise targets in the body. Hormones, on the other hand, deliver messages more slowly but can affect a larger set of tissues, producing large- scale changes in metabolism, growth, and behavior. The brain is one of the tissues that “listens” for hormonal signals — neurons throughout the brain are studded with hormone receptors — and the brain’s responses play an important part in regulating hormone secretion and changing behaviors to keep the body systems in Coordinated body clocks enable your body’s physiological systems to work together at the right times. Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| The Body in Balance 10The Body in Balance1068 equilibrium. The brain regions involved in hormone release are called the neuroendocrine system. The hypothalamus oversees the production and release of many hor- mones through its close ties to the pi- tuitary gland. The paraventricular and supraoptic nuclei of the hypothalamus send axons into the posterior part of the pituitary gland; activation of spe- cific neurons releases either vasopressin or oxytocin into capillaries within the pituitary. Both of these molecules act as neurotransmitters inside the brain, but they are also hormones that affect distant tissues of the body. Vasopressin (also called antidiuretic hormone) in- creases water retention in the kidneys and constricts blood vessels (vasocon- striction). Oxytocin promotes uterine contractions during labor and milk release during nursing. Other hypothalamic regions send axons to a capillary-rich area above the pituitary called the median eminence. When these neurons are activated, they release their hormones into the blood. These releasing (and inhibiting) hormones travel through local blood vessels to the anterior pituitary, where they trigger (or inhibit) secretion of a second specific hormone. Of the seven anterior pituitary hormones, five are trophic hormones — these travel in the bloodstream to stimulate activity in specific endocrine glands (thyroid, adrenal cortex, ovaries, etc.) throughout the body. The remaining two hormones act on non-endocrine tissues. Growth hormone stimulates the growth of bone and soft tissues, and prolactin stimulates milk produc- tion by the breasts. Hormones released from the anterior pituitary influence growth, cellular metabolism, emotion, and the physiology of reproduction, hunger, thirst, and stress. Many hormones produced by the pituitary and its target endocrine glands affect receptors inside the brain — thus, these hormones can alter neuronal function and gene transcrip- tion in the hypothalamus. The effect is to reduce the amount of hormone released by the hypothalamus when those circuits become active. These negative feedback loops enable precise doses of hormones to be delivered to body tissues, and ensure that the hor- mone levels are narrowly regulated. One of these three-hormone cascades regulates reproduction in mammals. Its underlying pattern is the same in both sexes: 1) gonadotropin- releasing hormone (GnRH) from the hypothalamus makes the anterior pi- tuitary release 2) luteinizing hormone (LH) and follicle stimulating hormone (FSH), which in turn make the gonads secrete 3) sex hormones and start the development of mature eggs or sperm. The neuroendocrine system maintains homeostasis, the body’s normal equilibrium, and controls the response to stress. The adrenal gland releases the stress hormones norepineph- rine, epinephrine, and cortisol, which quicken heart rate and prepare muscles for action. Corticotrophin releasing hormone (CRH) is released from the hypothalamus and travels to the pituitary gland, where it triggers the release of adrenocorticotropic hormone (ACTH). ACTH travels in the blood to the adrenal glands, where it stimulates the release of cortisol. 69 Sex hormones, in turn, attach to receptors in the hypothalamus and an- terior pituitary and modify the release of the hypothalamic and pituitary hormones. However, sex hormones regulate these feedback loops differ- ently in males and females. Male sex hormones induce simple negative feedback loops that reduce the secretion of gonadotropin-releas- ing hormone, luteinizing hormone, and follicle stimulating hormone. The interplay among these hormones creates a repetitive pulse of GnRH that peaks every 90 minutes. The waxing and wan- ing of GnRH keeps testosterone levels relatively steady within body tissues, maintains male libido, and keeps the testes producing new sperm each day. Female feedback patterns are more complex. Over the course of the month-long menstrual cycle, female sex hormones exert both positive and nega- tive feedback on GnRH, FSH, and LH. When circulating levels of the female sex hormones estrogen and progesterone are low, rising follicle stimulating hormone levels trigger egg maturation and estrogen production. Rising estrogen levels induce luteiniz- ing hormone levels to rise. As the levels of female sex hormones rise, they exert negative feedback on FSH secretion, limiting the number of eggs that ma- ture in a month, but positive feedback on LH, eventually producing the LH surge that triggers ovulation. After ovulation, high serum levels of sex hor- mones again exert negative feedback on GnRH, FSH, and LH which in turn reduces ovarian activity. Levels of fe- male sex hormones therefore decrease, allowing the cycle to start over again. Many other hormones are not regulated by the pituitary gland, but are released by specific tissues in response to physiological changes. The brain contains receptors for many of these hormones but, unlike pituitary hormones, it does not directly regulate their secretion. Instead, when these hormones bind to receptors on neu- rons, they modify the output of neural circuits, producing behavioral changes that have homeostatic effects. One example of this is a pair of hormones called leptin and ghrelin. Leptin and ghrelin change eating behavior by regulating food intake and energy balance. Both hormones affect hunger, and both are released in response to changes in an animal’s internal energy stores. However, they have different effects on the circuits they regulate. Ghrelin keeps the body fed. Released by the wall of the gastrointestinal tract when the stom- ach is empty, ghrelin activates hunger circuits in the hypothalamus that drive a search for food. Once the stomach is full, ghrelin production stops, reduc- ing the desire to eat. In contrast, leptin helps maintain body weight within a set range. Leptin is produced by fat cells and is released when fat stores are large. When it binds to neurons in the hypothalamus, leptin suppresses the activity of hunger circuits and reduces the desire to eat. As fat stores are used up, leptin levels decline, driving be- havior that makes an animal eat more often and replenish its fat stores. STRESS Your body reacts in stereotyped ways when you feel threatened. You breathe faster, your heartbeat speeds up, your muscles tense and prepare for action. These reactions may have helped our ancestors run from preda- tors, but any stressful situation — ar- guing with your parents, a blind date, a looming deadline at work, abdominal cramps, discovering your apartment was robbed, trying karaoke for the first time — has the potential to set them off. Scientists call this reaction the stress response, and your body turns it on to some degree in response to any external or internal threat to homeostasis. The Stress Response The stress response weaves togeth- er three of the brain’s parallel com- munication systems, coordinating the activity of voluntary and involuntary nervous systems, muscles, and metabo- lism to achieve one defensive goal. Messages sent to muscles through the somatic (voluntary) nervous system prime the body to fight or run from danger (the fight-or-flight response). Messages sent through the autonomic (involuntary) nervous system redirect nutrients and oxygen to those mus- cles. The sympathetic branch tells the adrenal medulla to release the hor- mone epinephrine (also called adren- aline), which makes the heart pump faster and relaxes the arterial walls that supply muscles with blood so they can respond more quickly. At the same time, the autonomic system’s parasym- pathetic branch restricts blood flow to other organs including the skin, gonads, digestive tract, and kidneys. Finally, a cascade of neuroendocrine hormones originating in the hypothal- amus and anterior pituitary circulates in the bloodstream, affecting processes like metabolic rate and sexual func- tion, and telling the adrenal cortex to release glucocorticoid hormones — like cortisol — into the blood. Glucocorticoid hormones bind to many body tissues and produce wide- spread effects that prepare the body to respond to potential threat. These hor- mones stimulate the production and release of sugar from storage sites such as the liver, making energy available to Brain Facts society for neuroscience\| The Body in Balance1070 muscles. They also bind to brain areas that ramp up attention and learning. And they help inhibit nonessential functions like growth and immune responses until the crisis ends. It’s easy to imagine how (and why) these physiological changes make your body alert and ready for action. But when it comes to stress, your body can’t tell the difference between the danger of facing down a bull elephant and the frustration of being stuck in traffic. When stress is chronic, whatever its cause, your adrenal glands keep pump- ing out epinephrine and glucocorti- coids. Many animal and human studies have shown that long-term exposure to these hormones can be detrimental. Chronic Stress Overexposure to glucocorticoids can damage a wide range of physiological systems. It can cause muscles to atrophy, push the body to store energy as fat, and keep blood sugar abnormal- ly high — all of these can worsen the symptoms of diabetes. Overexposure to glucocorticoids also contributes to the development of hypertension (high blood pressure) and atherosclerosis (hardening of the arteries), increasing the risk of heart attacks. Because the hormones inhibit immune system function, they also reduce resistance to infection and inflammation, some- times pushing the immune system to attack the body’s own tissues. Chronic stress can also have specif- ic negative effects on brain tissue and function. Persistently high levels of glucocorticoids inhibit neuron growth inside the hippocampus, impairing the normal processes of memory forma- tion and recall. Stress hormones can also suppress neural pathways that are normally active in decision-making and cognition, and speed the deteri- oration in brain function caused by aging. They may worsen the damage caused by a stroke. And they can lead to sleep disorders — cortisol is also an important wakeful signal in the brain, so the high cortisol levels due to chronic stress may delay sleep. Stress-induced insomnia can then start a vicious cycle, as the stress of sleep deprivation leads to the release of even more glucocorticoids. The effects of chronic stress may even extend beyond a single indi- vidual, because glucocorticoids play important roles in brain development. If a pregnant woman suffers from chronic stress, the elevated stress hor- mones can cross the placenta and shift the developmental trajectory of her fetus. Glucocorticoids are transcription factors, which can bind to DNA and modify which genes will be expressed as proteins. Studies with animal mod- els have shown that mothers with high blood levels of glucocorticoids during pregnancy often have babies with low- er birth weights, developmental delays, and more sensitive stress responses throughout their lives. Because metabolic stressors such as starvation induce high glucocorticoid levels, it’s been suggested that these hormones might help prepare the fetus for the environment it will be born into. Tough, stressful environments push fetuses to develop stress-sensitive “thrifty” metabolisms that store fat eas- ily. Unfortunately, these stress-sensitive metabolisms increase a person’s risk of developing chronic metabolic diseases like obesity or diabetes, especially if they subsequently grow up in lower-stress environments with plentiful food. The effects of stress can even be passed to subsequent generations by epigenetic mechanisms. Chronic stress can change the markers on DNA molecules that indicate which of the genes in a cell are expressed and which are silenced. Some animal studies indicate that when changes in markers occur in cells that develop into eggs or sperm, these changes can be passed on and expressed in the animal’s offspring. Further research might reveal wheth- er chronic stress has similar effects in humans, and whether inheriting silenced or activated genes contributes to family histories of cancer, obesity, cardiovascular, psychiatric, or neurode- velopmental disease. Chronic stress can also have specific negative effects on brain tissue and function. AUTISM SPECTRUM DISORDERS Autism is often considered a childhood condition, although many of its symptoms persist lifelong. Some people with autism also have mood and anxiety disorders, seizures, intellectual disability, attention deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD). However, more than 40 percent of people with autism have normal or above-average intelligence. With symptoms that range from mildly to severely disabling, autism is considered a spectrum. Autism spectrum disorders (ASD) are diagnosed based on two main criteria: impaired social commu- nication and interaction, and repetitive behaviors or narrow, obsessive inter- ests. For example, some people on the autism spectrum are unable to speak, while others are socially awkward but highly articulate. Many adults with an autism diagnosis think of their autism as a strength — enabling or motivating them to develop deep expertise in an area or a different perspective on the world — rather than a disorder that needs to be cured. Currently, 1 of every 68 American 8-year-olds is estimated to meet the diagnostic criteria for an autism spec- trum disorder. The prevalence of ASD has risen dramatically since the 1970s, but it is unclear whether changes to diagnostic criteria and wider recogni- tion of ASD have contributed to the increase in diagnoses. Four to five times more boys than girls are diagnosed with autism, although it is not clear whether some of that pattern is because of underdi- agnosis of girls. Environmental factors such as parents having children later in life, fever and infection during preg- nancy, and premature birth have been CHAPTER Childhood Disorders 11 71Brain Facts 7372Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Childhood Disorders 11Childhood Disorders11 linked to an increased risk of autism in children. A huge number of studies have found no connection between childhood vaccination and the increase in autism diagnoses. Autism is believed to be at least partially driven by genetics, but how do scientists know that for sure? One low-tech approach uses twin studies: If one of a pair of identical twins receives an autism diagnosis, the other twin has greater than a 50 percent chance of also being diagnosed with ASD. Children who have an older sibling on the spectrum also have a higher likelihood of being diagnosed with autism — nearly one in five also receives a diagnosis of ASD. The genetics of autism is very complicated in most cases, involving dozens (or more) of genes, leading to a unique condition in nearly every person. Recently, however, high-throughput genomic analyses have broadened the pool of potential genes, revealed their roles in the body, and suggested possible new therapies. It appears that many genes, each with a small effect, contribute to the inheritance of most ASDs. But such small effects make these genes hard to identify in genome-wide association studies. Scientists are now looking at the rare variants associated with ASD. These afflict fewer people with ASD, but their effects are larger and easier to detect. Some of these rare mutations are in single genes whose impairment is already known to cause intellectu- al disability and social dysfunction. These genes include FMR1 (codes for fragile X mental retardation protein, but its non-mutant form is needed for normal cognitive development); PTEN (codes for a tumor suppressor enzyme that regulates cell division, so cells don’t divide or grow too fast); and TSC1 or TSC2 (tuberous sclerosis complex 1 and 2), which also code for proteins that help control cell growth and size. Between 50 to 60 percent of people with fragile X syndrome and approximately 40 percent of people with tuberous sclerosis complex have ASD. Children with a variant of the gene NF-1 develop tumors in child- hood (neurofibromatosis) and a 2011 study found that nearly 10 percent met the criteria for autism. Intriguingly, these ASD-related genes influence a major signaling pathway for regulating cell metabo- lism, growth, and proliferation, the mTOR pathway. This suggests a very real potential for treating autism with drugs that target the mTOR pathway. For example, mouse models with mutations in PTEN show traits simi- lar to humans with these gene vari- ants: altered sociability, anxiety, and repetitive behaviors. These behaviors can be relieved or reversed by drugs that inhibit the mTOR pathway. Clinical trials of these drugs (rapamy- cin and lovastatin) are underway. Despite this progress, autism genetics is so complicated that it can’t be used to diagnose the condition. And unlike diabetes, kidney disease, or thyroid disease, there are no biochem- ical or other biomarkers of autism. Currently, autism diagnosis is based on behavioral analysis, but efforts are un- derway to use more objective criteria such as tracking eye movements and functional neuroimaging, which can even be done in infants. How early can autism be detect- ed? Parents often notice develop- mental issues before their child’s first birthday, and autism can be reliably diagnosed based on behavioral characteristics at age 2. Despite these possibilities for early detection, most American children aren’t diagnosed until they’re about 4½ years old. With evidence mounting that interventions are more effective the earlier they be- gin, researchers are hoping that more objective measures will enable earlier diagnoses and interventions. Although the molecular caus- es and characteristics of autism are unclear, it appears that the condition results from unusual cellular develop- ment within the cerebral cortex — a brain region that is crucial to mem- ory, attention, perception, language, and other functions. Both white and gray matter of the brain show consistent, but subtle, alterations in people with ASD. Long-term studies also have found that a minority of children on the autism spectrum have abnormally large brain volumes and faster brain growth. Other toddlers with autism have shown unusual development and network inefficien- cies at the back of the cerebral cortex. There is evidence that some atypical activity occurs in the cortex of people with ASD from older childhood into adulthood, and information might not be integrated in the usual way across distributed brain networks. At this point, no medications have been proven to reverse autism. Some people get symptomatic relief from drugs designed for other uses, such as anxiety conditions, and several stud- ies have reported social benefits from treatment with oxytocin — a hormone known to improve social bonding — but the findings have been mixed. For this challenging disorder, behavioral therapies are still the only proven treat- ments for autism, and early interven- tions are the most effective. ATTENTION DEFICIT HYPERACTIVITY DISORDER Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed childhood conditions. In 2014, approximately 11 percent of American parents with a child between the ages of 4 and 17 reported that their son or daughter had received an ADHD diagnosis. In at least 30 percent of those diagnosed with ADHD, the disorder continues into adulthood. ADHD is usually characterized by inattentiveness, as well as hyperactivity or impulsive behaviors. Although all young children can be hyperactive, impulsive, and inattentive from time to time, these symptoms are more extreme and last longer in children with ADHD. They often struggle to form strong friendships, and their grades in school can reflect their behavior instead of their academic ability. Executive functions, such as finishing what they start, remembering to bring homework back to school, and following multistep directions, can be especially challenging for those with ADHD. Young people with ADHD also have lower rates of high school graduation and a higher risk of suicide. No objective diagnostic test exists for ADHD, so diagnosis requires a comprehensive evaluation, including a clinical interview and parent and teacher ratings. Because problems with attention and hyperactivity can be caused by other conditions such as depression, sleep issues, and learning disorders, careful evaluation is always needed to determine whether ADHD is truly the cause of the symptoms. To warrant an ADHD diagnosis, atten- tion and behavioral problems must be severe enough that they interfere with normal functioning. In addition, the behavioral issues must be present in more than one context — not only at home or at school, but in both settings. Although ADHD tends to run in families, no well-defined set of genes is known to be responsible for the condition. Environmental risk factors, such as extreme early adversity, expo- sure to lead, and low birthweight, can also be involved. People with ADHD do not demonstrate any obvious brain alterations, but research has found that people with ADHD might have dif- ferences in the structure of brain cells and in the brain’s ability to remodel itself. Some people with ADHD show unusual activity in brain cells that re- lease dopamine, a chemical messenger involved in rewarding behavior. ADHD has no cure, but treat- ments include drugs, behavioral interventions, or both. Interestingly, ADHD medications include stimu- lants such as methylphenidate, as well as newer, non-stimulant drugs. The drugs are available in long-acting for- mulations so children do not have to interrupt the school day to take their medication. Determining the right drug and the right dose might require a period of experimentation and sup- port from a specialist, since dosage is adjusted to how fast a child metaboliz- es the drug, and to minimize the side effects. Nevertheless, most children with ADHD are diagnosed and treated by their pediatricians. Effective behav- ioral treatments include organizational support, exercise, and meditation. DOWN SYNDROME Down syndrome is named for the English physician who first described it in 1866, but nearly 100 years passed before scientists determined what caused the condition: possessing an extra copy of all or part of the 21st chromosome. People with this syn- drome have three copies of this genetic material, instead of two. In some cases, the extra copy, or trisomy, does not occur in every cell, producing what’s known as mosaicism. Currently, about 250,000 people in the United States are living with Down syndrome. There is no clear cause of the genetic glitch, although maternal age is a major risk factor for Down syn- drome. Mothers older than 40 are 8.5 times more likely to have a child with Down syndrome than mothers aged 20 to 24. Advanced paternal age has also been linked to higher incidence of Down syndrome. The genetics of autism is very complicated in most cases, involving dozens of genes, leading to a unique condition in nearly every person. 7574Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Childhood Disorders 11Childhood Disorders11 Since late 2011, fetuses can be screened for Down syndrome using the mother’s blood. In the past, the risk of test procedures meant that only older mothers (whose likelihood of having a Down syndrome child was known to be higher) should be screened. Younger mothers didn’t know until delivery whether their child would have Down syndrome. The new blood test, unlike amniocentesis and chorionic villus sampling, poses no risk to the baby, so it can also be used for younger moth- ers whose chance of having a child with Down syndrome is quite small. Children born with Down syn- drome have distinctive facial features, including a flattened face and bridge of the nose, eyes that slant upward, and small ears. They usually have small hands and feet, short stature, and poor muscle tone as well. The intellectual abilities of people with Down syndrome are typically low to moderate, although some graduate from high school and college, and many successfully hold jobs. Other symptoms of Down syndrome can include hearing loss and heart defects, and virtually everyone born with Down will develop early-on- set Alzheimer’s disease, often in their 40s or 50s. Chromosome 21 contains the gene that encodes amyloid precur- sor protein (APP), an Alzheimer’s dis- ease risk factor, and possessing an extra copy of this gene might cause the early onset of this fatal disease. Interestingly, people with mosaic Down syndrome seem to have milder symptoms and are more likely to live past 50. There is no real treatment for Down syndrome, nor any clear expla- nation of what occurs in the brain. Poor connections among nerve cells in the hippocampus, the part of the brain involved in memory (and the first brain area affected by Alzheimer’s disease), are believed to be a key factor in brain or intellectual differences in Down syn- drome. Dysfunction in the mitochon- dria, the cell’s power plants, might also play a role in development of related disorders that involve energy metabo- lism, such as diabetes and Alzheimer’s. Scientists have grown stem cells from fetuses with Down syndrome and used them to test potential treatments and confirm which molecular path- ways are involved in the condition. In one such laboratory study, researchers took a gene that normally inactivates the second X chromosome in female mammals and spliced it into a stem cell that had three copies of chromosome 21. In these cells, the inactivation gene muted the expression of genes on the extra chromosome 21, believed to con- tribute to Down syndrome. Although this is a long way from any clinical ap- plications, the model is being used to test the changes and cellular problems that occur with the tripling of the 21st chromosome, in hopes of eventually finding a treatment. DYSLEXIA Dyslexia is the most common and best-studied of the learning disabilities, affecting as many as 15 to 20 percent of all Americans. People with dyslexia have a pro- nounced difficulty with reading despite having normal intelligence, education, and motivation. Symptoms include trouble with pronunciation, lack of fluency, diffi- culty retrieving words, poor spelling, and hesitancy in speaking. People with dyslexia might need more time to respond orally to a question and might read much more slowly than their peers. Dyslexia is usually diagnosed in elemen- tary school, when a child is slow to read or struggling with reading. Although reading skills and fluency can improve, dyslexia persists lifelong. Deciphering printed letters and words and recalling their sounds and meaning involves many areas of the brain. Brain imaging studies indicate these areas can be less well connected in people with dyslexia. One of these areas is a region on the left side of the brain called the “word-form area,” which is involved in the recognition of printed letters and words. People with dyslexia also show less brain activity in the left occipitotemporal cortex, which is considered essential for skilled read- ing. Researchers believe that the brain differences are present before the read- ing and language difficulties become apparent — although it is possible that people with dyslexia read less and, therefore, their brains develop less in regions associated with reading. Those with dyslexia appear to compensate for reduced activity on the left side of the brain by relying more heavily on the right side. Genetic analyses have revealed a handful of susceptibility genes, with animal models suggesting that these genes affect the migration of brain cells during development, leading to differences in brain circuitry. Dyslexia runs in families, with roughly half of dyslexics sharing the condition with a close relative. When one twin is diagnosed with dyslexia, the second twin is found to have the condition 55-70 percent of the time. But the genetics of dyslexia is complex, and likely involves a wide range of genes and environmental factors. Treatment for dyslexia involves behavioral and educational interven- tion, especially exercises like breaking words down into sounds and linking the sounds to specific letter patterns. Some researchers use a child’s ability to rapidly and automatically name things as an early indicator of dyslexia. This rapid automatic naming, and the ability to recognize and work with the sounds of language, are often impaired in people with dyslexia. Both skills can be used in preschoolers and kinder- gartners to predict their later reading skills. Research suggests that treat- ments targeting phonology, as well as multiple levels of language skills, show the greatest promise. EPILEPSY If someone has two or more seizures that cannot be explained by a temporary underlying medical condi- tion such as a high fever or low blood sugar, their medical diagnosis will be “epilepsy” — from the Greek words meaning to “seize,” “attack,” or “take hold of.” About 1 percent of Ameri- can children and 1.8 percent of adults have been diagnosed with this brain disorder. Seizures result from irregular activities in brain cells that can last five or more minutes at a time. Some seizures look like staring spells, while others cause people to collapse, shake, and become unaware of what is going on around them. The pattern of symp- toms and after-seizure brain recordings using EEGs are used to distinguish between different types of epilepsy and determine whether the true cause of the seizures is epilepsy or a different medical condition. Seizures are classified by where they occur in the brain. General- ized seizures affect both sides of the brain. They include absence or petit mal seizures, which can cause rapid blinking or a few seconds of staring into space, and tonic-clonic or grand mal seizures, which can make some- one fall, have muscle spasms, cry out, and/or lose consciousness. Focal or partial seizures are localized to one area of the brain. A simple focal sei- zure can cause twitching or a change in sensation, triggering strange smells or tastes. Complex focal seizures can leave a person confused and unable to answer questions or follow direc- tions. A person can also have so-called secondary generalized seizures, which begin in one part of the brain but spread to become generalized seizures. In some patients with severe epilepsy, multiple types of seizure can occur at the same time. Epilepsy has many possible causes and thus is considered a spectrum rather than a single disorder. Causes include premature birth, brain trauma, and abnormal development due to genetic factors. Attributes of epilepsy patients such as head size, movement disorders, and family history suggest that genetics is involved. Seizures can also accompany or cause intellectual or psychiatric prob- lems. For example, some seizures may suppress the growth of dendrites, leav- ing the person emotionally unsettled or less able to learn. Treatments for epilepsy are direct- ed toward controlling seizures with medication or diet. For most patients, a single medication is enough to control seizures, although a significant minority cannot get adequate control from drugs. About half of epilepsy pa- tients, particularly those with general- ized epilepsy, can reduce their seizures by eating a ketogenic diet, which relies heavily on high-fat, low-carbohydrate foods, although it’s unclear why this diet is effective. For severe cases that are not relieved by medication, doctors might recommend surgery to remove or inactivate the seizure-initiating part of the brain. In the most severe cases, if one side of the brain triggers sei- zures on the other side, surgeons may perform “split-brain surgery,” cutting the corpus callosum, a thick band of white matter that connects the two sides of the brain. Once their seizures are controlled, people with epilepsy can resume their normal lives. Epilepsy has many possible causes and thus is considered a spectrum rather than a single disorder.	Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here. What are some effects of overexposure to glucocorticoids? 5756Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Adult & Aging Brain 8Adult & Aging Brain8 memory, which requires a high degree of synaptic plasticity. The loss of thin dendritic spines could impair neuro- nal communication and contribute to cognitive decline. So far, direct evidence of their role in cognitive decline is lacking, and more studies are needed. Finally, the formation of new neurons also declines with age. Although neurogenesis was once believed to halt after birth, we now know of two brain regions that con- tinue to add new neurons through- out life: the olfactory bulbs and the dentate gyrus of the hippocampus. Studies suggest that the rate of neu- rogenesis plummets with age in mice, but recent human studies suggest a more modest decline. It is not yet clear whether neurogenesis apprecia- bly affects cognition in the aging hu- man brain, but mouse studies indicate that strategies that boost neurogenesis can enhance cognitive function. Chemical Changes The amount of neurotransmit- ters and the number of their recep- tors might also decline with age. Several studies have reported that less dopamine is synthesized in the aged brain, and there are fewer re- ceptors to bind the neurotransmitter. Less robust evidence indicates that the amount of serotonin might also decline with age. WHY DOES THE BRAIN AGE? From cortical thinning to the loss of dendritic spines, you’ve seen how the brain ages. But what causes these changes? Many different theories have been advanced to explain why neurons, and cells in general, age. One possibility is that changes in gene expression play a role. Researchers have found that genes important for synaptic plasticity are expressed less in the brains of older people than in the brains of younger adults. The underexpressed genes also showed more signs of damage. Oxidative Stress and DNA Damage DNA damage that accumulates over a lifetime could contribute to aging processes throughout the brain and body, and DNA damage due to oxidative stress has received a great deal of attention. Every cell in your body contains organelles called mitochondria, which function a bit like cellular power plants, carrying out chemical reactions that provide energy for cell use. Some of these metabolic reactions produce harmful byproducts called free radicals, highly reactive molecules which, if left un- checked, can destroy fats and proteins vital to normal cell function and can damage DNA as well. Your body has natural defense mechanisms to neutralize free radi- cals. Unfortunately, these mechanisms decline with age, leaving aging tissues more vulnerable to oxidative damage by the free radicals. Studies of brain cells have shown that damage to their mitochondrial DNA accumulates with age. In addition, the brains of people with mild cognitive impairment and Alzheimer’s disease show more signs of oxidative damage than the brains of healthy people. Studies in rodents also link increased oxidative damage to memory impairments. Your brain is one of the most metabolically active organs, demand- ing around 20 percent of the body’s fuel. Its enormous energy require- ments might make the brain even more vulnerable than other tissues to the metabolic changes that occur in aging. While the brain’s energy demands remain high, its energy supply can no longer keep pace; the brain’s ability to take up and use glu- cose diminishes and mitochondrial metabolism declines. Immune Dysfunction Immune dysfunction often occurs in conjunction with the metabolic changes seen in aging. Microglia, the brain’s resident immune cells, per- form many important jobs: defending against pathogens, cleaning up cellular debris, and helping maintain and re- model synapses. These inflammatory responses are protective, but a pro- longed inflammatory state is harmful to brain health. Microglia become more reactive with age, increasing the inflammatory response in the brain while also damping production of helpful anti-inflammatory molecules. Mouse studies suggest that excessive microglial activity also contributes to cognitive impairments. Impaired Protein Recycling We know that excessive buildup of abnormal proteins in the brain contributes to age-related neurode- generative diseases like Alzheimer’s and Parkinson’s. Buildup of proteins and other cell components can also contribute to cellular degeneration in the healthy brain. Cells normally break down and recycle damaged proteins and molecules, using a pro- cess that is usually efficient but not perfect. Over time, damaged mole- cules can build up in cells and prevent them from functioning normally. Because neurons in the brain are not replaced as often as cells in other parts of the body (for example, bone marrow, intestinal lining, hair folli- cles), brain cells might be even more vulnerable to this buildup of damaged molecules. Also, the cellular ma- chinery involved in breakdown and recycling processes degrades with age, reducing the efficiency of the “waste removal” systems. Finally, remember that changes in the aging brain occur within the context of other changes throughout the body. Researchers speculate that worsening cardiovascular health, for example, could contribute to, or even drive, many changes seen in the aging brain. HEALTHY AGING We have learned how the brain changes with age and why these changes can occur. Now let’s turn our attention to a growing field in neuroscience that explores ways to slow these changes and preserve healthy brain function. Diet and Exercise Strong evidence now suggests that habits and choices that keep your body healthy also benefit your mind. Poor cardiovascular health puts a person at increased risk of age-related cognitive impairment. Diets rich in vegetables, fruits, and whole grains, and low in meat and dairy products, can reduce cardiovascular risk factors linked to cognitive impairment, such as high blood pressure and high levels of LDL cholesterol. Indeed, observa- tional studies have found that people who follow plant-rich diets such as the Mediterranean diet or Dietary Approaches to Stop Hypertension (DASH) are less likely to develop cognitive decline and dementia. Specific nutrients have been linked to improved cognitive performance and lower rates of dementia. Anti- oxidants, such as vitamins C and E, flavonoids, and omega-3 fatty acids have received considerable attention, with observational studies showing that high dietary intake of these compounds is beneficial. However, the results of lifestyle intervention studies using supplements have been more mixed. Finally, caloric restriction — substantially reducing the number of calories eaten without leading to malnutrition — has been linked to Many different theories have been advanced to explain why neurons, and cells in general, age. Synapses begin to weaken as a person ages, which can contribute to normal cognitive decline. Brain Facts society for neuroscience\| Adult & Aging Brain85958 improved cognitive health as well as a longer lifespan. Growing evidence shows that aerobic exercise can improve cognitive function and offset some of the de- clines seen in aging. Numerous studies have found that people who engage in regular physical activity show improved learning, improved mem- ory, and a reduced risk of developing dementia. Physical activity might even slow the progression of Alzheimer’s disease and dementia, and higher levels of physical activity have been linked to improvements in some markers of structural brain health, such as reduced cortical thinning and less shrinkage in the hippocampus. Exercise exerts its neuroprotec- tive effects in the brain by improving neuroplasticity — the brain’s ability to form and reorganize connections be- tween neurons in response to changes in behavior and environment. Scien- tists also believe that exercise increases neurogenesis (the formation of new nerve cells) which, in turn, enhances neuroplasticity. Evidence from rodent studies confirms that exercise increases neurogenesis: Older mice allowed to run on a wheel have higher rates of neurogenesis in the hippocampus than sedentary mice, and they perform bet- ter on learning and memory tests. Ex- ercise can also improve blood flow and increase production of neurotrophic factors that support new neurons and synapses. For humans, starting exercise later in life can be beneficial, but the studies suggest that adopting an exer- cise program earlier in life could yield even more neuroprotective benefits. Mental Stimulation and Social Networks Mental stimulation and large so- cial networks can also improve cogni- tive function in aging. In lab studies, mice housed in cognitively stimulat- ing environments with many oppor- tunities for social interaction perform better on learning and memory tests as they age compared to mice housed in standard cages. Much like physical exercise, cognitive stimulation appears to enhance neuroplasticity by increas- ing neurogenesis and boosting levels of important neurotrophic factors. People who perform cognitive- ly-demanding work or engage in stimulating activities such as reading, solving puzzles, or playing a musical instrument have lower rates of cog- nitive decline with aging. An active social life has also been shown to be beneficial for cognition as we age. Neuroscientists have learned a lot about the aging brain — how it changes, why it changes, and how to maintain healthy cognitive func- tioning as we age. Even so, many questions remain. Answers to those questions could identify new strate- gies for protecting the brain, not only in our later years, but throughout our lives. Exercise has been shown to increase neurogenesis in the adult brain, and can slow the cognitive decline associated with aging. iStock.com/artyme83. Have you ever considered the ups and downs that occur during your day? Speaking literally, you are up and awake during the day and lying down sleeping at night. Speaking figuratively, ups and downs could mean that you experi- ence periods of elevated alertness and arousal compared with your mood when you are tired or relaxed. Asleep, awake, aroused, and relaxed are different brain states, meaning that the brain’s activity is different during each of these peri- ods. Scientists have looked deep inside the brain to understand what sleep is and how rest differs from being alert. This research is especially important for people like doctors, pilots, and shift workers who sometimes must focus and make important decisions with very little sleep. Research on brain states can also help people who have disorders of sleep, attention, and learning. SLEEP How many hours of sleep do you get every night? Most people spend one-third of their lives asleep. While that might appear to be a lot of time spent doing nothing, our brains are active while we rest each night. The activity in our brains during sleep is important for brain health and for solidifying memories. Most people feel tired and un- able to focus if they don’t get enough sleep. In some cases, too little sleep can impair a person’s driving as much as drinking alcohol. The long-term ef- fects of lacking sleep also involve many health risks. Several studies in humans have revealed that sleep-deprived people are at increased risk for a wide range of health issues including diabe- tes, stress, obesity, high blood pres- sure, anxiety, cognitive impairment, and depression. CHAPTER Brain States 9 Brain Facts 6160Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Brain States 9Brain States9 Brain Activity During Sleep Scientists can measure the brain’s electrical activity using electroenceph- alography (EEG). Electrodes attached to the scalp detect and record the net electrical activity of hundreds of thou- sands of cortical nerve cells. When a neuron is active, ions move in and out of the cell, altering the electrical charge across the cell membrane. An EEG de- tects the net electrical charge produced when neurons increase and decrease their activity as a group, in synchrony. The results are “brain waves” — the cyclic rising and falling of brain activ- ity that can be important indicators of brain function. In sleep studies, scien- tists now recognize two main states: slow wave sleep (SWS) and rapid eye movement sleep (REM). SWS gets its name from the high amplitude, low frequency, brain waves in EEG recordings. The high amplitude of slow waves indicates that many cortical neu- rons are switching their activity in a synchronized way from a depolarized (more excitable) state to a hyperpo- larized (less excitable) state and back again. These slow waves appear to be important to sleep function — the longer a person stays awake, the more slow waves they will experience during the SWS state. Slow waves become less frequent the longer the person is asleep. If awakened during SWS, most people recall only frag- mented thoughts, not active dreams. Have you ever seen a cat dream- ing — twitching its whiskers or paws while it sleeps? Dreaming happens mainly during REM sleep, which takes its name from the periodic rapid eye movements people make in this state. Brain activity recorded during REM looks very similar to EEGs recorded while awake. EEG waves during REM sleep have much lower amplitudes than the SWS slow waves, because neuron activity is less synchronized — some nerve cells depolarize while others hyperpolarize, and the “sum” of their electrical states is less positive (or negative) than if they acted in synchro- ny. Paradoxically, the fast, waking-like EEG activity during REM sleep is ac- companied by atonia, a loss of muscle tone causing the body to become tem- porarily paralyzed. The only muscles remaining active are those that enable breathing and control eye movements. Oddly enough, the neurons of our motor cortex fire as rapidly during REM sleep as they do during waking movement — a fact that explains why movements like a kitten’s twitching paws can coincide with dreams. During the night, periods of SWS and REM sleep alternate in 90-minute cycles with 75–80 minutes of SWS followed by 10–15 minutes of REM sleep. This cycle repeats, typically with deeper and longer peri- ods of REM sleep towards morning. To study sleep disorders, researchers often use mice that have sleep struc- tures qualitatively very similar to hu- mans; however, rodents have shorter This chart shows the brain waves of an individual being recorded by an EEG machine during a night’s sleep. As the person falls asleep, the brain waves slow down and become larger. Throughout the night, the individual cycles though sleep stages, including REM sleep, where brain activity is similar to wakefulness. and more frequent sleep episodes lasting 3–30 minutes (sometimes lon- ger). Rodents also sleep more during the day and are more active at night. Compare that to human adults, who are typically more active during the day and have one sleep episode at night lasting about 8 hours. Sleep Regulation How does the brain keep us awake? Wakefulness is main- tained by the brain’s arousal systems, each regulating different aspects of the awake state. Many arousal systems are in the upper brainstem, where neurons connecting with the forebrain use the neurotransmitters acetylcholine, norepinephrine, serotonin, and glutamate to keep us awake. Orexin- producing neurons, located in the hypothalamus, send projections to the brainstem and spinal cord, the thala- mus and basal ganglia, as well as to the forebrain, the amygdala, and dopa- mine-producing neurons. In studies of rats and monkeys, orexin appears to exert excitatory effects on other arousal systems. Orexins (there are two types, both small neuropeptides) increase metabolic rate, and their production can be activated by insulin-induced low blood sugar. Thus, they are involved in energy metabolism. Given these functions, it comes as no surprise that orexin-producing neurons are important for preventing a sudden transition to sleep; their loss causes narcolepsy, as described below. Orexin neurons also connect to hypothalamic neurons containing the neurotransmit- ter histamine, which plays a role in staying awake. The balance of neurotransmitters in the brain is critically important for maintaining certain brain states. For example, the balance of acetylcholine and norepinephrine can affect wheth- er we are awake (high acetylcholine and norepinephrine) or in SWS (low acetylcholine and norepinephrine). During REM, norepinephrine re- mains low while acetylcholine is high, activating the thalamus and neocortex enough for dreaming to occur; in this brain state, forebrain excitation without external sensory stimuli pro- duces dreams. The forebrain becomes excited by signals from the REM sleep generator (special brainstem neurons), leading to rapid eye move- ments and suppression of muscle tone — hallmark signs of REM. During SWS, the brain systems that keep us awake are actively sup- pressed. This active suppression of arousal systems is caused by the ven- trolateral preoptic (VLPO) nucleus, a group of nerve cells in the hypothala- mus. Cells in the VLPO release the in- hibitory neurotransmitters galanin and gamma-aminobutyric acid (GABA), which can suppress the arousal sys- tems. Damage to the VLPO nucleus causes irreversible insomnia. Sleep-Wake Cycle Two main factors drive your body to crave sleep: the time of day or night (circadian system) and how long you have been awake (homeostatic system). The homeostatic and circadian systems are separate and act independently. The circadian timing system is regulated by the suprachiasmatic nucleus, a small group of nerve cells in the hypothalamus that functions as a master clock. These cells express “clock proteins,” which go through a biochemical cycle of about 24 hours, setting the pace for daily cycles of activity, sleep, hormone release, and other bodily functions. The master clock neurons also receive input directly from the retina of the eye. Thus, light can reset the master clock, adjusting it to the outside world’s day/night cycle — this explains how your sleep cycles can shift when you change time zones during travel. In addition, the suprachiasmatic nucleus sends signals through different brain regions, eventually contacting the VLPO and the orexin neurons in the lateral hypothalamus, which directly regulate arousal. What happens in the brain when we don’t get enough sleep? The second system that regulates sleepiness is the The balance of neurotransmitters in the brain is critically important for maintaining certain brain states. 6362Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Brain States 9Brain States9 homeostatic system, which makes you feel sleepy if you stay awake longer than usual. One important sleep factor is a chemical in the brain called adenosine. When you stay awake for a long time, adenosine levels in the brain increase. The increased ade- nosine binds to specific receptors on nerve cells in arousal centers to slow cellular activity and reduce arousal. Adenosine can increase the number of slow waves during SWS. As you get more sleep, adenosine levels fall and slow waves decrease in number. Caf- feine acts as a stimulant by binding to adenosine receptors throughout the brain and preventing their interaction with adenosine. As a result, in the presence of caffeine, fewer receptors are available for the slowing influence of adenosine. People often say they need to “catch up on sleep.” But can you really make up for lost sleep? Normally, the homeostatic and circadian systems act in a complementary fashion to produce a normal 24-hour cycle of sleep and wakefulness. Nonetheless, activating the brain’s arousal system can keep us awake even after a long pe- riod of wakefulness — for example, a late-night study session to prepare for an important exam. In normal circum- stances, the homeostatic system will respond to the loss of sleep by increas- ing the duration of ensuing sleep and increasing the number of slow waves during the SWS episodes. As noted above, this rebound slow wave activity correlates with the previous time spent awake and is mediated by adenosine. Sleep Disorders The most common sleep disorder, and the one most people are familiar with, is insomnia. Some people with insomnia have difficulty falling asleep initially; others fall asleep, then awak- en part way through the night and can’t fall back asleep. Several common disorders, listed below, disrupt sleep and prevent people from getting an adequate amount of sleep. Daytime sleepiness (not narcolep- sy), characterized by excessive feelings of tiredness during the day, has many causes including sleep apnea (see be- low). Increased daytime sleepiness can increase the risk of daytime accidents, especially car accidents. Sleep apnea occurs when the air- way muscles of the throat relax during sleep, to the point of collapse, closing the airway. People with sleep apnea have difficulty breathing and wake up without entering the deeper stages of SWS. This condition can cause high blood pressure and may increase the risk of heart attack. Treatments for sleep apnea focus on reducing airway collapse during sleep; simple changes that may help include losing weight, avoiding alcohol or sedating drugs prior to sleep, and avoiding sleeping on one’s back. However, most people with sleep apnea require breathing machines to keep their airway open. One such device, called a continuous positive airway pressure or “CPAP” machine, uses a small mask that fits over the nose to provide an airstream under pressure during sleep. In some cases, people need surgery to correct their airway anatomy. REM sleep behavior disorder occurs when nerve pathways in the brain that prevent muscle movement during REM sleep do not work. Remember that dreaming happens during REM sleep, so imagine people literally acting out their dreams by getting up and moving around. This can be very disruptive to a normal night’s sleep. The cause of REM be- havior disorder is unknown, but it is more common in people with degen- erative neural disease such as Parkin- son’s, stroke, and types of dementia. The disorder can be treated with drugs for Parkinson’s or with a ben- zodiazepine drug, clonazepam, which enhances the effects of the inhibitory neurotransmitter GABA. FPO Electroencephalography measures brain activity through sensors placed on the head. It can record how the brain reacts to all kinds of stimuli and activities, including sleep. Simon Fraser University. Narcolepsy: An Example of Sleep Disorder Research Narcolepsy is a relatively uncommon sleep disorder — only 1 case per 2,000 people in the United States — in which the brain lacks the special neurons that help control the transition into sleep, so that the regular cycling is disrupted. People with narcolepsy have sleep attacks during the day, causing them to suddenly fall asleep, which is especially dangerous if they are driving. The problem is caused by the loss of orexin neurons in the lateral hypothalamus. People with narcolep- sy tend to enter REM sleep very quickly and may even enter a dream- ing state while still partially awake, a condition known as hypnagogic hallucination. Some people with narcolepsy also have attacks in which they lose muscle tone — similar to what happens in REM sleep, but while they’re awake. These attacks of paralysis, known as cataplexy, can be triggered by emotional experiences and even by hearing a funny joke. Recent research into the mech- anisms of narcolepsy has provided important insights into the processes that control the mysterious transitions between waking, slow wave sleep, and REM sleep states. Orexin (in the lateral hypothalamus) is critical for preventing abnormal transitions into REM sleep during the day. In one study, scientists inactivated the gene for orexin in mice and measured their sleep patterns. They found that mice lacking the orexin gene showed symp- toms of narcolepsy. Similarly, humans with narcolepsy have abnormally low levels of orexin levels in their brain and spinal fluid. Because orexin levels are disrupt- ed in narcolepsy, scientists also began studying neurons that were neighbors to orexin neurons to see what hap- pened if the neighboring neurons were activated in narcoleptic mice. Those neurons contained melanin-concen- trating hormone, and stimulating them (using a technique called opto- genetics) induced sleep — opposite to the effect of stimulating orexin neu- rons. A balance between the activation of orexin neurons and their neighbor- ing neurons could control the tran- sition between waking and sleeping. These findings will be important in developing treatments for narcolepsy. AROUSAL Think about what happens in your body and mind when you speak in front of a crowd — your brain state is very different from when you are asleep. Perhaps you notice changes in your breathing, heart rate, or stomach. Maybe your thoughts are racing or panicked. Or maybe you are energized and excited to perform for your audience. These are exam- ples of the complex brain state called arousal. Rather than merely being awake, arousal involves changes in the body and brain that provide motivations to do an action — teaching a class, speaking in public, or focusing your attention. People experience arousal daily when searching for food while hungry, or when talking with other people (social interaction). Arousal is also important for reproduction and for avoiding danger. The level of arousal varies across a spectrum from low to high. When arousal falls below a certain threshold we can transition from wake to sleep, for example. But under heightened arousal, like intense anxiety, we cannot reach this threshold and we stay awake. Neurotransmitters During arousal, the brain must de- vote resources to specific brain regions, much as an emergency call center redirects resources like ambulances and fire trucks during a fire. Specific types of neurons in the brain regions involved in arousal release multiple neurotransmitters, telling the rest of the brain and the body to be on alert. These neurotransmitters are dopamine (for movement), norepinephrine (for alertness), serotonin (for emotion), and acetylcholine and histamine, which help the brain communicate with the body to increase arousal. Sensory Input While neurotransmitters provide the internal signals for arousal, external signals from the outside world — like the bright lights (visual input) and cheering crowds (auditory input) at a stage performance — can also stimu- late arousal. Sensory input gets sorted in the brain region called the thala- mus. Often called a “sensory clearing house,” the thalamus regulates arous- al, receiving and processing sensory inputs from brain regions important in senses like vision and hearing and relaying these inputs to the cortex. Autonomic Nervous System Once the brain is aroused, what does the body do? The reticular activating system, in the brainstem, co- ordinates signals coming from sensory inputs and neurotransmitters to make sense of events in the brain and pass that information to the rest of the body. The reticular activating system specifically controls the autonomic nervous system, which affects heart rate, blood flow, and breathing. By controlling these automatic body pro- cesses, the reticular activating system 6564Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Brain States 9Brain States9 sets up the physical state of arousal, bringing important resources like oxy- gen and nutrients to parts of the body where they are needed. Together, the changes that happen in the brain and body during arous- al enable us to be alert and focused, which helps us process information quickly. Using this information, we can choose the appropriate emotional response or physical action for a given situation. Sexual Arousal Several complex brain systems and endocrine (hormone) systems contrib- ute to sexual arousal and behaviors, but the brain regions, neurotransmitters, and body systems are similar to those involved in general arousal. The dis- tinguishing factor is that sexual arousal also involves hormones such as estrogen and testosterone, which then activate neurons that release the same neu- rotransmitters that are released during general arousal. Many human and ani- mal studies report interactions between sex hormones and neurotransmitters dopamine, serotonin, GABA, and glutamate. Researchers have also found that brain regions such as the hypo- thalamus, amygdala, and hippocampus contain many estrogen and progester- one receptors, and brain regions that mediate feelings of reward (nucleus accumbens) and emotions like pleasure (amygdala) motivate sexual behaviors. Overall, the primary involvement of sex hormones is a key in defining the brain state of sexual arousal. ATTENTION If you are paying attention right now, there should be detectable changes in your heart rate, breathing, and blood flow. If that sounds familiar, it’s because those same physiological changes occur during arousal, which is necessary for being alert and paying attention. As mentioned previously, the state of arousal calls for reactions to the environment. To make deci- sions about what to do, you need to focus on what’s happening in the environment, especially involving anything relevant to your goals. For example, if your goal is to run away from an angry bear, you need to be alert and pay attention to where you’re running so you don’t trip and fall. Scientists have theorized that the state of arousal speeds processing and improves comprehension of environ- mental details. Otherwise, your brain would need an infinite amount of time and energy to process all of its sensory inputs (sounds, sights, smells, and other feelings), because the environment is always changing. Focus Even with multitasking, it is impossible for the brain to process all its sensory inputs. Instead, people focus their attention on one thing at a time. Attention is a fascinating abil- ity, because it enables you to have so much control and the ability to fine- tune your focus to different locations, times, and topics. Consider the page you are reading right now. Although you can see the whole page, you focus on only one line at a time. Alterna- tively, you can turn your attention to the past — just minutes ago when you were reading about arousal. Or you can ignore the sentences alto- gether and focus on the number of times the word “you” occurs on this page. Scientists recognize two types of attention, which involve different brain processes: voluntary (endog- enous) attention and involuntary (exogenous) attention. Voluntary attention happens when you choose what to focus on — like finding a loved one in a crowd. The frontal and parietal cortices of the brain are active when you control your attention or direct it towards a specific object or location. Involun- tary attention occurs when something in the environment (like a sudden noise or movement) grabs your atten- tion. Involuntary attention is a dis- traction from your chosen goals and, in fact, researchers often use distrac- tor objects in attention experiments. Distractors can be emotional, like pictures of family, or non-emotional images that stand out from other stimuli, like a red circle surrounded by gray squares. Brain regions in the right hemisphere, collectively known as the ventral frontoparietal network, form a system that processes new and interesting stimuli that distract you from the task at hand. Research on at- tention can help us understand visual tasks, learning, child development, and disorders of attention. Disorders of Attention Paying attention for long periods of time, such as a 3-hour lecture, can be difficult for many people. For some people, even focusing for a short time can be hard. Several disorders that affect the ability to pay attention are attention deficit hyperactivity disorder (ADHD), schizophrenia, prosopagnosia, and hemineglect syndrome. It may seem strange to regard schizophrenia as an attention disturbance, but some psychiatric studies suggest that it involves a failure of selective attention. Prosopagnosia, or face blindness, is a cognitive disorder in which a person is unable to recognize faces — even their own family members. The severity of this condition varies, and genetic factors might be involved. Attention disorders have various causes, but we will focus on hemineglect syndrome, caused by damage to the right parietal cortex, a brain region important in involuntary attention. Between 50–82 percent of pa- tients who suffer stroke in the right hemisphere experience hemineglect syndrome, also known as spatial ne- glect and unilateral neglect. In these cases, patients with neglect ignore the left side of their visual field. Some- times they ignore the left side of the body and the left side of individual objects, as well. Diagnosis of hemine- glect syndrome can be done with a pen and paper. For example, patients can be instructed to draw a copy of a picture like a butterfly or a castle, and those patients with hemineglect usually draw only the right half of the picture or leave out details of the left side. Research on patients with hemineglect syndrome contributes to our understanding of rehabilitation after stroke, as well as the role of the right parietal cortex in attention and perception. REST: DEFAULT MODE NETWORK What is the difference between being alert and resting while awake? During times of rest and relaxation, you’re usually avoiding heavy thinking or complicat- ed tasks, and parts of the brain called the default mode network are more active. You may think of the default mode network as a personal lullaby or a playlist that turns on when you are ready to relax. Activity of the default mode network decreases (the lullaby gets quieter) when you start doing or thinking about a demanding task. Human studies using imaging tech- niques such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) have identified which brain regions belong to the default mode network. These brain areas, which are involved in emotion, personality, introspection, and memory, include frontal brain regions (ventromedial prefrontal cortex, dorsomedial prefrontal cortex, and anterior cingulate cortex), as well as the posterior cingulate cortex, lateral parietal cortex, and precuneus. Although the exact role of the default mode network is unclear, the functions of its “participating” brain regions provide hints about its purpose. Studies on emotion have revealed that activity in the ventro- medial PFC is directly related to how anxious a subject feels while performing a task — suggesting that the default mode network may play a role in regulating emotion and mood. Activity in the dorsomedial PFC (a region involved in self-referential or introspective thoughts) increases when a person is at rest and day- dreaming. The dorsomedial PFC is also involved in stream-of-conscious- ness thoughts and thoughts about oneself in the past, present, or future (autobiographical self ). The roles of these regions suggest that the default mode network may also function in self-reflection and our sense of self in time. The posterior brain regions of the default mode network (posterior cin- gulate cortex, lateral parietal cortex, and precuneus) become more active when remembering concrete mem- ories from past experiences. These brain regions are connected with the hippocampus, which is important for learning and forming memories. Both the hippocampus and the default mode network are more active when a person is at rest in the evening and less active when waking up early in the day. These patterns indicate that the default mode network helps to process and remember the events of the day. Future studies using electrical re- cordings from inside the human brain can be paired with fMRI to tell us more about the brain activity patterns of the default mode network and how brain regions coordinate their activity during tasks that utilize the functions of this network. Scientists recognize two types of attention, which involve different brain processes: voluntary attention and involuntary attention. 67Brain Factssociety for neuroscience \| The Body in Balance 10 The cells of your body are immersed in a constantly changing environment. The nutrients that sustain them rise and fall with each meal. Gases, ions, and other solutes flow back and forth between your cells and blood. Chemicals bind to cells and trigger the building and re- lease of proteins. Your cells digest food, get rid of wastes, build new tissues, and destroy old cells. Environmental changes, both internal and external, ripple through your body’s physio- logical systems. One of your brain’s less-visible jobs is to cope with all these changes, keep them within a normal range, and maintain the healthy func- tions of your body. The tendency of your body’s tissues and organ systems to maintain a condi- tion of balance or equilibrium is called homeostasis. Homeostasis depends on active regulation, with dynamic adjustments that keep the environ- ment of your cells and tissues relatively constant. The brain is part of many homeostatic systems, providing signals that coordinate your body’s internal clocks and regulating hormone secre- tion by the endocrine system. These functions often involve a region of the forebrain called the hypothalamus. CIRCADIAN RHYTHMS Almost every cell in your body has an internal clock that tells it when to become active, when to rest, and when to divide. These clocks broker changes in many of the body’s physiological systems over a 24-hour, or circadian, period. For example, the clocks cause faster pulses of peristaltic waves in your gut during the day and make your blood pressure dip at night. But because these clocks are deep inside your body and cannot detect daylight, none of them can tell time CHAPTER The Body in Balance 10 on its own. Instead, daily rhythms are coordinated by the suprachiasmatic nucleus (SCN), a tiny group of neurons in the hypothalamus. Neurons in the SCN act like a met- ronome for the rest of the body, emit- ting a steady stream of action potentials during the day and becoming quiet at night. The shift between active and silent states is controlled by cyclic in- teractions between two sets of proteins encoded by your body’s “clock” genes. Researchers first identified clock genes in the fruit fly Drosophila melanogaster and studied how they keep time; since then, a nearly identical set of genes has been found in mammals. The SCN also tracks what time it is based on signals it receives from photoreceptors in the retina, which keeps its activity in sync with the Earth’s actual day/night cycle. That little nudge is very important be- cause, on their own, clock proteins take slightly more than 24 hours to complete a full cycle. Studies of animals deprived of light have discovered that they go to sleep and wake up a bit later each day. An autonomic neural pathway ties the daily rhythmic activity of the SCN directly to other clocks in the body. Neurons in the SCN stimulate an adjacent region of the brain called the paraventricular nucleus (PVN), which in turn sends signals down a chain of neurons through the spinal cord to the peripheral organs of the body. You’ve al- ready learned how signals in part of this neural pathway stimulate orexin neu- rons to regulate the body’s sleep/wake cycle. Related pathways also govern the secretion of melatonin, a hormone that influences sleep behaviors. Specifically, electrical activity originating in the SCN enters the PVN’s neural network and sends signals up to the pineal gland, a small pinecone-shaped gland embedded between the cerebral hemispheres. The pineal gland secretes melatonin into the bloodstream at night. Melatonin binds to cells in many tissues, and although it has no direct effect on clock gene expression in the SCN, its systemic effects seem to reduce alertness and increase sleepiness. Light exposure trig- gers signals that stop melatonin secre- tion, promoting wakeful behaviors. Together, these signals keep all the body’s clocks synchronized to the same 24-hour cycle. Coordinated body clocks enable your body’s physiological systems to work together at the right times. When your body prepares to wake from sleep, 1) levels of the stress hormone cortisol peak in the blood, releasing sugars from storage and increasing appetite, and 2) core body temperature begins to drift upwards, raising your body’s metabolic rate. These events, synchronized with others, prepare your body for a new day’s activity. Desynchronizing the body’s phys- iological clocks can cause noticeable and sometimes serious health effects. You might have experienced a familiar example of circadian rhythm distur- bance: jet lag. After crossing many time zones in a short time period, a person’s patterns of wakefulness and hunger are out of sync with day and night. Exposure to the local day/night cycle resets the brain and body, but it can take several days to get fully resynchro- nized. Circadian rhythms can also be disturbed by situations like late-shift jobs or blindness, which decouple nor- mal daylight signals from wake/sleep cycles. Long-term circadian disruptions are associated with health problems including weight gain, increased rates of insomnia, depression, and cancers. HORMONES, HOMEOSTASIS, AND BEHAVIOR Neurons can quickly deliver the brain’s messages to precise targets in the body. Hormones, on the other hand, deliver messages more slowly but can affect a larger set of tissues, producing large- scale changes in metabolism, growth, and behavior. The brain is one of the tissues that “listens” for hormonal signals — neurons throughout the brain are studded with hormone receptors — and the brain’s responses play an important part in regulating hormone secretion and changing behaviors to keep the body systems in Coordinated body clocks enable your body’s physiological systems to work together at the right times. Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| The Body in Balance 10The Body in Balance1068 equilibrium. The brain regions involved in hormone release are called the neuroendocrine system. The hypothalamus oversees the production and release of many hor- mones through its close ties to the pi- tuitary gland. The paraventricular and supraoptic nuclei of the hypothalamus send axons into the posterior part of the pituitary gland; activation of spe- cific neurons releases either vasopressin or oxytocin into capillaries within the pituitary. Both of these molecules act as neurotransmitters inside the brain, but they are also hormones that affect distant tissues of the body. Vasopressin (also called antidiuretic hormone) in- creases water retention in the kidneys and constricts blood vessels (vasocon- striction). Oxytocin promotes uterine contractions during labor and milk release during nursing. Other hypothalamic regions send axons to a capillary-rich area above the pituitary called the median eminence. When these neurons are activated, they release their hormones into the blood. These releasing (and inhibiting) hormones travel through local blood vessels to the anterior pituitary, where they trigger (or inhibit) secretion of a second specific hormone. Of the seven anterior pituitary hormones, five are trophic hormones — these travel in the bloodstream to stimulate activity in specific endocrine glands (thyroid, adrenal cortex, ovaries, etc.) throughout the body. The remaining two hormones act on non-endocrine tissues. Growth hormone stimulates the growth of bone and soft tissues, and prolactin stimulates milk produc- tion by the breasts. Hormones released from the anterior pituitary influence growth, cellular metabolism, emotion, and the physiology of reproduction, hunger, thirst, and stress. Many hormones produced by the pituitary and its target endocrine glands affect receptors inside the brain — thus, these hormones can alter neuronal function and gene transcrip- tion in the hypothalamus. The effect is to reduce the amount of hormone released by the hypothalamus when those circuits become active. These negative feedback loops enable precise doses of hormones to be delivered to body tissues, and ensure that the hor- mone levels are narrowly regulated. One of these three-hormone cascades regulates reproduction in mammals. Its underlying pattern is the same in both sexes: 1) gonadotropin- releasing hormone (GnRH) from the hypothalamus makes the anterior pi- tuitary release 2) luteinizing hormone (LH) and follicle stimulating hormone (FSH), which in turn make the gonads secrete 3) sex hormones and start the development of mature eggs or sperm. The neuroendocrine system maintains homeostasis, the body’s normal equilibrium, and controls the response to stress. The adrenal gland releases the stress hormones norepineph- rine, epinephrine, and cortisol, which quicken heart rate and prepare muscles for action. Corticotrophin releasing hormone (CRH) is released from the hypothalamus and travels to the pituitary gland, where it triggers the release of adrenocorticotropic hormone (ACTH). ACTH travels in the blood to the adrenal glands, where it stimulates the release of cortisol. 69 Sex hormones, in turn, attach to receptors in the hypothalamus and an- terior pituitary and modify the release of the hypothalamic and pituitary hormones. However, sex hormones regulate these feedback loops differ- ently in males and females. Male sex hormones induce simple negative feedback loops that reduce the secretion of gonadotropin-releas- ing hormone, luteinizing hormone, and follicle stimulating hormone. The interplay among these hormones creates a repetitive pulse of GnRH that peaks every 90 minutes. The waxing and wan- ing of GnRH keeps testosterone levels relatively steady within body tissues, maintains male libido, and keeps the testes producing new sperm each day. Female feedback patterns are more complex. Over the course of the month-long menstrual cycle, female sex hormones exert both positive and nega- tive feedback on GnRH, FSH, and LH. When circulating levels of the female sex hormones estrogen and progesterone are low, rising follicle stimulating hormone levels trigger egg maturation and estrogen production. Rising estrogen levels induce luteiniz- ing hormone levels to rise. As the levels of female sex hormones rise, they exert negative feedback on FSH secretion, limiting the number of eggs that ma- ture in a month, but positive feedback on LH, eventually producing the LH surge that triggers ovulation. After ovulation, high serum levels of sex hor- mones again exert negative feedback on GnRH, FSH, and LH which in turn reduces ovarian activity. Levels of fe- male sex hormones therefore decrease, allowing the cycle to start over again. Many other hormones are not regulated by the pituitary gland, but are released by specific tissues in response to physiological changes. The brain contains receptors for many of these hormones but, unlike pituitary hormones, it does not directly regulate their secretion. Instead, when these hormones bind to receptors on neu- rons, they modify the output of neural circuits, producing behavioral changes that have homeostatic effects. One example of this is a pair of hormones called leptin and ghrelin. Leptin and ghrelin change eating behavior by regulating food intake and energy balance. Both hormones affect hunger, and both are released in response to changes in an animal’s internal energy stores. However, they have different effects on the circuits they regulate. Ghrelin keeps the body fed. Released by the wall of the gastrointestinal tract when the stom- ach is empty, ghrelin activates hunger circuits in the hypothalamus that drive a search for food. Once the stomach is full, ghrelin production stops, reduc- ing the desire to eat. In contrast, leptin helps maintain body weight within a set range. Leptin is produced by fat cells and is released when fat stores are large. When it binds to neurons in the hypothalamus, leptin suppresses the activity of hunger circuits and reduces the desire to eat. As fat stores are used up, leptin levels decline, driving be- havior that makes an animal eat more often and replenish its fat stores. STRESS Your body reacts in stereotyped ways when you feel threatened. You breathe faster, your heartbeat speeds up, your muscles tense and prepare for action. These reactions may have helped our ancestors run from preda- tors, but any stressful situation — ar- guing with your parents, a blind date, a looming deadline at work, abdominal cramps, discovering your apartment was robbed, trying karaoke for the first time — has the potential to set them off. Scientists call this reaction the stress response, and your body turns it on to some degree in response to any external or internal threat to homeostasis. The Stress Response The stress response weaves togeth- er three of the brain’s parallel com- munication systems, coordinating the activity of voluntary and involuntary nervous systems, muscles, and metabo- lism to achieve one defensive goal. Messages sent to muscles through the somatic (voluntary) nervous system prime the body to fight or run from danger (the fight-or-flight response). Messages sent through the autonomic (involuntary) nervous system redirect nutrients and oxygen to those mus- cles. The sympathetic branch tells the adrenal medulla to release the hor- mone epinephrine (also called adren- aline), which makes the heart pump faster and relaxes the arterial walls that supply muscles with blood so they can respond more quickly. At the same time, the autonomic system’s parasym- pathetic branch restricts blood flow to other organs including the skin, gonads, digestive tract, and kidneys. Finally, a cascade of neuroendocrine hormones originating in the hypothal- amus and anterior pituitary circulates in the bloodstream, affecting processes like metabolic rate and sexual func- tion, and telling the adrenal cortex to release glucocorticoid hormones — like cortisol — into the blood. Glucocorticoid hormones bind to many body tissues and produce wide- spread effects that prepare the body to respond to potential threat. These hor- mones stimulate the production and release of sugar from storage sites such as the liver, making energy available to Brain Facts society for neuroscience\| The Body in Balance1070 muscles. They also bind to brain areas that ramp up attention and learning. And they help inhibit nonessential functions like growth and immune responses until the crisis ends. It’s easy to imagine how (and why) these physiological changes make your body alert and ready for action. But when it comes to stress, your body can’t tell the difference between the danger of facing down a bull elephant and the frustration of being stuck in traffic. When stress is chronic, whatever its cause, your adrenal glands keep pump- ing out epinephrine and glucocorti- coids. Many animal and human studies have shown that long-term exposure to these hormones can be detrimental. Chronic Stress Overexposure to glucocorticoids can damage a wide range of physiological systems. It can cause muscles to atrophy, push the body to store energy as fat, and keep blood sugar abnormal- ly high — all of these can worsen the symptoms of diabetes. Overexposure to glucocorticoids also contributes to the development of hypertension (high blood pressure) and atherosclerosis (hardening of the arteries), increasing the risk of heart attacks. Because the hormones inhibit immune system function, they also reduce resistance to infection and inflammation, some- times pushing the immune system to attack the body’s own tissues. Chronic stress can also have specif- ic negative effects on brain tissue and function. Persistently high levels of glucocorticoids inhibit neuron growth inside the hippocampus, impairing the normal processes of memory forma- tion and recall. Stress hormones can also suppress neural pathways that are normally active in decision-making and cognition, and speed the deteri- oration in brain function caused by aging. They may worsen the damage caused by a stroke. And they can lead to sleep disorders — cortisol is also an important wakeful signal in the brain, so the high cortisol levels due to chronic stress may delay sleep. Stress-induced insomnia can then start a vicious cycle, as the stress of sleep deprivation leads to the release of even more glucocorticoids. The effects of chronic stress may even extend beyond a single indi- vidual, because glucocorticoids play important roles in brain development. If a pregnant woman suffers from chronic stress, the elevated stress hor- mones can cross the placenta and shift the developmental trajectory of her fetus. Glucocorticoids are transcription factors, which can bind to DNA and modify which genes will be expressed as proteins. Studies with animal mod- els have shown that mothers with high blood levels of glucocorticoids during pregnancy often have babies with low- er birth weights, developmental delays, and more sensitive stress responses throughout their lives. Because metabolic stressors such as starvation induce high glucocorticoid levels, it’s been suggested that these hormones might help prepare the fetus for the environment it will be born into. Tough, stressful environments push fetuses to develop stress-sensitive “thrifty” metabolisms that store fat eas- ily. Unfortunately, these stress-sensitive metabolisms increase a person’s risk of developing chronic metabolic diseases like obesity or diabetes, especially if they subsequently grow up in lower-stress environments with plentiful food. The effects of stress can even be passed to subsequent generations by epigenetic mechanisms. Chronic stress can change the markers on DNA molecules that indicate which of the genes in a cell are expressed and which are silenced. Some animal studies indicate that when changes in markers occur in cells that develop into eggs or sperm, these changes can be passed on and expressed in the animal’s offspring. Further research might reveal wheth- er chronic stress has similar effects in humans, and whether inheriting silenced or activated genes contributes to family histories of cancer, obesity, cardiovascular, psychiatric, or neurode- velopmental disease. Chronic stress can also have specific negative effects on brain tissue and function. AUTISM SPECTRUM DISORDERS Autism is often considered a childhood condition, although many of its symptoms persist lifelong. Some people with autism also have mood and anxiety disorders, seizures, intellectual disability, attention deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD). However, more than 40 percent of people with autism have normal or above-average intelligence. With symptoms that range from mildly to severely disabling, autism is considered a spectrum. Autism spectrum disorders (ASD) are diagnosed based on two main criteria: impaired social commu- nication and interaction, and repetitive behaviors or narrow, obsessive inter- ests. For example, some people on the autism spectrum are unable to speak, while others are socially awkward but highly articulate. Many adults with an autism diagnosis think of their autism as a strength — enabling or motivating them to develop deep expertise in an area or a different perspective on the world — rather than a disorder that needs to be cured. Currently, 1 of every 68 American 8-year-olds is estimated to meet the diagnostic criteria for an autism spec- trum disorder. The prevalence of ASD has risen dramatically since the 1970s, but it is unclear whether changes to diagnostic criteria and wider recogni- tion of ASD have contributed to the increase in diagnoses. Four to five times more boys than girls are diagnosed with autism, although it is not clear whether some of that pattern is because of underdi- agnosis of girls. Environmental factors such as parents having children later in life, fever and infection during preg- nancy, and premature birth have been CHAPTER Childhood Disorders 11 71Brain Facts 7372Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Childhood Disorders 11Childhood Disorders11 linked to an increased risk of autism in children. A huge number of studies have found no connection between childhood vaccination and the increase in autism diagnoses. Autism is believed to be at least partially driven by genetics, but how do scientists know that for sure? One low-tech approach uses twin studies: If one of a pair of identical twins receives an autism diagnosis, the other twin has greater than a 50 percent chance of also being diagnosed with ASD. Children who have an older sibling on the spectrum also have a higher likelihood of being diagnosed with autism — nearly one in five also receives a diagnosis of ASD. The genetics of autism is very complicated in most cases, involving dozens (or more) of genes, leading to a unique condition in nearly every person. Recently, however, high-throughput genomic analyses have broadened the pool of potential genes, revealed their roles in the body, and suggested possible new therapies. It appears that many genes, each with a small effect, contribute to the inheritance of most ASDs. But such small effects make these genes hard to identify in genome-wide association studies. Scientists are now looking at the rare variants associated with ASD. These afflict fewer people with ASD, but their effects are larger and easier to detect. Some of these rare mutations are in single genes whose impairment is already known to cause intellectu- al disability and social dysfunction. These genes include FMR1 (codes for fragile X mental retardation protein, but its non-mutant form is needed for normal cognitive development); PTEN (codes for a tumor suppressor enzyme that regulates cell division, so cells don’t divide or grow too fast); and TSC1 or TSC2 (tuberous sclerosis complex 1 and 2), which also code for proteins that help control cell growth and size. Between 50 to 60 percent of people with fragile X syndrome and approximately 40 percent of people with tuberous sclerosis complex have ASD. Children with a variant of the gene NF-1 develop tumors in child- hood (neurofibromatosis) and a 2011 study found that nearly 10 percent met the criteria for autism. Intriguingly, these ASD-related genes influence a major signaling pathway for regulating cell metabo- lism, growth, and proliferation, the mTOR pathway. This suggests a very real potential for treating autism with drugs that target the mTOR pathway. For example, mouse models with mutations in PTEN show traits simi- lar to humans with these gene vari- ants: altered sociability, anxiety, and repetitive behaviors. These behaviors can be relieved or reversed by drugs that inhibit the mTOR pathway. Clinical trials of these drugs (rapamy- cin and lovastatin) are underway. Despite this progress, autism genetics is so complicated that it can’t be used to diagnose the condition. And unlike diabetes, kidney disease, or thyroid disease, there are no biochem- ical or other biomarkers of autism. Currently, autism diagnosis is based on behavioral analysis, but efforts are un- derway to use more objective criteria such as tracking eye movements and functional neuroimaging, which can even be done in infants. How early can autism be detect- ed? Parents often notice develop- mental issues before their child’s first birthday, and autism can be reliably diagnosed based on behavioral characteristics at age 2. Despite these possibilities for early detection, most American children aren’t diagnosed until they’re about 4½ years old. With evidence mounting that interventions are more effective the earlier they be- gin, researchers are hoping that more objective measures will enable earlier diagnoses and interventions. Although the molecular caus- es and characteristics of autism are unclear, it appears that the condition results from unusual cellular develop- ment within the cerebral cortex — a brain region that is crucial to mem- ory, attention, perception, language, and other functions. Both white and gray matter of the brain show consistent, but subtle, alterations in people with ASD. Long-term studies also have found that a minority of children on the autism spectrum have abnormally large brain volumes and faster brain growth. Other toddlers with autism have shown unusual development and network inefficien- cies at the back of the cerebral cortex. There is evidence that some atypical activity occurs in the cortex of people with ASD from older childhood into adulthood, and information might not be integrated in the usual way across distributed brain networks. At this point, no medications have been proven to reverse autism. Some people get symptomatic relief from drugs designed for other uses, such as anxiety conditions, and several stud- ies have reported social benefits from treatment with oxytocin — a hormone known to improve social bonding — but the findings have been mixed. For this challenging disorder, behavioral therapies are still the only proven treat- ments for autism, and early interven- tions are the most effective. ATTENTION DEFICIT HYPERACTIVITY DISORDER Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed childhood conditions. In 2014, approximately 11 percent of American parents with a child between the ages of 4 and 17 reported that their son or daughter had received an ADHD diagnosis. In at least 30 percent of those diagnosed with ADHD, the disorder continues into adulthood. ADHD is usually characterized by inattentiveness, as well as hyperactivity or impulsive behaviors. Although all young children can be hyperactive, impulsive, and inattentive from time to time, these symptoms are more extreme and last longer in children with ADHD. They often struggle to form strong friendships, and their grades in school can reflect their behavior instead of their academic ability. Executive functions, such as finishing what they start, remembering to bring homework back to school, and following multistep directions, can be especially challenging for those with ADHD. Young people with ADHD also have lower rates of high school graduation and a higher risk of suicide. No objective diagnostic test exists for ADHD, so diagnosis requires a comprehensive evaluation, including a clinical interview and parent and teacher ratings. Because problems with attention and hyperactivity can be caused by other conditions such as depression, sleep issues, and learning disorders, careful evaluation is always needed to determine whether ADHD is truly the cause of the symptoms. To warrant an ADHD diagnosis, atten- tion and behavioral problems must be severe enough that they interfere with normal functioning. In addition, the behavioral issues must be present in more than one context — not only at home or at school, but in both settings. Although ADHD tends to run in families, no well-defined set of genes is known to be responsible for the condition. Environmental risk factors, such as extreme early adversity, expo- sure to lead, and low birthweight, can also be involved. People with ADHD do not demonstrate any obvious brain alterations, but research has found that people with ADHD might have dif- ferences in the structure of brain cells and in the brain’s ability to remodel itself. Some people with ADHD show unusual activity in brain cells that re- lease dopamine, a chemical messenger involved in rewarding behavior. ADHD has no cure, but treat- ments include drugs, behavioral interventions, or both. Interestingly, ADHD medications include stimu- lants such as methylphenidate, as well as newer, non-stimulant drugs. The drugs are available in long-acting for- mulations so children do not have to interrupt the school day to take their medication. Determining the right drug and the right dose might require a period of experimentation and sup- port from a specialist, since dosage is adjusted to how fast a child metaboliz- es the drug, and to minimize the side effects. Nevertheless, most children with ADHD are diagnosed and treated by their pediatricians. Effective behav- ioral treatments include organizational support, exercise, and meditation. DOWN SYNDROME Down syndrome is named for the English physician who first described it in 1866, but nearly 100 years passed before scientists determined what caused the condition: possessing an extra copy of all or part of the 21st chromosome. People with this syn- drome have three copies of this genetic material, instead of two. In some cases, the extra copy, or trisomy, does not occur in every cell, producing what’s known as mosaicism. Currently, about 250,000 people in the United States are living with Down syndrome. There is no clear cause of the genetic glitch, although maternal age is a major risk factor for Down syn- drome. Mothers older than 40 are 8.5 times more likely to have a child with Down syndrome than mothers aged 20 to 24. Advanced paternal age has also been linked to higher incidence of Down syndrome. The genetics of autism is very complicated in most cases, involving dozens of genes, leading to a unique condition in nearly every person. 7574Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Childhood Disorders 11Childhood Disorders11 Since late 2011, fetuses can be screened for Down syndrome using the mother’s blood. In the past, the risk of test procedures meant that only older mothers (whose likelihood of having a Down syndrome child was known to be higher) should be screened. Younger mothers didn’t know until delivery whether their child would have Down syndrome. The new blood test, unlike amniocentesis and chorionic villus sampling, poses no risk to the baby, so it can also be used for younger moth- ers whose chance of having a child with Down syndrome is quite small. Children born with Down syn- drome have distinctive facial features, including a flattened face and bridge of the nose, eyes that slant upward, and small ears. They usually have small hands and feet, short stature, and poor muscle tone as well. The intellectual abilities of people with Down syndrome are typically low to moderate, although some graduate from high school and college, and many successfully hold jobs. Other symptoms of Down syndrome can include hearing loss and heart defects, and virtually everyone born with Down will develop early-on- set Alzheimer’s disease, often in their 40s or 50s. Chromosome 21 contains the gene that encodes amyloid precur- sor protein (APP), an Alzheimer’s dis- ease risk factor, and possessing an extra copy of this gene might cause the early onset of this fatal disease. Interestingly, people with mosaic Down syndrome seem to have milder symptoms and are more likely to live past 50. There is no real treatment for Down syndrome, nor any clear expla- nation of what occurs in the brain. Poor connections among nerve cells in the hippocampus, the part of the brain involved in memory (and the first brain area affected by Alzheimer’s disease), are believed to be a key factor in brain or intellectual differences in Down syn- drome. Dysfunction in the mitochon- dria, the cell’s power plants, might also play a role in development of related disorders that involve energy metabo- lism, such as diabetes and Alzheimer’s. Scientists have grown stem cells from fetuses with Down syndrome and used them to test potential treatments and confirm which molecular path- ways are involved in the condition. In one such laboratory study, researchers took a gene that normally inactivates the second X chromosome in female mammals and spliced it into a stem cell that had three copies of chromosome 21. In these cells, the inactivation gene muted the expression of genes on the extra chromosome 21, believed to con- tribute to Down syndrome. Although this is a long way from any clinical ap- plications, the model is being used to test the changes and cellular problems that occur with the tripling of the 21st chromosome, in hopes of eventually finding a treatment. DYSLEXIA Dyslexia is the most common and best-studied of the learning disabilities, affecting as many as 15 to 20 percent of all Americans. People with dyslexia have a pro- nounced difficulty with reading despite having normal intelligence, education, and motivation. Symptoms include trouble with pronunciation, lack of fluency, diffi- culty retrieving words, poor spelling, and hesitancy in speaking. People with dyslexia might need more time to respond orally to a question and might read much more slowly than their peers. Dyslexia is usually diagnosed in elemen- tary school, when a child is slow to read or struggling with reading. Although reading skills and fluency can improve, dyslexia persists lifelong. Deciphering printed letters and words and recalling their sounds and meaning involves many areas of the brain. Brain imaging studies indicate these areas can be less well connected in people with dyslexia. One of these areas is a region on the left side of the brain called the “word-form area,” which is involved in the recognition of printed letters and words. People with dyslexia also show less brain activity in the left occipitotemporal cortex, which is considered essential for skilled read- ing. Researchers believe that the brain differences are present before the read- ing and language difficulties become apparent — although it is possible that people with dyslexia read less and, therefore, their brains develop less in regions associated with reading. Those with dyslexia appear to compensate for reduced activity on the left side of the brain by relying more heavily on the right side. Genetic analyses have revealed a handful of susceptibility genes, with animal models suggesting that these genes affect the migration of brain cells during development, leading to differences in brain circuitry. Dyslexia runs in families, with roughly half of dyslexics sharing the condition with a close relative. When one twin is diagnosed with dyslexia, the second twin is found to have the condition 55-70 percent of the time. But the genetics of dyslexia is complex, and likely involves a wide range of genes and environmental factors. Treatment for dyslexia involves behavioral and educational interven- tion, especially exercises like breaking words down into sounds and linking the sounds to specific letter patterns. Some researchers use a child’s ability to rapidly and automatically name things as an early indicator of dyslexia. This rapid automatic naming, and the ability to recognize and work with the sounds of language, are often impaired in people with dyslexia. Both skills can be used in preschoolers and kinder- gartners to predict their later reading skills. Research suggests that treat- ments targeting phonology, as well as multiple levels of language skills, show the greatest promise. EPILEPSY If someone has two or more seizures that cannot be explained by a temporary underlying medical condi- tion such as a high fever or low blood sugar, their medical diagnosis will be “epilepsy” — from the Greek words meaning to “seize,” “attack,” or “take hold of.” About 1 percent of Ameri- can children and 1.8 percent of adults have been diagnosed with this brain disorder. Seizures result from irregular activities in brain cells that can last five or more minutes at a time. Some seizures look like staring spells, while others cause people to collapse, shake, and become unaware of what is going on around them. The pattern of symp- toms and after-seizure brain recordings using EEGs are used to distinguish between different types of epilepsy and determine whether the true cause of the seizures is epilepsy or a different medical condition. Seizures are classified by where they occur in the brain. General- ized seizures affect both sides of the brain. They include absence or petit mal seizures, which can cause rapid blinking or a few seconds of staring into space, and tonic-clonic or grand mal seizures, which can make some- one fall, have muscle spasms, cry out, and/or lose consciousness. Focal or partial seizures are localized to one area of the brain. A simple focal sei- zure can cause twitching or a change in sensation, triggering strange smells or tastes. Complex focal seizures can leave a person confused and unable to answer questions or follow direc- tions. A person can also have so-called secondary generalized seizures, which begin in one part of the brain but spread to become generalized seizures. In some patients with severe epilepsy, multiple types of seizure can occur at the same time. Epilepsy has many possible causes and thus is considered a spectrum rather than a single disorder. Causes include premature birth, brain trauma, and abnormal development due to genetic factors. Attributes of epilepsy patients such as head size, movement disorders, and family history suggest that genetics is involved. Seizures can also accompany or cause intellectual or psychiatric prob- lems. For example, some seizures may suppress the growth of dendrites, leav- ing the person emotionally unsettled or less able to learn. Treatments for epilepsy are direct- ed toward controlling seizures with medication or diet. For most patients, a single medication is enough to control seizures, although a significant minority cannot get adequate control from drugs. About half of epilepsy pa- tients, particularly those with general- ized epilepsy, can reduce their seizures by eating a ketogenic diet, which relies heavily on high-fat, low-carbohydrate foods, although it’s unclear why this diet is effective. For severe cases that are not relieved by medication, doctors might recommend surgery to remove or inactivate the seizure-initiating part of the brain. In the most severe cases, if one side of the brain triggers sei- zures on the other side, surgeons may perform “split-brain surgery,” cutting the corpus callosum, a thick band of white matter that connects the two sides of the brain. Once their seizures are controlled, people with epilepsy can resume their normal lives. Epilepsy has many possible causes and thus is considered a spectrum rather than a single disorder.	Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here. EVIDENCE: 5756Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Adult & Aging Brain 8Adult & Aging Brain8 memory, which requires a high degree of synaptic plasticity. The loss of thin dendritic spines could impair neuro- nal communication and contribute to cognitive decline. So far, direct evidence of their role in cognitive decline is lacking, and more studies are needed. Finally, the formation of new neurons also declines with age. Although neurogenesis was once believed to halt after birth, we now know of two brain regions that con- tinue to add new neurons through- out life: the olfactory bulbs and the dentate gyrus of the hippocampus. Studies suggest that the rate of neu- rogenesis plummets with age in mice, but recent human studies suggest a more modest decline. It is not yet clear whether neurogenesis apprecia- bly affects cognition in the aging hu- man brain, but mouse studies indicate that strategies that boost neurogenesis can enhance cognitive function. Chemical Changes The amount of neurotransmit- ters and the number of their recep- tors might also decline with age. Several studies have reported that less dopamine is synthesized in the aged brain, and there are fewer re- ceptors to bind the neurotransmitter. Less robust evidence indicates that the amount of serotonin might also decline with age. WHY DOES THE BRAIN AGE? From cortical thinning to the loss of dendritic spines, you’ve seen how the brain ages. But what causes these changes? Many different theories have been advanced to explain why neurons, and cells in general, age. One possibility is that changes in gene expression play a role. Researchers have found that genes important for synaptic plasticity are expressed less in the brains of older people than in the brains of younger adults. The underexpressed genes also showed more signs of damage. Oxidative Stress and DNA Damage DNA damage that accumulates over a lifetime could contribute to aging processes throughout the brain and body, and DNA damage due to oxidative stress has received a great deal of attention. Every cell in your body contains organelles called mitochondria, which function a bit like cellular power plants, carrying out chemical reactions that provide energy for cell use. Some of these metabolic reactions produce harmful byproducts called free radicals, highly reactive molecules which, if left un- checked, can destroy fats and proteins vital to normal cell function and can damage DNA as well. Your body has natural defense mechanisms to neutralize free radi- cals. Unfortunately, these mechanisms decline with age, leaving aging tissues more vulnerable to oxidative damage by the free radicals. Studies of brain cells have shown that damage to their mitochondrial DNA accumulates with age. In addition, the brains of people with mild cognitive impairment and Alzheimer’s disease show more signs of oxidative damage than the brains of healthy people. Studies in rodents also link increased oxidative damage to memory impairments. Your brain is one of the most metabolically active organs, demand- ing around 20 percent of the body’s fuel. Its enormous energy require- ments might make the brain even more vulnerable than other tissues to the metabolic changes that occur in aging. While the brain’s energy demands remain high, its energy supply can no longer keep pace; the brain’s ability to take up and use glu- cose diminishes and mitochondrial metabolism declines. Immune Dysfunction Immune dysfunction often occurs in conjunction with the metabolic changes seen in aging. Microglia, the brain’s resident immune cells, per- form many important jobs: defending against pathogens, cleaning up cellular debris, and helping maintain and re- model synapses. These inflammatory responses are protective, but a pro- longed inflammatory state is harmful to brain health. Microglia become more reactive with age, increasing the inflammatory response in the brain while also damping production of helpful anti-inflammatory molecules. Mouse studies suggest that excessive microglial activity also contributes to cognitive impairments. Impaired Protein Recycling We know that excessive buildup of abnormal proteins in the brain contributes to age-related neurode- generative diseases like Alzheimer’s and Parkinson’s. Buildup of proteins and other cell components can also contribute to cellular degeneration in the healthy brain. Cells normally break down and recycle damaged proteins and molecules, using a pro- cess that is usually efficient but not perfect. Over time, damaged mole- cules can build up in cells and prevent them from functioning normally. Because neurons in the brain are not replaced as often as cells in other parts of the body (for example, bone marrow, intestinal lining, hair folli- cles), brain cells might be even more vulnerable to this buildup of damaged molecules. Also, the cellular ma- chinery involved in breakdown and recycling processes degrades with age, reducing the efficiency of the “waste removal” systems. Finally, remember that changes in the aging brain occur within the context of other changes throughout the body. Researchers speculate that worsening cardiovascular health, for example, could contribute to, or even drive, many changes seen in the aging brain. HEALTHY AGING We have learned how the brain changes with age and why these changes can occur. Now let’s turn our attention to a growing field in neuroscience that explores ways to slow these changes and preserve healthy brain function. Diet and Exercise Strong evidence now suggests that habits and choices that keep your body healthy also benefit your mind. Poor cardiovascular health puts a person at increased risk of age-related cognitive impairment. Diets rich in vegetables, fruits, and whole grains, and low in meat and dairy products, can reduce cardiovascular risk factors linked to cognitive impairment, such as high blood pressure and high levels of LDL cholesterol. Indeed, observa- tional studies have found that people who follow plant-rich diets such as the Mediterranean diet or Dietary Approaches to Stop Hypertension (DASH) are less likely to develop cognitive decline and dementia. Specific nutrients have been linked to improved cognitive performance and lower rates of dementia. Anti- oxidants, such as vitamins C and E, flavonoids, and omega-3 fatty acids have received considerable attention, with observational studies showing that high dietary intake of these compounds is beneficial. However, the results of lifestyle intervention studies using supplements have been more mixed. Finally, caloric restriction — substantially reducing the number of calories eaten without leading to malnutrition — has been linked to Many different theories have been advanced to explain why neurons, and cells in general, age. Synapses begin to weaken as a person ages, which can contribute to normal cognitive decline. Brain Facts society for neuroscience\| Adult & Aging Brain85958 improved cognitive health as well as a longer lifespan. Growing evidence shows that aerobic exercise can improve cognitive function and offset some of the de- clines seen in aging. Numerous studies have found that people who engage in regular physical activity show improved learning, improved mem- ory, and a reduced risk of developing dementia. Physical activity might even slow the progression of Alzheimer’s disease and dementia, and higher levels of physical activity have been linked to improvements in some markers of structural brain health, such as reduced cortical thinning and less shrinkage in the hippocampus. Exercise exerts its neuroprotec- tive effects in the brain by improving neuroplasticity — the brain’s ability to form and reorganize connections be- tween neurons in response to changes in behavior and environment. Scien- tists also believe that exercise increases neurogenesis (the formation of new nerve cells) which, in turn, enhances neuroplasticity. Evidence from rodent studies confirms that exercise increases neurogenesis: Older mice allowed to run on a wheel have higher rates of neurogenesis in the hippocampus than sedentary mice, and they perform bet- ter on learning and memory tests. Ex- ercise can also improve blood flow and increase production of neurotrophic factors that support new neurons and synapses. For humans, starting exercise later in life can be beneficial, but the studies suggest that adopting an exer- cise program earlier in life could yield even more neuroprotective benefits. Mental Stimulation and Social Networks Mental stimulation and large so- cial networks can also improve cogni- tive function in aging. In lab studies, mice housed in cognitively stimulat- ing environments with many oppor- tunities for social interaction perform better on learning and memory tests as they age compared to mice housed in standard cages. Much like physical exercise, cognitive stimulation appears to enhance neuroplasticity by increas- ing neurogenesis and boosting levels of important neurotrophic factors. People who perform cognitive- ly-demanding work or engage in stimulating activities such as reading, solving puzzles, or playing a musical instrument have lower rates of cog- nitive decline with aging. An active social life has also been shown to be beneficial for cognition as we age. Neuroscientists have learned a lot about the aging brain — how it changes, why it changes, and how to maintain healthy cognitive func- tioning as we age. Even so, many questions remain. Answers to those questions could identify new strate- gies for protecting the brain, not only in our later years, but throughout our lives. Exercise has been shown to increase neurogenesis in the adult brain, and can slow the cognitive decline associated with aging. iStock.com/artyme83. Have you ever considered the ups and downs that occur during your day? Speaking literally, you are up and awake during the day and lying down sleeping at night. Speaking figuratively, ups and downs could mean that you experi- ence periods of elevated alertness and arousal compared with your mood when you are tired or relaxed. Asleep, awake, aroused, and relaxed are different brain states, meaning that the brain’s activity is different during each of these peri- ods. Scientists have looked deep inside the brain to understand what sleep is and how rest differs from being alert. This research is especially important for people like doctors, pilots, and shift workers who sometimes must focus and make important decisions with very little sleep. Research on brain states can also help people who have disorders of sleep, attention, and learning. SLEEP How many hours of sleep do you get every night? Most people spend one-third of their lives asleep. While that might appear to be a lot of time spent doing nothing, our brains are active while we rest each night. The activity in our brains during sleep is important for brain health and for solidifying memories. Most people feel tired and un- able to focus if they don’t get enough sleep. In some cases, too little sleep can impair a person’s driving as much as drinking alcohol. The long-term ef- fects of lacking sleep also involve many health risks. Several studies in humans have revealed that sleep-deprived people are at increased risk for a wide range of health issues including diabe- tes, stress, obesity, high blood pres- sure, anxiety, cognitive impairment, and depression. CHAPTER Brain States 9 Brain Facts 6160Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Brain States 9Brain States9 Brain Activity During Sleep Scientists can measure the brain’s electrical activity using electroenceph- alography (EEG). Electrodes attached to the scalp detect and record the net electrical activity of hundreds of thou- sands of cortical nerve cells. When a neuron is active, ions move in and out of the cell, altering the electrical charge across the cell membrane. An EEG de- tects the net electrical charge produced when neurons increase and decrease their activity as a group, in synchrony. The results are “brain waves” — the cyclic rising and falling of brain activ- ity that can be important indicators of brain function. In sleep studies, scien- tists now recognize two main states: slow wave sleep (SWS) and rapid eye movement sleep (REM). SWS gets its name from the high amplitude, low frequency, brain waves in EEG recordings. The high amplitude of slow waves indicates that many cortical neu- rons are switching their activity in a synchronized way from a depolarized (more excitable) state to a hyperpo- larized (less excitable) state and back again. These slow waves appear to be important to sleep function — the longer a person stays awake, the more slow waves they will experience during the SWS state. Slow waves become less frequent the longer the person is asleep. If awakened during SWS, most people recall only frag- mented thoughts, not active dreams. Have you ever seen a cat dream- ing — twitching its whiskers or paws while it sleeps? Dreaming happens mainly during REM sleep, which takes its name from the periodic rapid eye movements people make in this state. Brain activity recorded during REM looks very similar to EEGs recorded while awake. EEG waves during REM sleep have much lower amplitudes than the SWS slow waves, because neuron activity is less synchronized — some nerve cells depolarize while others hyperpolarize, and the “sum” of their electrical states is less positive (or negative) than if they acted in synchro- ny. Paradoxically, the fast, waking-like EEG activity during REM sleep is ac- companied by atonia, a loss of muscle tone causing the body to become tem- porarily paralyzed. The only muscles remaining active are those that enable breathing and control eye movements. Oddly enough, the neurons of our motor cortex fire as rapidly during REM sleep as they do during waking movement — a fact that explains why movements like a kitten’s twitching paws can coincide with dreams. During the night, periods of SWS and REM sleep alternate in 90-minute cycles with 75–80 minutes of SWS followed by 10–15 minutes of REM sleep. This cycle repeats, typically with deeper and longer peri- ods of REM sleep towards morning. To study sleep disorders, researchers often use mice that have sleep struc- tures qualitatively very similar to hu- mans; however, rodents have shorter This chart shows the brain waves of an individual being recorded by an EEG machine during a night’s sleep. As the person falls asleep, the brain waves slow down and become larger. Throughout the night, the individual cycles though sleep stages, including REM sleep, where brain activity is similar to wakefulness. and more frequent sleep episodes lasting 3–30 minutes (sometimes lon- ger). Rodents also sleep more during the day and are more active at night. Compare that to human adults, who are typically more active during the day and have one sleep episode at night lasting about 8 hours. Sleep Regulation How does the brain keep us awake? Wakefulness is main- tained by the brain’s arousal systems, each regulating different aspects of the awake state. Many arousal systems are in the upper brainstem, where neurons connecting with the forebrain use the neurotransmitters acetylcholine, norepinephrine, serotonin, and glutamate to keep us awake. Orexin- producing neurons, located in the hypothalamus, send projections to the brainstem and spinal cord, the thala- mus and basal ganglia, as well as to the forebrain, the amygdala, and dopa- mine-producing neurons. In studies of rats and monkeys, orexin appears to exert excitatory effects on other arousal systems. Orexins (there are two types, both small neuropeptides) increase metabolic rate, and their production can be activated by insulin-induced low blood sugar. Thus, they are involved in energy metabolism. Given these functions, it comes as no surprise that orexin-producing neurons are important for preventing a sudden transition to sleep; their loss causes narcolepsy, as described below. Orexin neurons also connect to hypothalamic neurons containing the neurotransmit- ter histamine, which plays a role in staying awake. The balance of neurotransmitters in the brain is critically important for maintaining certain brain states. For example, the balance of acetylcholine and norepinephrine can affect wheth- er we are awake (high acetylcholine and norepinephrine) or in SWS (low acetylcholine and norepinephrine). During REM, norepinephrine re- mains low while acetylcholine is high, activating the thalamus and neocortex enough for dreaming to occur; in this brain state, forebrain excitation without external sensory stimuli pro- duces dreams. The forebrain becomes excited by signals from the REM sleep generator (special brainstem neurons), leading to rapid eye move- ments and suppression of muscle tone — hallmark signs of REM. During SWS, the brain systems that keep us awake are actively sup- pressed. This active suppression of arousal systems is caused by the ven- trolateral preoptic (VLPO) nucleus, a group of nerve cells in the hypothala- mus. Cells in the VLPO release the in- hibitory neurotransmitters galanin and gamma-aminobutyric acid (GABA), which can suppress the arousal sys- tems. Damage to the VLPO nucleus causes irreversible insomnia. Sleep-Wake Cycle Two main factors drive your body to crave sleep: the time of day or night (circadian system) and how long you have been awake (homeostatic system). The homeostatic and circadian systems are separate and act independently. The circadian timing system is regulated by the suprachiasmatic nucleus, a small group of nerve cells in the hypothalamus that functions as a master clock. These cells express “clock proteins,” which go through a biochemical cycle of about 24 hours, setting the pace for daily cycles of activity, sleep, hormone release, and other bodily functions. The master clock neurons also receive input directly from the retina of the eye. Thus, light can reset the master clock, adjusting it to the outside world’s day/night cycle — this explains how your sleep cycles can shift when you change time zones during travel. In addition, the suprachiasmatic nucleus sends signals through different brain regions, eventually contacting the VLPO and the orexin neurons in the lateral hypothalamus, which directly regulate arousal. What happens in the brain when we don’t get enough sleep? The second system that regulates sleepiness is the The balance of neurotransmitters in the brain is critically important for maintaining certain brain states. 6362Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Brain States 9Brain States9 homeostatic system, which makes you feel sleepy if you stay awake longer than usual. One important sleep factor is a chemical in the brain called adenosine. When you stay awake for a long time, adenosine levels in the brain increase. The increased ade- nosine binds to specific receptors on nerve cells in arousal centers to slow cellular activity and reduce arousal. Adenosine can increase the number of slow waves during SWS. As you get more sleep, adenosine levels fall and slow waves decrease in number. Caf- feine acts as a stimulant by binding to adenosine receptors throughout the brain and preventing their interaction with adenosine. As a result, in the presence of caffeine, fewer receptors are available for the slowing influence of adenosine. People often say they need to “catch up on sleep.” But can you really make up for lost sleep? Normally, the homeostatic and circadian systems act in a complementary fashion to produce a normal 24-hour cycle of sleep and wakefulness. Nonetheless, activating the brain’s arousal system can keep us awake even after a long pe- riod of wakefulness — for example, a late-night study session to prepare for an important exam. In normal circum- stances, the homeostatic system will respond to the loss of sleep by increas- ing the duration of ensuing sleep and increasing the number of slow waves during the SWS episodes. As noted above, this rebound slow wave activity correlates with the previous time spent awake and is mediated by adenosine. Sleep Disorders The most common sleep disorder, and the one most people are familiar with, is insomnia. Some people with insomnia have difficulty falling asleep initially; others fall asleep, then awak- en part way through the night and can’t fall back asleep. Several common disorders, listed below, disrupt sleep and prevent people from getting an adequate amount of sleep. Daytime sleepiness (not narcolep- sy), characterized by excessive feelings of tiredness during the day, has many causes including sleep apnea (see be- low). Increased daytime sleepiness can increase the risk of daytime accidents, especially car accidents. Sleep apnea occurs when the air- way muscles of the throat relax during sleep, to the point of collapse, closing the airway. People with sleep apnea have difficulty breathing and wake up without entering the deeper stages of SWS. This condition can cause high blood pressure and may increase the risk of heart attack. Treatments for sleep apnea focus on reducing airway collapse during sleep; simple changes that may help include losing weight, avoiding alcohol or sedating drugs prior to sleep, and avoiding sleeping on one’s back. However, most people with sleep apnea require breathing machines to keep their airway open. One such device, called a continuous positive airway pressure or “CPAP” machine, uses a small mask that fits over the nose to provide an airstream under pressure during sleep. In some cases, people need surgery to correct their airway anatomy. REM sleep behavior disorder occurs when nerve pathways in the brain that prevent muscle movement during REM sleep do not work. Remember that dreaming happens during REM sleep, so imagine people literally acting out their dreams by getting up and moving around. This can be very disruptive to a normal night’s sleep. The cause of REM be- havior disorder is unknown, but it is more common in people with degen- erative neural disease such as Parkin- son’s, stroke, and types of dementia. The disorder can be treated with drugs for Parkinson’s or with a ben- zodiazepine drug, clonazepam, which enhances the effects of the inhibitory neurotransmitter GABA. FPO Electroencephalography measures brain activity through sensors placed on the head. It can record how the brain reacts to all kinds of stimuli and activities, including sleep. Simon Fraser University. Narcolepsy: An Example of Sleep Disorder Research Narcolepsy is a relatively uncommon sleep disorder — only 1 case per 2,000 people in the United States — in which the brain lacks the special neurons that help control the transition into sleep, so that the regular cycling is disrupted. People with narcolepsy have sleep attacks during the day, causing them to suddenly fall asleep, which is especially dangerous if they are driving. The problem is caused by the loss of orexin neurons in the lateral hypothalamus. People with narcolep- sy tend to enter REM sleep very quickly and may even enter a dream- ing state while still partially awake, a condition known as hypnagogic hallucination. Some people with narcolepsy also have attacks in which they lose muscle tone — similar to what happens in REM sleep, but while they’re awake. These attacks of paralysis, known as cataplexy, can be triggered by emotional experiences and even by hearing a funny joke. Recent research into the mech- anisms of narcolepsy has provided important insights into the processes that control the mysterious transitions between waking, slow wave sleep, and REM sleep states. Orexin (in the lateral hypothalamus) is critical for preventing abnormal transitions into REM sleep during the day. In one study, scientists inactivated the gene for orexin in mice and measured their sleep patterns. They found that mice lacking the orexin gene showed symp- toms of narcolepsy. Similarly, humans with narcolepsy have abnormally low levels of orexin levels in their brain and spinal fluid. Because orexin levels are disrupt- ed in narcolepsy, scientists also began studying neurons that were neighbors to orexin neurons to see what hap- pened if the neighboring neurons were activated in narcoleptic mice. Those neurons contained melanin-concen- trating hormone, and stimulating them (using a technique called opto- genetics) induced sleep — opposite to the effect of stimulating orexin neu- rons. A balance between the activation of orexin neurons and their neighbor- ing neurons could control the tran- sition between waking and sleeping. These findings will be important in developing treatments for narcolepsy. AROUSAL Think about what happens in your body and mind when you speak in front of a crowd — your brain state is very different from when you are asleep. Perhaps you notice changes in your breathing, heart rate, or stomach. Maybe your thoughts are racing or panicked. Or maybe you are energized and excited to perform for your audience. These are exam- ples of the complex brain state called arousal. Rather than merely being awake, arousal involves changes in the body and brain that provide motivations to do an action — teaching a class, speaking in public, or focusing your attention. People experience arousal daily when searching for food while hungry, or when talking with other people (social interaction). Arousal is also important for reproduction and for avoiding danger. The level of arousal varies across a spectrum from low to high. When arousal falls below a certain threshold we can transition from wake to sleep, for example. But under heightened arousal, like intense anxiety, we cannot reach this threshold and we stay awake. Neurotransmitters During arousal, the brain must de- vote resources to specific brain regions, much as an emergency call center redirects resources like ambulances and fire trucks during a fire. Specific types of neurons in the brain regions involved in arousal release multiple neurotransmitters, telling the rest of the brain and the body to be on alert. These neurotransmitters are dopamine (for movement), norepinephrine (for alertness), serotonin (for emotion), and acetylcholine and histamine, which help the brain communicate with the body to increase arousal. Sensory Input While neurotransmitters provide the internal signals for arousal, external signals from the outside world — like the bright lights (visual input) and cheering crowds (auditory input) at a stage performance — can also stimu- late arousal. Sensory input gets sorted in the brain region called the thala- mus. Often called a “sensory clearing house,” the thalamus regulates arous- al, receiving and processing sensory inputs from brain regions important in senses like vision and hearing and relaying these inputs to the cortex. Autonomic Nervous System Once the brain is aroused, what does the body do? The reticular activating system, in the brainstem, co- ordinates signals coming from sensory inputs and neurotransmitters to make sense of events in the brain and pass that information to the rest of the body. The reticular activating system specifically controls the autonomic nervous system, which affects heart rate, blood flow, and breathing. By controlling these automatic body pro- cesses, the reticular activating system 6564Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Brain States 9Brain States9 sets up the physical state of arousal, bringing important resources like oxy- gen and nutrients to parts of the body where they are needed. Together, the changes that happen in the brain and body during arous- al enable us to be alert and focused, which helps us process information quickly. Using this information, we can choose the appropriate emotional response or physical action for a given situation. Sexual Arousal Several complex brain systems and endocrine (hormone) systems contrib- ute to sexual arousal and behaviors, but the brain regions, neurotransmitters, and body systems are similar to those involved in general arousal. The dis- tinguishing factor is that sexual arousal also involves hormones such as estrogen and testosterone, which then activate neurons that release the same neu- rotransmitters that are released during general arousal. Many human and ani- mal studies report interactions between sex hormones and neurotransmitters dopamine, serotonin, GABA, and glutamate. Researchers have also found that brain regions such as the hypo- thalamus, amygdala, and hippocampus contain many estrogen and progester- one receptors, and brain regions that mediate feelings of reward (nucleus accumbens) and emotions like pleasure (amygdala) motivate sexual behaviors. Overall, the primary involvement of sex hormones is a key in defining the brain state of sexual arousal. ATTENTION If you are paying attention right now, there should be detectable changes in your heart rate, breathing, and blood flow. If that sounds familiar, it’s because those same physiological changes occur during arousal, which is necessary for being alert and paying attention. As mentioned previously, the state of arousal calls for reactions to the environment. To make deci- sions about what to do, you need to focus on what’s happening in the environment, especially involving anything relevant to your goals. For example, if your goal is to run away from an angry bear, you need to be alert and pay attention to where you’re running so you don’t trip and fall. Scientists have theorized that the state of arousal speeds processing and improves comprehension of environ- mental details. Otherwise, your brain would need an infinite amount of time and energy to process all of its sensory inputs (sounds, sights, smells, and other feelings), because the environment is always changing. Focus Even with multitasking, it is impossible for the brain to process all its sensory inputs. Instead, people focus their attention on one thing at a time. Attention is a fascinating abil- ity, because it enables you to have so much control and the ability to fine- tune your focus to different locations, times, and topics. Consider the page you are reading right now. Although you can see the whole page, you focus on only one line at a time. Alterna- tively, you can turn your attention to the past — just minutes ago when you were reading about arousal. Or you can ignore the sentences alto- gether and focus on the number of times the word “you” occurs on this page. Scientists recognize two types of attention, which involve different brain processes: voluntary (endog- enous) attention and involuntary (exogenous) attention. Voluntary attention happens when you choose what to focus on — like finding a loved one in a crowd. The frontal and parietal cortices of the brain are active when you control your attention or direct it towards a specific object or location. Involun- tary attention occurs when something in the environment (like a sudden noise or movement) grabs your atten- tion. Involuntary attention is a dis- traction from your chosen goals and, in fact, researchers often use distrac- tor objects in attention experiments. Distractors can be emotional, like pictures of family, or non-emotional images that stand out from other stimuli, like a red circle surrounded by gray squares. Brain regions in the right hemisphere, collectively known as the ventral frontoparietal network, form a system that processes new and interesting stimuli that distract you from the task at hand. Research on at- tention can help us understand visual tasks, learning, child development, and disorders of attention. Disorders of Attention Paying attention for long periods of time, such as a 3-hour lecture, can be difficult for many people. For some people, even focusing for a short time can be hard. Several disorders that affect the ability to pay attention are attention deficit hyperactivity disorder (ADHD), schizophrenia, prosopagnosia, and hemineglect syndrome. It may seem strange to regard schizophrenia as an attention disturbance, but some psychiatric studies suggest that it involves a failure of selective attention. Prosopagnosia, or face blindness, is a cognitive disorder in which a person is unable to recognize faces — even their own family members. The severity of this condition varies, and genetic factors might be involved. Attention disorders have various causes, but we will focus on hemineglect syndrome, caused by damage to the right parietal cortex, a brain region important in involuntary attention. Between 50–82 percent of pa- tients who suffer stroke in the right hemisphere experience hemineglect syndrome, also known as spatial ne- glect and unilateral neglect. In these cases, patients with neglect ignore the left side of their visual field. Some- times they ignore the left side of the body and the left side of individual objects, as well. Diagnosis of hemine- glect syndrome can be done with a pen and paper. For example, patients can be instructed to draw a copy of a picture like a butterfly or a castle, and those patients with hemineglect usually draw only the right half of the picture or leave out details of the left side. Research on patients with hemineglect syndrome contributes to our understanding of rehabilitation after stroke, as well as the role of the right parietal cortex in attention and perception. REST: DEFAULT MODE NETWORK What is the difference between being alert and resting while awake? During times of rest and relaxation, you’re usually avoiding heavy thinking or complicat- ed tasks, and parts of the brain called the default mode network are more active. You may think of the default mode network as a personal lullaby or a playlist that turns on when you are ready to relax. Activity of the default mode network decreases (the lullaby gets quieter) when you start doing or thinking about a demanding task. Human studies using imaging tech- niques such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) have identified which brain regions belong to the default mode network. These brain areas, which are involved in emotion, personality, introspection, and memory, include frontal brain regions (ventromedial prefrontal cortex, dorsomedial prefrontal cortex, and anterior cingulate cortex), as well as the posterior cingulate cortex, lateral parietal cortex, and precuneus. Although the exact role of the default mode network is unclear, the functions of its “participating” brain regions provide hints about its purpose. Studies on emotion have revealed that activity in the ventro- medial PFC is directly related to how anxious a subject feels while performing a task — suggesting that the default mode network may play a role in regulating emotion and mood. Activity in the dorsomedial PFC (a region involved in self-referential or introspective thoughts) increases when a person is at rest and day- dreaming. The dorsomedial PFC is also involved in stream-of-conscious- ness thoughts and thoughts about oneself in the past, present, or future (autobiographical self ). The roles of these regions suggest that the default mode network may also function in self-reflection and our sense of self in time. The posterior brain regions of the default mode network (posterior cin- gulate cortex, lateral parietal cortex, and precuneus) become more active when remembering concrete mem- ories from past experiences. These brain regions are connected with the hippocampus, which is important for learning and forming memories. Both the hippocampus and the default mode network are more active when a person is at rest in the evening and less active when waking up early in the day. These patterns indicate that the default mode network helps to process and remember the events of the day. Future studies using electrical re- cordings from inside the human brain can be paired with fMRI to tell us more about the brain activity patterns of the default mode network and how brain regions coordinate their activity during tasks that utilize the functions of this network. Scientists recognize two types of attention, which involve different brain processes: voluntary attention and involuntary attention. 67Brain Factssociety for neuroscience \| The Body in Balance 10 The cells of your body are immersed in a constantly changing environment. The nutrients that sustain them rise and fall with each meal. Gases, ions, and other solutes flow back and forth between your cells and blood. Chemicals bind to cells and trigger the building and re- lease of proteins. Your cells digest food, get rid of wastes, build new tissues, and destroy old cells. Environmental changes, both internal and external, ripple through your body’s physio- logical systems. One of your brain’s less-visible jobs is to cope with all these changes, keep them within a normal range, and maintain the healthy func- tions of your body. The tendency of your body’s tissues and organ systems to maintain a condi- tion of balance or equilibrium is called homeostasis. Homeostasis depends on active regulation, with dynamic adjustments that keep the environ- ment of your cells and tissues relatively constant. The brain is part of many homeostatic systems, providing signals that coordinate your body’s internal clocks and regulating hormone secre- tion by the endocrine system. These functions often involve a region of the forebrain called the hypothalamus. CIRCADIAN RHYTHMS Almost every cell in your body has an internal clock that tells it when to become active, when to rest, and when to divide. These clocks broker changes in many of the body’s physiological systems over a 24-hour, or circadian, period. For example, the clocks cause faster pulses of peristaltic waves in your gut during the day and make your blood pressure dip at night. But because these clocks are deep inside your body and cannot detect daylight, none of them can tell time CHAPTER The Body in Balance 10 on its own. Instead, daily rhythms are coordinated by the suprachiasmatic nucleus (SCN), a tiny group of neurons in the hypothalamus. Neurons in the SCN act like a met- ronome for the rest of the body, emit- ting a steady stream of action potentials during the day and becoming quiet at night. The shift between active and silent states is controlled by cyclic in- teractions between two sets of proteins encoded by your body’s “clock” genes. Researchers first identified clock genes in the fruit fly Drosophila melanogaster and studied how they keep time; since then, a nearly identical set of genes has been found in mammals. The SCN also tracks what time it is based on signals it receives from photoreceptors in the retina, which keeps its activity in sync with the Earth’s actual day/night cycle. That little nudge is very important be- cause, on their own, clock proteins take slightly more than 24 hours to complete a full cycle. Studies of animals deprived of light have discovered that they go to sleep and wake up a bit later each day. An autonomic neural pathway ties the daily rhythmic activity of the SCN directly to other clocks in the body. Neurons in the SCN stimulate an adjacent region of the brain called the paraventricular nucleus (PVN), which in turn sends signals down a chain of neurons through the spinal cord to the peripheral organs of the body. You’ve al- ready learned how signals in part of this neural pathway stimulate orexin neu- rons to regulate the body’s sleep/wake cycle. Related pathways also govern the secretion of melatonin, a hormone that influences sleep behaviors. Specifically, electrical activity originating in the SCN enters the PVN’s neural network and sends signals up to the pineal gland, a small pinecone-shaped gland embedded between the cerebral hemispheres. The pineal gland secretes melatonin into the bloodstream at night. Melatonin binds to cells in many tissues, and although it has no direct effect on clock gene expression in the SCN, its systemic effects seem to reduce alertness and increase sleepiness. Light exposure trig- gers signals that stop melatonin secre- tion, promoting wakeful behaviors. Together, these signals keep all the body’s clocks synchronized to the same 24-hour cycle. Coordinated body clocks enable your body’s physiological systems to work together at the right times. When your body prepares to wake from sleep, 1) levels of the stress hormone cortisol peak in the blood, releasing sugars from storage and increasing appetite, and 2) core body temperature begins to drift upwards, raising your body’s metabolic rate. These events, synchronized with others, prepare your body for a new day’s activity. Desynchronizing the body’s phys- iological clocks can cause noticeable and sometimes serious health effects. You might have experienced a familiar example of circadian rhythm distur- bance: jet lag. After crossing many time zones in a short time period, a person’s patterns of wakefulness and hunger are out of sync with day and night. Exposure to the local day/night cycle resets the brain and body, but it can take several days to get fully resynchro- nized. Circadian rhythms can also be disturbed by situations like late-shift jobs or blindness, which decouple nor- mal daylight signals from wake/sleep cycles. Long-term circadian disruptions are associated with health problems including weight gain, increased rates of insomnia, depression, and cancers. HORMONES, HOMEOSTASIS, AND BEHAVIOR Neurons can quickly deliver the brain’s messages to precise targets in the body. Hormones, on the other hand, deliver messages more slowly but can affect a larger set of tissues, producing large- scale changes in metabolism, growth, and behavior. The brain is one of the tissues that “listens” for hormonal signals — neurons throughout the brain are studded with hormone receptors — and the brain’s responses play an important part in regulating hormone secretion and changing behaviors to keep the body systems in Coordinated body clocks enable your body’s physiological systems to work together at the right times. Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| The Body in Balance 10The Body in Balance1068 equilibrium. The brain regions involved in hormone release are called the neuroendocrine system. The hypothalamus oversees the production and release of many hor- mones through its close ties to the pi- tuitary gland. The paraventricular and supraoptic nuclei of the hypothalamus send axons into the posterior part of the pituitary gland; activation of spe- cific neurons releases either vasopressin or oxytocin into capillaries within the pituitary. Both of these molecules act as neurotransmitters inside the brain, but they are also hormones that affect distant tissues of the body. Vasopressin (also called antidiuretic hormone) in- creases water retention in the kidneys and constricts blood vessels (vasocon- striction). Oxytocin promotes uterine contractions during labor and milk release during nursing. Other hypothalamic regions send axons to a capillary-rich area above the pituitary called the median eminence. When these neurons are activated, they release their hormones into the blood. These releasing (and inhibiting) hormones travel through local blood vessels to the anterior pituitary, where they trigger (or inhibit) secretion of a second specific hormone. Of the seven anterior pituitary hormones, five are trophic hormones — these travel in the bloodstream to stimulate activity in specific endocrine glands (thyroid, adrenal cortex, ovaries, etc.) throughout the body. The remaining two hormones act on non-endocrine tissues. Growth hormone stimulates the growth of bone and soft tissues, and prolactin stimulates milk produc- tion by the breasts. Hormones released from the anterior pituitary influence growth, cellular metabolism, emotion, and the physiology of reproduction, hunger, thirst, and stress. Many hormones produced by the pituitary and its target endocrine glands affect receptors inside the brain — thus, these hormones can alter neuronal function and gene transcrip- tion in the hypothalamus. The effect is to reduce the amount of hormone released by the hypothalamus when those circuits become active. These negative feedback loops enable precise doses of hormones to be delivered to body tissues, and ensure that the hor- mone levels are narrowly regulated. One of these three-hormone cascades regulates reproduction in mammals. Its underlying pattern is the same in both sexes: 1) gonadotropin- releasing hormone (GnRH) from the hypothalamus makes the anterior pi- tuitary release 2) luteinizing hormone (LH) and follicle stimulating hormone (FSH), which in turn make the gonads secrete 3) sex hormones and start the development of mature eggs or sperm. The neuroendocrine system maintains homeostasis, the body’s normal equilibrium, and controls the response to stress. The adrenal gland releases the stress hormones norepineph- rine, epinephrine, and cortisol, which quicken heart rate and prepare muscles for action. Corticotrophin releasing hormone (CRH) is released from the hypothalamus and travels to the pituitary gland, where it triggers the release of adrenocorticotropic hormone (ACTH). ACTH travels in the blood to the adrenal glands, where it stimulates the release of cortisol. 69 Sex hormones, in turn, attach to receptors in the hypothalamus and an- terior pituitary and modify the release of the hypothalamic and pituitary hormones. However, sex hormones regulate these feedback loops differ- ently in males and females. Male sex hormones induce simple negative feedback loops that reduce the secretion of gonadotropin-releas- ing hormone, luteinizing hormone, and follicle stimulating hormone. The interplay among these hormones creates a repetitive pulse of GnRH that peaks every 90 minutes. The waxing and wan- ing of GnRH keeps testosterone levels relatively steady within body tissues, maintains male libido, and keeps the testes producing new sperm each day. Female feedback patterns are more complex. Over the course of the month-long menstrual cycle, female sex hormones exert both positive and nega- tive feedback on GnRH, FSH, and LH. When circulating levels of the female sex hormones estrogen and progesterone are low, rising follicle stimulating hormone levels trigger egg maturation and estrogen production. Rising estrogen levels induce luteiniz- ing hormone levels to rise. As the levels of female sex hormones rise, they exert negative feedback on FSH secretion, limiting the number of eggs that ma- ture in a month, but positive feedback on LH, eventually producing the LH surge that triggers ovulation. After ovulation, high serum levels of sex hor- mones again exert negative feedback on GnRH, FSH, and LH which in turn reduces ovarian activity. Levels of fe- male sex hormones therefore decrease, allowing the cycle to start over again. Many other hormones are not regulated by the pituitary gland, but are released by specific tissues in response to physiological changes. The brain contains receptors for many of these hormones but, unlike pituitary hormones, it does not directly regulate their secretion. Instead, when these hormones bind to receptors on neu- rons, they modify the output of neural circuits, producing behavioral changes that have homeostatic effects. One example of this is a pair of hormones called leptin and ghrelin. Leptin and ghrelin change eating behavior by regulating food intake and energy balance. Both hormones affect hunger, and both are released in response to changes in an animal’s internal energy stores. However, they have different effects on the circuits they regulate. Ghrelin keeps the body fed. Released by the wall of the gastrointestinal tract when the stom- ach is empty, ghrelin activates hunger circuits in the hypothalamus that drive a search for food. Once the stomach is full, ghrelin production stops, reduc- ing the desire to eat. In contrast, leptin helps maintain body weight within a set range. Leptin is produced by fat cells and is released when fat stores are large. When it binds to neurons in the hypothalamus, leptin suppresses the activity of hunger circuits and reduces the desire to eat. As fat stores are used up, leptin levels decline, driving be- havior that makes an animal eat more often and replenish its fat stores. STRESS Your body reacts in stereotyped ways when you feel threatened. You breathe faster, your heartbeat speeds up, your muscles tense and prepare for action. These reactions may have helped our ancestors run from preda- tors, but any stressful situation — ar- guing with your parents, a blind date, a looming deadline at work, abdominal cramps, discovering your apartment was robbed, trying karaoke for the first time — has the potential to set them off. Scientists call this reaction the stress response, and your body turns it on to some degree in response to any external or internal threat to homeostasis. The Stress Response The stress response weaves togeth- er three of the brain’s parallel com- munication systems, coordinating the activity of voluntary and involuntary nervous systems, muscles, and metabo- lism to achieve one defensive goal. Messages sent to muscles through the somatic (voluntary) nervous system prime the body to fight or run from danger (the fight-or-flight response). Messages sent through the autonomic (involuntary) nervous system redirect nutrients and oxygen to those mus- cles. The sympathetic branch tells the adrenal medulla to release the hor- mone epinephrine (also called adren- aline), which makes the heart pump faster and relaxes the arterial walls that supply muscles with blood so they can respond more quickly. At the same time, the autonomic system’s parasym- pathetic branch restricts blood flow to other organs including the skin, gonads, digestive tract, and kidneys. Finally, a cascade of neuroendocrine hormones originating in the hypothal- amus and anterior pituitary circulates in the bloodstream, affecting processes like metabolic rate and sexual func- tion, and telling the adrenal cortex to release glucocorticoid hormones — like cortisol — into the blood. Glucocorticoid hormones bind to many body tissues and produce wide- spread effects that prepare the body to respond to potential threat. These hor- mones stimulate the production and release of sugar from storage sites such as the liver, making energy available to Brain Facts society for neuroscience\| The Body in Balance1070 muscles. They also bind to brain areas that ramp up attention and learning. And they help inhibit nonessential functions like growth and immune responses until the crisis ends. It’s easy to imagine how (and why) these physiological changes make your body alert and ready for action. But when it comes to stress, your body can’t tell the difference between the danger of facing down a bull elephant and the frustration of being stuck in traffic. When stress is chronic, whatever its cause, your adrenal glands keep pump- ing out epinephrine and glucocorti- coids. Many animal and human studies have shown that long-term exposure to these hormones can be detrimental. Chronic Stress Overexposure to glucocorticoids can damage a wide range of physiological systems. It can cause muscles to atrophy, push the body to store energy as fat, and keep blood sugar abnormal- ly high — all of these can worsen the symptoms of diabetes. Overexposure to glucocorticoids also contributes to the development of hypertension (high blood pressure) and atherosclerosis (hardening of the arteries), increasing the risk of heart attacks. Because the hormones inhibit immune system function, they also reduce resistance to infection and inflammation, some- times pushing the immune system to attack the body’s own tissues. Chronic stress can also have specif- ic negative effects on brain tissue and function. Persistently high levels of glucocorticoids inhibit neuron growth inside the hippocampus, impairing the normal processes of memory forma- tion and recall. Stress hormones can also suppress neural pathways that are normally active in decision-making and cognition, and speed the deteri- oration in brain function caused by aging. They may worsen the damage caused by a stroke. And they can lead to sleep disorders — cortisol is also an important wakeful signal in the brain, so the high cortisol levels due to chronic stress may delay sleep. Stress-induced insomnia can then start a vicious cycle, as the stress of sleep deprivation leads to the release of even more glucocorticoids. The effects of chronic stress may even extend beyond a single indi- vidual, because glucocorticoids play important roles in brain development. If a pregnant woman suffers from chronic stress, the elevated stress hor- mones can cross the placenta and shift the developmental trajectory of her fetus. Glucocorticoids are transcription factors, which can bind to DNA and modify which genes will be expressed as proteins. Studies with animal mod- els have shown that mothers with high blood levels of glucocorticoids during pregnancy often have babies with low- er birth weights, developmental delays, and more sensitive stress responses throughout their lives. Because metabolic stressors such as starvation induce high glucocorticoid levels, it’s been suggested that these hormones might help prepare the fetus for the environment it will be born into. Tough, stressful environments push fetuses to develop stress-sensitive “thrifty” metabolisms that store fat eas- ily. Unfortunately, these stress-sensitive metabolisms increase a person’s risk of developing chronic metabolic diseases like obesity or diabetes, especially if they subsequently grow up in lower-stress environments with plentiful food. The effects of stress can even be passed to subsequent generations by epigenetic mechanisms. Chronic stress can change the markers on DNA molecules that indicate which of the genes in a cell are expressed and which are silenced. Some animal studies indicate that when changes in markers occur in cells that develop into eggs or sperm, these changes can be passed on and expressed in the animal’s offspring. Further research might reveal wheth- er chronic stress has similar effects in humans, and whether inheriting silenced or activated genes contributes to family histories of cancer, obesity, cardiovascular, psychiatric, or neurode- velopmental disease. Chronic stress can also have specific negative effects on brain tissue and function. AUTISM SPECTRUM DISORDERS Autism is often considered a childhood condition, although many of its symptoms persist lifelong. Some people with autism also have mood and anxiety disorders, seizures, intellectual disability, attention deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD). However, more than 40 percent of people with autism have normal or above-average intelligence. With symptoms that range from mildly to severely disabling, autism is considered a spectrum. Autism spectrum disorders (ASD) are diagnosed based on two main criteria: impaired social commu- nication and interaction, and repetitive behaviors or narrow, obsessive inter- ests. For example, some people on the autism spectrum are unable to speak, while others are socially awkward but highly articulate. Many adults with an autism diagnosis think of their autism as a strength — enabling or motivating them to develop deep expertise in an area or a different perspective on the world — rather than a disorder that needs to be cured. Currently, 1 of every 68 American 8-year-olds is estimated to meet the diagnostic criteria for an autism spec- trum disorder. The prevalence of ASD has risen dramatically since the 1970s, but it is unclear whether changes to diagnostic criteria and wider recogni- tion of ASD have contributed to the increase in diagnoses. Four to five times more boys than girls are diagnosed with autism, although it is not clear whether some of that pattern is because of underdi- agnosis of girls. Environmental factors such as parents having children later in life, fever and infection during preg- nancy, and premature birth have been CHAPTER Childhood Disorders 11 71Brain Facts 7372Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Childhood Disorders 11Childhood Disorders11 linked to an increased risk of autism in children. A huge number of studies have found no connection between childhood vaccination and the increase in autism diagnoses. Autism is believed to be at least partially driven by genetics, but how do scientists know that for sure? One low-tech approach uses twin studies: If one of a pair of identical twins receives an autism diagnosis, the other twin has greater than a 50 percent chance of also being diagnosed with ASD. Children who have an older sibling on the spectrum also have a higher likelihood of being diagnosed with autism — nearly one in five also receives a diagnosis of ASD. The genetics of autism is very complicated in most cases, involving dozens (or more) of genes, leading to a unique condition in nearly every person. Recently, however, high-throughput genomic analyses have broadened the pool of potential genes, revealed their roles in the body, and suggested possible new therapies. It appears that many genes, each with a small effect, contribute to the inheritance of most ASDs. But such small effects make these genes hard to identify in genome-wide association studies. Scientists are now looking at the rare variants associated with ASD. These afflict fewer people with ASD, but their effects are larger and easier to detect. Some of these rare mutations are in single genes whose impairment is already known to cause intellectu- al disability and social dysfunction. These genes include FMR1 (codes for fragile X mental retardation protein, but its non-mutant form is needed for normal cognitive development); PTEN (codes for a tumor suppressor enzyme that regulates cell division, so cells don’t divide or grow too fast); and TSC1 or TSC2 (tuberous sclerosis complex 1 and 2), which also code for proteins that help control cell growth and size. Between 50 to 60 percent of people with fragile X syndrome and approximately 40 percent of people with tuberous sclerosis complex have ASD. Children with a variant of the gene NF-1 develop tumors in child- hood (neurofibromatosis) and a 2011 study found that nearly 10 percent met the criteria for autism. Intriguingly, these ASD-related genes influence a major signaling pathway for regulating cell metabo- lism, growth, and proliferation, the mTOR pathway. This suggests a very real potential for treating autism with drugs that target the mTOR pathway. For example, mouse models with mutations in PTEN show traits simi- lar to humans with these gene vari- ants: altered sociability, anxiety, and repetitive behaviors. These behaviors can be relieved or reversed by drugs that inhibit the mTOR pathway. Clinical trials of these drugs (rapamy- cin and lovastatin) are underway. Despite this progress, autism genetics is so complicated that it can’t be used to diagnose the condition. And unlike diabetes, kidney disease, or thyroid disease, there are no biochem- ical or other biomarkers of autism. Currently, autism diagnosis is based on behavioral analysis, but efforts are un- derway to use more objective criteria such as tracking eye movements and functional neuroimaging, which can even be done in infants. How early can autism be detect- ed? Parents often notice develop- mental issues before their child’s first birthday, and autism can be reliably diagnosed based on behavioral characteristics at age 2. Despite these possibilities for early detection, most American children aren’t diagnosed until they’re about 4½ years old. With evidence mounting that interventions are more effective the earlier they be- gin, researchers are hoping that more objective measures will enable earlier diagnoses and interventions. Although the molecular caus- es and characteristics of autism are unclear, it appears that the condition results from unusual cellular develop- ment within the cerebral cortex — a brain region that is crucial to mem- ory, attention, perception, language, and other functions. Both white and gray matter of the brain show consistent, but subtle, alterations in people with ASD. Long-term studies also have found that a minority of children on the autism spectrum have abnormally large brain volumes and faster brain growth. Other toddlers with autism have shown unusual development and network inefficien- cies at the back of the cerebral cortex. There is evidence that some atypical activity occurs in the cortex of people with ASD from older childhood into adulthood, and information might not be integrated in the usual way across distributed brain networks. At this point, no medications have been proven to reverse autism. Some people get symptomatic relief from drugs designed for other uses, such as anxiety conditions, and several stud- ies have reported social benefits from treatment with oxytocin — a hormone known to improve social bonding — but the findings have been mixed. For this challenging disorder, behavioral therapies are still the only proven treat- ments for autism, and early interven- tions are the most effective. ATTENTION DEFICIT HYPERACTIVITY DISORDER Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed childhood conditions. In 2014, approximately 11 percent of American parents with a child between the ages of 4 and 17 reported that their son or daughter had received an ADHD diagnosis. In at least 30 percent of those diagnosed with ADHD, the disorder continues into adulthood. ADHD is usually characterized by inattentiveness, as well as hyperactivity or impulsive behaviors. Although all young children can be hyperactive, impulsive, and inattentive from time to time, these symptoms are more extreme and last longer in children with ADHD. They often struggle to form strong friendships, and their grades in school can reflect their behavior instead of their academic ability. Executive functions, such as finishing what they start, remembering to bring homework back to school, and following multistep directions, can be especially challenging for those with ADHD. Young people with ADHD also have lower rates of high school graduation and a higher risk of suicide. No objective diagnostic test exists for ADHD, so diagnosis requires a comprehensive evaluation, including a clinical interview and parent and teacher ratings. Because problems with attention and hyperactivity can be caused by other conditions such as depression, sleep issues, and learning disorders, careful evaluation is always needed to determine whether ADHD is truly the cause of the symptoms. To warrant an ADHD diagnosis, atten- tion and behavioral problems must be severe enough that they interfere with normal functioning. In addition, the behavioral issues must be present in more than one context — not only at home or at school, but in both settings. Although ADHD tends to run in families, no well-defined set of genes is known to be responsible for the condition. Environmental risk factors, such as extreme early adversity, expo- sure to lead, and low birthweight, can also be involved. People with ADHD do not demonstrate any obvious brain alterations, but research has found that people with ADHD might have dif- ferences in the structure of brain cells and in the brain’s ability to remodel itself. Some people with ADHD show unusual activity in brain cells that re- lease dopamine, a chemical messenger involved in rewarding behavior. ADHD has no cure, but treat- ments include drugs, behavioral interventions, or both. Interestingly, ADHD medications include stimu- lants such as methylphenidate, as well as newer, non-stimulant drugs. The drugs are available in long-acting for- mulations so children do not have to interrupt the school day to take their medication. Determining the right drug and the right dose might require a period of experimentation and sup- port from a specialist, since dosage is adjusted to how fast a child metaboliz- es the drug, and to minimize the side effects. Nevertheless, most children with ADHD are diagnosed and treated by their pediatricians. Effective behav- ioral treatments include organizational support, exercise, and meditation. DOWN SYNDROME Down syndrome is named for the English physician who first described it in 1866, but nearly 100 years passed before scientists determined what caused the condition: possessing an extra copy of all or part of the 21st chromosome. People with this syn- drome have three copies of this genetic material, instead of two. In some cases, the extra copy, or trisomy, does not occur in every cell, producing what’s known as mosaicism. Currently, about 250,000 people in the United States are living with Down syndrome. There is no clear cause of the genetic glitch, although maternal age is a major risk factor for Down syn- drome. Mothers older than 40 are 8.5 times more likely to have a child with Down syndrome than mothers aged 20 to 24. Advanced paternal age has also been linked to higher incidence of Down syndrome. The genetics of autism is very complicated in most cases, involving dozens of genes, leading to a unique condition in nearly every person. 7574Brain Factssociety for neuroscience \|Brain Facts society for neuroscience\| Childhood Disorders 11Childhood Disorders11 Since late 2011, fetuses can be screened for Down syndrome using the mother’s blood. In the past, the risk of test procedures meant that only older mothers (whose likelihood of having a Down syndrome child was known to be higher) should be screened. Younger mothers didn’t know until delivery whether their child would have Down syndrome. The new blood test, unlike amniocentesis and chorionic villus sampling, poses no risk to the baby, so it can also be used for younger moth- ers whose chance of having a child with Down syndrome is quite small. Children born with Down syn- drome have distinctive facial features, including a flattened face and bridge of the nose, eyes that slant upward, and small ears. They usually have small hands and feet, short stature, and poor muscle tone as well. The intellectual abilities of people with Down syndrome are typically low to moderate, although some graduate from high school and college, and many successfully hold jobs. Other symptoms of Down syndrome can include hearing loss and heart defects, and virtually everyone born with Down will develop early-on- set Alzheimer’s disease, often in their 40s or 50s. Chromosome 21 contains the gene that encodes amyloid precur- sor protein (APP), an Alzheimer’s dis- ease risk factor, and possessing an extra copy of this gene might cause the early onset of this fatal disease. Interestingly, people with mosaic Down syndrome seem to have milder symptoms and are more likely to live past 50. There is no real treatment for Down syndrome, nor any clear expla- nation of what occurs in the brain. Poor connections among nerve cells in the hippocampus, the part of the brain involved in memory (and the first brain area affected by Alzheimer’s disease), are believed to be a key factor in brain or intellectual differences in Down syn- drome. Dysfunction in the mitochon- dria, the cell’s power plants, might also play a role in development of related disorders that involve energy metabo- lism, such as diabetes and Alzheimer’s. Scientists have grown stem cells from fetuses with Down syndrome and used them to test potential treatments and confirm which molecular path- ways are involved in the condition. In one such laboratory study, researchers took a gene that normally inactivates the second X chromosome in female mammals and spliced it into a stem cell that had three copies of chromosome 21. In these cells, the inactivation gene muted the expression of genes on the extra chromosome 21, believed to con- tribute to Down syndrome. Although this is a long way from any clinical ap- plications, the model is being used to test the changes and cellular problems that occur with the tripling of the 21st chromosome, in hopes of eventually finding a treatment. DYSLEXIA Dyslexia is the most common and best-studied of the learning disabilities, affecting as many as 15 to 20 percent of all Americans. People with dyslexia have a pro- nounced difficulty with reading despite having normal intelligence, education, and motivation. Symptoms include trouble with pronunciation, lack of fluency, diffi- culty retrieving words, poor spelling, and hesitancy in speaking. People with dyslexia might need more time to respond orally to a question and might read much more slowly than their peers. Dyslexia is usually diagnosed in elemen- tary school, when a child is slow to read or struggling with reading. Although reading skills and fluency can improve, dyslexia persists lifelong. Deciphering printed letters and words and recalling their sounds and meaning involves many areas of the brain. Brain imaging studies indicate these areas can be less well connected in people with dyslexia. One of these areas is a region on the left side of the brain called the “word-form area,” which is involved in the recognition of printed letters and words. People with dyslexia also show less brain activity in the left occipitotemporal cortex, which is considered essential for skilled read- ing. Researchers believe that the brain differences are present before the read- ing and language difficulties become apparent — although it is possible that people with dyslexia read less and, therefore, their brains develop less in regions associated with reading. Those with dyslexia appear to compensate for reduced activity on the left side of the brain by relying more heavily on the right side. Genetic analyses have revealed a handful of susceptibility genes, with animal models suggesting that these genes affect the migration of brain cells during development, leading to differences in brain circuitry. Dyslexia runs in families, with roughly half of dyslexics sharing the condition with a close relative. When one twin is diagnosed with dyslexia, the second twin is found to have the condition 55-70 percent of the time. But the genetics of dyslexia is complex, and likely involves a wide range of genes and environmental factors. Treatment for dyslexia involves behavioral and educational interven- tion, especially exercises like breaking words down into sounds and linking the sounds to specific letter patterns. Some researchers use a child’s ability to rapidly and automatically name things as an early indicator of dyslexia. This rapid automatic naming, and the ability to recognize and work with the sounds of language, are often impaired in people with dyslexia. Both skills can be used in preschoolers and kinder- gartners to predict their later reading skills. Research suggests that treat- ments targeting phonology, as well as multiple levels of language skills, show the greatest promise. EPILEPSY If someone has two or more seizures that cannot be explained by a temporary underlying medical condi- tion such as a high fever or low blood sugar, their medical diagnosis will be “epilepsy” — from the Greek words meaning to “seize,” “attack,” or “take hold of.” About 1 percent of Ameri- can children and 1.8 percent of adults have been diagnosed with this brain disorder. Seizures result from irregular activities in brain cells that can last five or more minutes at a time. Some seizures look like staring spells, while others cause people to collapse, shake, and become unaware of what is going on around them. The pattern of symp- toms and after-seizure brain recordings using EEGs are used to distinguish between different types of epilepsy and determine whether the true cause of the seizures is epilepsy or a different medical condition. Seizures are classified by where they occur in the brain. General- ized seizures affect both sides of the brain. They include absence or petit mal seizures, which can cause rapid blinking or a few seconds of staring into space, and tonic-clonic or grand mal seizures, which can make some- one fall, have muscle spasms, cry out, and/or lose consciousness. Focal or partial seizures are localized to one area of the brain. A simple focal sei- zure can cause twitching or a change in sensation, triggering strange smells or tastes. Complex focal seizures can leave a person confused and unable to answer questions or follow direc- tions. A person can also have so-called secondary generalized seizures, which begin in one part of the brain but spread to become generalized seizures. In some patients with severe epilepsy, multiple types of seizure can occur at the same time. Epilepsy has many possible causes and thus is considered a spectrum rather than a single disorder. Causes include premature birth, brain trauma, and abnormal development due to genetic factors. Attributes of epilepsy patients such as head size, movement disorders, and family history suggest that genetics is involved. Seizures can also accompany or cause intellectual or psychiatric prob- lems. For example, some seizures may suppress the growth of dendrites, leav- ing the person emotionally unsettled or less able to learn. Treatments for epilepsy are direct- ed toward controlling seizures with medication or diet. For most patients, a single medication is enough to control seizures, although a significant minority cannot get adequate control from drugs. About half of epilepsy pa- tients, particularly those with general- ized epilepsy, can reduce their seizures by eating a ketogenic diet, which relies heavily on high-fat, low-carbohydrate foods, although it’s unclear why this diet is effective. For severe cases that are not relieved by medication, doctors might recommend surgery to remove or inactivate the seizure-initiating part of the brain. In the most severe cases, if one side of the brain triggers sei- zures on the other side, surgeons may perform “split-brain surgery,” cutting the corpus callosum, a thick band of white matter that connects the two sides of the brain. Once their seizures are controlled, people with epilepsy can resume their normal lives. Epilepsy has many possible causes and thus is considered a spectrum rather than a single disorder. USER: What are some effects of overexposure to glucocorticoids? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	24	8	11,678	null	600
You may only respond to the prompt using the information in the context block. If you cannot answer based on the context block alone, say, "I am unable to answer that due to lack of context." Do not use more than 300 words in your response.	Summarize the argument for not holding companies to contracts signed before the pandemic but fulfilled during the pandemic.	THE ROLE OF CONTRACT LAW IN SUPPLY CHAINS Food supply chains are normally composed of vertical and horizontal chains of contracts connecting various core value-chain actors from producers to consumers, as well as contractual relations among operators of support services (e.g. purchase of inputs, financial agreements). All contracts in the chain should be fair and equitable for all parties and administered in good faith. The contracts should clarify the parties’ rights and responsibilities, paying attention to the essential elements of a contract as stipulated in the national contract law. Commonly, these essential elements would include, at least, the identification of the parties, offer and acceptance, obligations, price determination, remedies in case of partial or non-compliance, termination and provisions on dispute resolution, including alternative dispute resolution (ADR). In the context of a pandemic, the risk thatsome of these elements may be compromised is increased. Contracts should always ensure fair and equitable risk allocation and management. Certain risk allocation and management would – to some extent – be covered by the concepts of force majeure and/or change of circumstances, which are designed to respond to both natural disasters (disease outbreaks, disasters, etc.) and societal events (export bans, movement restrictions, etc.). Domestic legislation often requires four simultaneous conditions to be fulfilled before the application of force majeure: the event should be 1) unforeseeable, 2) unavoidable 3) outside the parties’ control and 4) it should objectively prevent one or both of them from performing. Change of circumstances (hardship-like situations) generally requires the first three pre-conditions. Such change in circumstances would not necessarily prevent parties from performing, but it would fundamentally change the basis on which the contract was formed and alter the balance of the relationship, making it unfair to hold either or both parties to their original obligations (UNIDROIT, FAO and IFAD, 2015). Parties who concluded a contract prior to the outbreak of COVID-19 and the subsequent imposition of related restrictions, may claim that either force majeure or change of circumstances, depending on the legal and factual context, apply to their ongoing contractual relationship. The final application of force majeure or change of circumstances would depend on a national court’s or an ADR mechanism’s interpretation of the applicable criteria and may excuse compliance with, or suspend, the affected obligations or lead to renegotiation of the contract. For contracts concluded after the declaration of the emergency, the application or not of these clauses would depend on whether further changes in circumstances, connected to the emergency, can be considered “unforeseeable”, months into the pandemic. This uncertainty needs to be taken into account by those who enter into new contracts under current conditions. The negotiation and drafting of new contracts should aim at providing clarity on what should happen to the contractual relationship due to the continuing and emerging impacts of COVID-19. Considerable contractual innovation, as supported and protected by the principle of freedom of contract, is required to ensure equitable risk allocation. One option could be to explicitly agree in the contract to consider COVID-19 and its related upheavals as force majeure, or change of circumstances, where the domestic legislation allows partiesto depart from the standard andmost probably narrowlegal definitions of these terms. Another option would be for the contract to mandate the parties to renegotiate the contract, either after some time has passed or if a certain event triggers the need to do so (such as new movement restrictions imposed by the government). Finally, the contracts could also explicitly consider COVID-19 and its effects when drafting remedies for contractual breaches, such as waiving the use of remedies or opting for less disruptive and more lenient options when the underlying breach was demonstrably caused by the pandemic. Unfortunately, contractual innovation may also open the door for the stronger party in a contract to take advantage and impose imbalancesin risk allocation between the parties through the introduction of unfair contractual terms and practices. A classic example of an unfair practice would be for the contract to allow only one party to unilaterally terminate the contract without notifying or discussing it in advance with the other party. On a general level, this requires governments to either adopt, or increase enforcement of, unfair contractual practices legislation to prohibit the use of contractual terms and practices that are considered unfair. Enhanced enforcement should begin immediately, as abuses may already be happening. At the same time, if there are gaps, the reform of the legislative framework should commence in earnest as it requires an investment of effort and time and will likely go beyond the duration of the current COVID-19 crisis. In the context of food supply chains, at least for nodessuch as contracts between smallholder producers and their buyers, governments may consider creating either mandatory or voluntary registries for contracts. These can increase transparency and legal certainty for parties, when they know that their contract (with sensitive commercial information removed) may be accessible to a defined audience (Viinikainen and Bullón, 2018). Greater prominence and application of the common, but not universally accepted, principle of good faith should be promoted in this time of uncertainty and can be effective if it is backed by the threat of enforcement. The principle of good faith requires the parties to interact honestly and fairly, and refrain from taking actions that would deny their counterparty from receiving the expected benefits of the contract. Essentially, good faith infuses the contract relationship with the kind of flexibility required to address the complications that come with a pandemic or any other global emergency. Good faith may involve applying, orrefraining from adopting, certain conduct (UNIDROIT, FAO and IFAD, 2015). In the context of COVID-19 this could include greater flexibility for delivery times, honest and timely exchange of information between the parties on the impacts that the emergency has had to better anticipate difficulties, as well as willingnessto renegotiate to better adjust the contractual relationship to the rapidly changing circumstances. Finally, as good contractual practice, it is important to include reference to grievance mechanisms in the contract. This is even more important in the uncertainty created by COVID19, which may increase the likelihood of both breaches and disputes. Deciding on the method of dispute resolution in advance is important as, once a dispute has arisen, it may be difficult for the parties to agree on how to resolve it. In general, for smallholders in particular, the use of ADR mechanisms, such as arbitration and mediation, may be preferable as they tend to be less costly, less formal and faster in dealing with disputes than the courts.	[Context Block] THE ROLE OF CONTRACT LAW IN SUPPLY CHAINS Food supply chains are normally composed of vertical and horizontal chains of contracts connecting various core value-chain actors from producers to consumers, as well as contractual relations among operators of support services (e.g. purchase of inputs, financial agreements). All contracts in the chain should be fair and equitable for all parties and administered in good faith. The contracts should clarify the parties’ rights and responsibilities, paying attention to the essential elements of a contract as stipulated in the national contract law. Commonly, these essential elements would include, at least, the identification of the parties, offer and acceptance, obligations, price determination, remedies in case of partial or non-compliance, termination and provisions on dispute resolution, including alternative dispute resolution (ADR). In the context of a pandemic, the risk thatsome of these elements may be compromised is increased. Contracts should always ensure fair and equitable risk allocation and management. Certain risk allocation and management would – to some extent – be covered by the concepts of force majeure and/or change of circumstances, which are designed to respond to both natural disasters (disease outbreaks, disasters, etc.) and societal events (export bans, movement restrictions, etc.). Domestic legislation often requires four simultaneous conditions to be fulfilled before the application of force majeure: the event should be 1) unforeseeable, 2) unavoidable 3) outside the parties’ control and 4) it should objectively prevent one or both of them from performing. Change of circumstances (hardship-like situations) generally requires the first three pre-conditions. Such change in circumstances would not necessarily prevent parties from performing, but it would fundamentally change the basis on which the contract was formed and alter the balance of the relationship, making it unfair to hold either or both parties to their original obligations (UNIDROIT, FAO and IFAD, 2015). Parties who concluded a contract prior to the outbreak of COVID-19 and the subsequent imposition of related restrictions, may claim that either force majeure or change of circumstances, depending on the legal and factual context, apply to their ongoing contractual relationship. The final application of force majeure or change of circumstances would depend on a national court’s or an ADR mechanism’s interpretation of the applicable criteria and may excuse compliance with, or suspend, the affected obligations or lead to renegotiation of the contract. For contracts concluded after the declaration of the emergency, the application or not of these clauses would depend on whether further changes in circumstances, connected to the emergency, can be considered “unforeseeable”, months into the pandemic. This uncertainty needs to be taken into account by those who enter into new contracts under current conditions. The negotiation and drafting of new contracts should aim at providing clarity on what should happen to the contractual relationship due to the continuing and emerging impacts of COVID-19. Considerable contractual innovation, as supported and protected by the principle of freedom of contract, is required to ensure equitable risk allocation. One option could be to explicitly agree in the contract to consider COVID-19 and its related upheavals as force majeure, or change of circumstances, where the domestic legislation allows partiesto depart from the standard andmost probably narrowlegal definitions of these terms. Another option would be for the contract to mandate the parties to renegotiate the contract, either after some time has passed or if a certain event triggers the need to do so (such as new movement restrictions imposed by the government). Finally, the contracts could also explicitly consider COVID-19 and its effects when drafting remedies for contractual breaches, such as waiving the use of remedies or opting for less disruptive and more lenient options when the underlying breach was demonstrably caused by the pandemic. Unfortunately, contractual innovation may also open the door for the stronger party in a contract to take advantage and impose imbalancesin risk allocation between the parties through the introduction of unfair contractual terms and practices. A classic example of an unfair practice would be for the contract to allow only one party to unilaterally terminate the contract without notifying or discussing it in advance with the other party. On a general level, this requires governments to either adopt, or increase enforcement of, unfair contractual practices legislation to prohibit the use of contractual terms and practices that are considered unfair. Enhanced enforcement should begin immediately, as abuses may already be happening. At the same time, if there are gaps, the reform of the legislative framework should commence in earnest as it requires an investment of effort and time and will likely go beyond the duration of the current COVID-19 crisis. In the context of food supply chains, at least for nodessuch as contracts between smallholder producers and their buyers, governments may consider creating either mandatory or voluntary registries for contracts. These can increase transparency and legal certainty for parties, when they know that their contract (with sensitive commercial information removed) may be accessible to a defined audience (Viinikainen and Bullón, 2018). Greater prominence and application of the common, but not universally accepted, principle of good faith should be promoted in this time of uncertainty and can be effective if it is backed by the threat of enforcement. The principle of good faith requires the parties to interact honestly and fairly, and refrain from taking actions that would deny their counterparty from receiving the expected benefits of the contract. Essentially, good faith infuses the contract relationship with the kind of flexibility required to address the complications that come with a pandemic or any other global emergency. Good faith may involve applying, orrefraining from adopting, certain conduct (UNIDROIT, FAO and IFAD, 2015). In the context of COVID-19 this could include greater flexibility for delivery times, honest and timely exchange of information between the parties on the impacts that the emergency has had to better anticipate difficulties, as well as willingnessto renegotiate to better adjust the contractual relationship to the rapidly changing circumstances. Finally, as good contractual practice, it is important to include reference to grievance mechanisms in the contract. This is even more important in the uncertainty created by COVID19, which may increase the likelihood of both breaches and disputes. Deciding on the method of dispute resolution in advance is important as, once a dispute has arisen, it may be difficult for the parties to agree on how to resolve it. In general, for smallholders in particular, the use of ADR mechanisms, such as arbitration and mediation, may be preferable as they tend to be less costly, less formal and faster in dealing with disputes than the courts. [System Instruction] You may only respond to the prompt using the information in the context block. If you cannot answer based on the context block alone, say, "I am unable to answer that due to lack of context." Do not use more than 300 words in your response. [Question] Summarize the argument for not holding companies to contracts signed before the pandemic but fulfilled during the pandemic.	You may only respond to the prompt using the information in the context block. If you cannot answer based on the context block alone, say, "I am unable to answer that due to lack of context." Do not use more than 300 words in your response. EVIDENCE: THE ROLE OF CONTRACT LAW IN SUPPLY CHAINS Food supply chains are normally composed of vertical and horizontal chains of contracts connecting various core value-chain actors from producers to consumers, as well as contractual relations among operators of support services (e.g. purchase of inputs, financial agreements). All contracts in the chain should be fair and equitable for all parties and administered in good faith. The contracts should clarify the parties’ rights and responsibilities, paying attention to the essential elements of a contract as stipulated in the national contract law. Commonly, these essential elements would include, at least, the identification of the parties, offer and acceptance, obligations, price determination, remedies in case of partial or non-compliance, termination and provisions on dispute resolution, including alternative dispute resolution (ADR). In the context of a pandemic, the risk thatsome of these elements may be compromised is increased. Contracts should always ensure fair and equitable risk allocation and management. Certain risk allocation and management would – to some extent – be covered by the concepts of force majeure and/or change of circumstances, which are designed to respond to both natural disasters (disease outbreaks, disasters, etc.) and societal events (export bans, movement restrictions, etc.). Domestic legislation often requires four simultaneous conditions to be fulfilled before the application of force majeure: the event should be 1) unforeseeable, 2) unavoidable 3) outside the parties’ control and 4) it should objectively prevent one or both of them from performing. Change of circumstances (hardship-like situations) generally requires the first three pre-conditions. Such change in circumstances would not necessarily prevent parties from performing, but it would fundamentally change the basis on which the contract was formed and alter the balance of the relationship, making it unfair to hold either or both parties to their original obligations (UNIDROIT, FAO and IFAD, 2015). Parties who concluded a contract prior to the outbreak of COVID-19 and the subsequent imposition of related restrictions, may claim that either force majeure or change of circumstances, depending on the legal and factual context, apply to their ongoing contractual relationship. The final application of force majeure or change of circumstances would depend on a national court’s or an ADR mechanism’s interpretation of the applicable criteria and may excuse compliance with, or suspend, the affected obligations or lead to renegotiation of the contract. For contracts concluded after the declaration of the emergency, the application or not of these clauses would depend on whether further changes in circumstances, connected to the emergency, can be considered “unforeseeable”, months into the pandemic. This uncertainty needs to be taken into account by those who enter into new contracts under current conditions. The negotiation and drafting of new contracts should aim at providing clarity on what should happen to the contractual relationship due to the continuing and emerging impacts of COVID-19. Considerable contractual innovation, as supported and protected by the principle of freedom of contract, is required to ensure equitable risk allocation. One option could be to explicitly agree in the contract to consider COVID-19 and its related upheavals as force majeure, or change of circumstances, where the domestic legislation allows partiesto depart from the standard andmost probably narrowlegal definitions of these terms. Another option would be for the contract to mandate the parties to renegotiate the contract, either after some time has passed or if a certain event triggers the need to do so (such as new movement restrictions imposed by the government). Finally, the contracts could also explicitly consider COVID-19 and its effects when drafting remedies for contractual breaches, such as waiving the use of remedies or opting for less disruptive and more lenient options when the underlying breach was demonstrably caused by the pandemic. Unfortunately, contractual innovation may also open the door for the stronger party in a contract to take advantage and impose imbalancesin risk allocation between the parties through the introduction of unfair contractual terms and practices. A classic example of an unfair practice would be for the contract to allow only one party to unilaterally terminate the contract without notifying or discussing it in advance with the other party. On a general level, this requires governments to either adopt, or increase enforcement of, unfair contractual practices legislation to prohibit the use of contractual terms and practices that are considered unfair. Enhanced enforcement should begin immediately, as abuses may already be happening. At the same time, if there are gaps, the reform of the legislative framework should commence in earnest as it requires an investment of effort and time and will likely go beyond the duration of the current COVID-19 crisis. In the context of food supply chains, at least for nodessuch as contracts between smallholder producers and their buyers, governments may consider creating either mandatory or voluntary registries for contracts. These can increase transparency and legal certainty for parties, when they know that their contract (with sensitive commercial information removed) may be accessible to a defined audience (Viinikainen and Bullón, 2018). Greater prominence and application of the common, but not universally accepted, principle of good faith should be promoted in this time of uncertainty and can be effective if it is backed by the threat of enforcement. The principle of good faith requires the parties to interact honestly and fairly, and refrain from taking actions that would deny their counterparty from receiving the expected benefits of the contract. Essentially, good faith infuses the contract relationship with the kind of flexibility required to address the complications that come with a pandemic or any other global emergency. Good faith may involve applying, orrefraining from adopting, certain conduct (UNIDROIT, FAO and IFAD, 2015). In the context of COVID-19 this could include greater flexibility for delivery times, honest and timely exchange of information between the parties on the impacts that the emergency has had to better anticipate difficulties, as well as willingnessto renegotiate to better adjust the contractual relationship to the rapidly changing circumstances. Finally, as good contractual practice, it is important to include reference to grievance mechanisms in the contract. This is even more important in the uncertainty created by COVID19, which may increase the likelihood of both breaches and disputes. Deciding on the method of dispute resolution in advance is important as, once a dispute has arisen, it may be difficult for the parties to agree on how to resolve it. In general, for smallholders in particular, the use of ADR mechanisms, such as arbitration and mediation, may be preferable as they tend to be less costly, less formal and faster in dealing with disputes than the courts. USER: Summarize the argument for not holding companies to contracts signed before the pandemic but fulfilled during the pandemic. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	46	18	1,087	null	506
You can only respond using data from the information provided in the prompt. Don't use any other data, or external searches.	How could having overly high expectations for the diverse functionality of a product not be good for the user? How could this be more harmful to the product experience?	The management of the complexity does not try to avoid the conflict existing inside the process of human vs. product interaction by modifying the user behavior. Instead, to reduce the complexity is necessary to alter the suggested tasks for that product, and which are susceptible of being modified by the future user. This modification made by the person is dynamic, such as the evolutionary process of adaptation of the product to his own preferences. But this spectrum of changes must be contemplated inside the original plans of the product conceptualization. Then, the existing level of complexity must be measured by the agent (user) skills. From this point we have two possibilities to define the level of complexity. The first one is aims to identify the level of complexity inside the prescribed activity to be made the agent. And the second possibility is related to the skills or incompetence of the agent. This works with the level of instruction of the human being related to the product that will use. This consideration is important, because it will show in which extend the product will satisfy the users expected necessities. To deal with the components of the system and avoiding its complexity is important to define clearly the kind of model and its final target use. In many situations, the intention of creating ways to demonstrate and clarifying the functions of the product has as a consequence a highly complex product with high cost and underutilization functionality, because the agent (user) is not properly defined or over assisted. While analyzing a group of students, by using a observation and non interventional methodology, was detected the “rookie intention to provide the highest technology to they projects, without considering the total information of users capability or the target of the product under development. Is know, that the intention is the best, but this could generate new problems instead of solve the older. The human evolutionary capability must provide him conditions to assimilate new technologies, but this is not a clearly condition because it depends on his social group and the way it conditions that evolutionary process. So, if this dynamic process is not really understood, the conceptualization of a new product could overestimate the learning capability (increasing the mental load to restrict management levels), generating uncontrollable interface andhigh-level complexity that demands a rework of the tasks defined for that product. An example for this situation, level of product complexity, is the Wi-Fi router. On one side the user operates it and understand it as a easy way of connectivity of its electronic appliances without physic contact (this demands a basic information of its use). On the other side a physic scientist will analyze from another perspective, like radiation, signal intensity or electromagnetic behaviors. So, this is a situation when the complexity achieves highest level, needing to incorporate the interface as its own domain [8].	System Instruction: You can only respond using data from the information provided in the prompt. Don't use any other data, or external searches. Question: How could having overly high expectations for the diverse functionality of a product not be good for the user? How could this be more harmful to the product experience? Context Block: The management of the complexity does not try to avoid the conflict existing inside the process of human vs. product interaction by modifying the user behavior. Instead, to reduce the complexity is necessary to alter the suggested tasks for that product, and which are susceptible of being modified by the future user. This modification made by the person is dynamic, such as the evolutionary process of adaptation of the product to his own preferences. But this spectrum of changes must be contemplated inside the original plans of the product conceptualization. Then, the existing level of complexity must be measured by the agent (user) skills. From this point we have two possibilities to define the level of complexity. The first one is aims to identify the level of complexity inside the prescribed activity to be made the agent. And the second possibility is related to the skills or incompetence of the agent. This works with the level of instruction of the human being related to the product that will use. This consideration is important, because it will show in which extend the product will satisfy the users expected necessities. To deal with the components of the system and avoiding its complexity is important to define clearly the kind of model and its final target use. In many situations, the intention of creating ways to demonstrate and clarifying the functions of the product has as a consequence a highly complex product with high cost and underutilization functionality, because the agent (user) is not properly defined or over assisted. While analyzing a group of students, by using a observation and non interventional methodology, was detected the “rookie intention to provide the highest technology to they projects, without considering the total information of users capability or the target of the product under development. Is know, that the intention is the best, but this could generate new problems instead of solve the older. The human evolutionary capability must provide him conditions to assimilate new technologies, but this is not a clearly condition because it depends on his social group and the way it conditions that evolutionary process. So, if this dynamic process is not really understood, the conceptualization of a new product could overestimate the learning capability (increasing the mental load to restrict management levels), generating uncontrollable interface andhigh-level complexity that demands a rework of the tasks defined for that product. An example for this situation, level of product complexity, is the Wi-Fi router. On one side the user operates it and understand it as a easy way of connectivity of its electronic appliances without physic contact (this demands a basic information of its use). On the other side a physic scientist will analyze from another perspective, like radiation, signal intensity or electromagnetic behaviors. So, this is a situation when the complexity achieves highest level, needing to incorporate the interface as its own domain [8].	You can only respond using data from the information provided in the prompt. Don't use any other data, or external searches. EVIDENCE: The management of the complexity does not try to avoid the conflict existing inside the process of human vs. product interaction by modifying the user behavior. Instead, to reduce the complexity is necessary to alter the suggested tasks for that product, and which are susceptible of being modified by the future user. This modification made by the person is dynamic, such as the evolutionary process of adaptation of the product to his own preferences. But this spectrum of changes must be contemplated inside the original plans of the product conceptualization. Then, the existing level of complexity must be measured by the agent (user) skills. From this point we have two possibilities to define the level of complexity. The first one is aims to identify the level of complexity inside the prescribed activity to be made the agent. And the second possibility is related to the skills or incompetence of the agent. This works with the level of instruction of the human being related to the product that will use. This consideration is important, because it will show in which extend the product will satisfy the users expected necessities. To deal with the components of the system and avoiding its complexity is important to define clearly the kind of model and its final target use. In many situations, the intention of creating ways to demonstrate and clarifying the functions of the product has as a consequence a highly complex product with high cost and underutilization functionality, because the agent (user) is not properly defined or over assisted. While analyzing a group of students, by using a observation and non interventional methodology, was detected the “rookie intention to provide the highest technology to they projects, without considering the total information of users capability or the target of the product under development. Is know, that the intention is the best, but this could generate new problems instead of solve the older. The human evolutionary capability must provide him conditions to assimilate new technologies, but this is not a clearly condition because it depends on his social group and the way it conditions that evolutionary process. So, if this dynamic process is not really understood, the conceptualization of a new product could overestimate the learning capability (increasing the mental load to restrict management levels), generating uncontrollable interface andhigh-level complexity that demands a rework of the tasks defined for that product. An example for this situation, level of product complexity, is the Wi-Fi router. On one side the user operates it and understand it as a easy way of connectivity of its electronic appliances without physic contact (this demands a basic information of its use). On the other side a physic scientist will analyze from another perspective, like radiation, signal intensity or electromagnetic behaviors. So, this is a situation when the complexity achieves highest level, needing to incorporate the interface as its own domain [8]. USER: How could having overly high expectations for the diverse functionality of a product not be good for the user? How could this be more harmful to the product experience? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	21	29	480	null	78
You may only respond to the prompt using information provided in the context block. Provide your answer using a bulleted list.	What was decided in Robinson v. California?	The Eighth Amendment provides, “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.” The Eighth Amendment’s prohibitions apply to laws enacted by the federal government, and by state governments and their local subdivisions by operation of the Fourteenth Amendment. The Supreme Court has interpreted the Amendment’s prohibition on cruel and unusual punishments to, among other things, impose some “substantive limits on what the government may criminalize.” Before Grants Pass, the Supreme Court had issued two primary cases elaborating on the Eighth Amendment’s substantive limits on what a government may criminalize: Robinson v. California and Powell v. Texas. In Robinson v. California, a 1962 case, the Court heard an Eighth Amendment challenge to a California law that made it a misdemeanor offense for an individual to “be addicted to the use of narcotics.” The defendant was convicted under the law; however, at the time of his arrest, he “was neither under the influence of narcotics nor suffering withdrawal symptoms.” The Supreme Court reversed the conviction and expressed concern that the defendant was convicted on the basis of his “status,” specifically that he suffered from the “chronic condition . . . of [being] addicted to the use of narcotics.” Put differently, the Court was troubled that the defendant was not convicted “upon proof of the actual use of narcotics.” The majority thus ruled that, under the Eighth Amendment, an individual may not be punished for a status or in the absence of some conduct (or “actus reus”). Six years after Robinson, the Court issued its opinion in Powell v. Texas, a case involving an Eighth Amendment challenge to a law that proscribed public intoxication. The defendant argued that because he was a chronic alcoholic, being intoxicated in public was “not of his own volition.” While the case produced multiple opinions, the plurality determined that “Texas has sought to punish not for a status, as California did in Robinson,” but rather “for public behavior which may create substantial health and safety hazards, both for [the defendant] and for members of the general public.” That is, the plurality indicated that the law at issue criminalized conduct, not status, which it viewed as permissible. In his concurring opinion in Powell, Justice Black stated that Robinson established a status-conduct distinction, forbidding punishment when the individual has not committed a “wrongful act.” Justice White also concurred in the result. Citing Robinson, Justice White opined that “[i]f it cannot be a crime to have an irresistible compulsion to use narcotics, I do not see how it can constitutionally be a crime to yield to such a compulsion.” He thus suggested that an individual may not be punished for conduct symptomatic of or compelled by an addiction. Justice White, however, concluded that the record did not support a finding that the defendant could not avoid being in public while intoxicated. Accordingly, Justice White was not prepared to “say that the chronic alcoholic who proves his disease and a compulsion to drink is shielded from conviction [for] the [additional] act of going to or remaining in a public place.” Four Justices dissented. They contended that the defendant was “powerless” to drink, had an “uncontrollable compulsion to drink to the point of intoxication,” and that once in this state “he could not prevent himself from appearing in public places.” In other words, they suggested that, here, drinking and appearing in public were both involuntary acts making criminal punishment inappropriate.	You may only respond to the prompt using information provided in the context block. Provide your answer using a bulleted list. What was decided in Robinson v. California? The Eighth Amendment provides, “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.” The Eighth Amendment’s prohibitions apply to laws enacted by the federal government, and by state governments and their local subdivisions by operation of the Fourteenth Amendment. The Supreme Court has interpreted the Amendment’s prohibition on cruel and unusual punishments to, among other things, impose some “substantive limits on what the government may criminalize.” Before Grants Pass, the Supreme Court had issued two primary cases elaborating on the Eighth Amendment’s substantive limits on what a government may criminalize: Robinson v. California and Powell v. Texas. In Robinson v. California, a 1962 case, the Court heard an Eighth Amendment challenge to a California law that made it a misdemeanor offense for an individual to “be addicted to the use of narcotics.” The defendant was convicted under the law; however, at the time of his arrest, he “was neither under the influence of narcotics nor suffering withdrawal symptoms.” The Supreme Court reversed the conviction and expressed concern that the defendant was convicted on the basis of his “status,” specifically that he suffered from the “chronic condition . . . of [being] addicted to the use of narcotics.” Put differently, the Court was troubled that the defendant was not convicted “upon proof of the actual use of narcotics.” The majority thus ruled that, under the Eighth Amendment, an individual may not be punished for a status or in the absence of some conduct (or “actus reus”). Six years after Robinson, the Court issued its opinion in Powell v. Texas, a case involving an Eighth Amendment challenge to a law that proscribed public intoxication. The defendant argued that because he was a chronic alcoholic, being intoxicated in public was “not of his own volition.” While the case produced multiple opinions, the plurality determined that “Texas has sought to punish not for a status, as California did in Robinson,” but rather “for public behavior which may create substantial health and safety hazards, both for [the defendant] and for members of the general public.” That is, the plurality indicated that the law at issue criminalized conduct, not status, which it viewed as permissible. In his concurring opinion in Powell, Justice Black stated that Robinson established a status-conduct distinction, forbidding punishment when the individual has not committed a “wrongful act.” Justice White also concurred in the result. Citing Robinson, Justice White opined that “[i]f it cannot be a crime to have an irresistible compulsion to use narcotics, I do not see how it can constitutionally be a crime to yield to such a compulsion.” He thus suggested that an individual may not be punished for conduct symptomatic of or compelled by an addiction. Justice White, however, concluded that the record did not support a finding that the defendant could not avoid being in public while intoxicated. Accordingly, Justice White was not prepared to “say that the chronic alcoholic who proves his disease and a compulsion to drink is shielded from conviction [for] the [additional] act of going to or remaining in a public place.” Four Justices dissented. They contended that the defendant was “powerless” to drink, had an “uncontrollable compulsion to drink to the point of intoxication,” and that once in this state “he could not prevent himself from appearing in public places.” In other words, they suggested that, here, drinking and appearing in public were both involuntary acts making criminal punishment inappropriate.	You may only respond to the prompt using information provided in the context block. Provide your answer using a bulleted list. EVIDENCE: The Eighth Amendment provides, “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.” The Eighth Amendment’s prohibitions apply to laws enacted by the federal government, and by state governments and their local subdivisions by operation of the Fourteenth Amendment. The Supreme Court has interpreted the Amendment’s prohibition on cruel and unusual punishments to, among other things, impose some “substantive limits on what the government may criminalize.” Before Grants Pass, the Supreme Court had issued two primary cases elaborating on the Eighth Amendment’s substantive limits on what a government may criminalize: Robinson v. California and Powell v. Texas. In Robinson v. California, a 1962 case, the Court heard an Eighth Amendment challenge to a California law that made it a misdemeanor offense for an individual to “be addicted to the use of narcotics.” The defendant was convicted under the law; however, at the time of his arrest, he “was neither under the influence of narcotics nor suffering withdrawal symptoms.” The Supreme Court reversed the conviction and expressed concern that the defendant was convicted on the basis of his “status,” specifically that he suffered from the “chronic condition . . . of [being] addicted to the use of narcotics.” Put differently, the Court was troubled that the defendant was not convicted “upon proof of the actual use of narcotics.” The majority thus ruled that, under the Eighth Amendment, an individual may not be punished for a status or in the absence of some conduct (or “actus reus”). Six years after Robinson, the Court issued its opinion in Powell v. Texas, a case involving an Eighth Amendment challenge to a law that proscribed public intoxication. The defendant argued that because he was a chronic alcoholic, being intoxicated in public was “not of his own volition.” While the case produced multiple opinions, the plurality determined that “Texas has sought to punish not for a status, as California did in Robinson,” but rather “for public behavior which may create substantial health and safety hazards, both for [the defendant] and for members of the general public.” That is, the plurality indicated that the law at issue criminalized conduct, not status, which it viewed as permissible. In his concurring opinion in Powell, Justice Black stated that Robinson established a status-conduct distinction, forbidding punishment when the individual has not committed a “wrongful act.” Justice White also concurred in the result. Citing Robinson, Justice White opined that “[i]f it cannot be a crime to have an irresistible compulsion to use narcotics, I do not see how it can constitutionally be a crime to yield to such a compulsion.” He thus suggested that an individual may not be punished for conduct symptomatic of or compelled by an addiction. Justice White, however, concluded that the record did not support a finding that the defendant could not avoid being in public while intoxicated. Accordingly, Justice White was not prepared to “say that the chronic alcoholic who proves his disease and a compulsion to drink is shielded from conviction [for] the [additional] act of going to or remaining in a public place.” Four Justices dissented. They contended that the defendant was “powerless” to drink, had an “uncontrollable compulsion to drink to the point of intoxication,” and that once in this state “he could not prevent himself from appearing in public places.” In other words, they suggested that, here, drinking and appearing in public were both involuntary acts making criminal punishment inappropriate. USER: What was decided in Robinson v. California? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	21	7	575	null	240
Only answer the question from the information provided in the prompt, and don't use any external information or prior knowledge. If you can't answer part or all of the question, say something like "There is not enough information to answer this".	What are five effects that high interest rates could have on the economy?	Why Is the Federal Reserve Keeping Interest Rates “High for Longer”? July 3, 2024 The Federal Reserve (Fed) responded to the post-pandemic spike in inflation by rapidly raising short-term interest rates between 2022 and 2023. Since July 2023, the Fed has maintained a target range of 5.25%- 5.5%, the highest target since 2001. As inflation subsequently fell, futures markets expected the Fed to begin reducing rates this spring. Instead, rates have remained unchanged through the first half of the year—a stance that has been popularly referred to as keeping rates “high for longer.” This Insight examines why. Inflation and Monetary Policy The Fed has a statutory mandate to promote “maximum employment, stable prices, and moderate longterm interest rates.” The Fed has defined 2% inflation—as measured by the personal consumer expenditures price (PCE) index—as consistent with its price stability mandate. Economists view monetary policy as the primary policy tool for influencing inflation. External factors can lead to short-term changes in inflation, but the Fed has demonstrated in recent decades that monetary policy has the ability to guide inflation to the Fed’s desired target over the medium term. To carry out monetary policy, the Fed targets the federal funds rate (the overnight bank lending rate), as explained in CRS In Focus IF11751, Introduction to U.S. Economy: Monetary Policy. When the Fed raises the federal funds rate, it reduces interest-sensitive spending, causing overall demand (spending) to cool off and inflation to fall, all else equal. Recent Trends and Policy Inflation was mostly near the Fed’s 2% target for decades until supply and demand disruptions caused by COVID-19 and the invasion of Ukraine caused inflation to rise rapidly (see CRS Report R47273, Inflation in the U.S. Economy: Causes and Policy Options). As seen in Figure 1, inflation has exceeded 2% since March 2021 as measured both by total PCE and core PCE, which excludes volatile food and energy prices. Overall inflation peaked above 7% in June 2022—its highest level since 1981. (By Congressional Research Service https://crsreports.congress.gov IN12388 Congressional Research Service 2 contrast, unemployment has been below 5% since 2021, so the Fed has not had to focus on supporting its employment mandate.) Figure 1. Inflation and Interest Rates January 2020 to April 2024 Source: Bureau of Economic Analysis and Federal Reserve. Notes: The figure plots the 12-month change in prices and the effective federal funds rate. Inflation fell rapidly in the second half of 2022 and 2023, falling below 3% by the end of 2023 because most supply disruptions were resolved and energy prices declined rapidly for most of 2023. September 2023 was the first meeting where the Fed left rates unchanged. The Fed reasoned that lags between changes in monetary policy and their effects on the economy meant that earlier rate increases would continue to reduce inflation. In December 2023, most Fed officials anticipated that the Fed would reduce rates by a projected cumulative 0.5-1.25 percentage points in 2024. In January 2024, with new data that overall and core inflation were both below 3%, the Fed shifted its language from “additional policy firming” to “moving into better balance,” which market participants interpreted as the Fed planning to begin reducing rates in the first half of 2024. For example, after the Fed’s January meeting, futures markets predicted a 94% chance that rates would be cut by May 2024. The Fed would like to eventually reduce rates, because it believes, as articulated by the chair, that the current interest rate target is too high to be consistent with maintaining full employment and a robust expansion once inflation has returned to 2%. It would like to avoid a “hard landing,” where high interest rates trigger a recession. Therefore, the Fed’s goal is to reduce rates but not until it “has gained greater confidence that inflation is moving sustainably toward 2%.” According to this position, inflation does not have to fall to 2% before rates are cut—rather, the Fed must have confidence that inflation is heading toward 2%. It first used this language in January 2024. Since then, it has backed off near-term rate cuts because the deceleration in inflation has stalled out. Since December 2023, overall inflation has not changed, and core inflation has fallen by less than ¼ of a percentage point. Although it is close to 2%, those measures of inflation cover the past 12 months, which includes several months of very small changes to the price indices in 2023 that bring down the average. By contrast, the one-month changes in prices in most months in 2024 have been high enough—with the exception of May, which was very low—that, were they to continue in the coming months, the 12-month inflation rate would start rising again as the low inflation months from 2023 drop out of the data. In June, most Fed officials anticipated Congressional Research Service 3 IN12388 · VERSION 1 · NEW that the Fed would reduce rates by a cumulative 0.25-0.5 percentage points in 2024, but some did not anticipate that rates would be cut at all. Looking Ahead Because rates have been above 5% for over a year, the lagged effects of monetary policy are largely working through the economy at this point. It is increasingly unlikely that the current stance of monetary policy alone will cause a hard landing, and private forecasters have lowered their probability of the economy entering a recession in the near term. So far, the Fed believes that the current level of rates will eventually reduce inflation to 2% if left in place long enough. One reason that it might prove to be correct is because, as inflation has fallen and nominal (i.e., not adjusted for inflation) interest rates have stayed the same, real (i.e., inflation-adjusted) interest rates have risen. Because economic activity is primarily influenced by real rates, the same nominal rate is more contractionary today than it was in July 2023. But at some point, if the decline in inflation continues to stall out, the Fed may need to consider whether somewhat higher rates are needed to reduce inflation and how that would affect the odds of a recession. Author Information Marc Labonte Specialist in Macroeconomic Policy Disclaimer This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you wish to copy or otherwise use copyrighted material.	Only answer the question from the information provided in the prompt, and don't use any external information or prior knowledge. If you can't answer part or all of the question, say something like "There is not enough information to answer this". What are five effects that high interest rates could have on the economy? Why Is the Federal Reserve Keeping Interest Rates “High for Longer”? July 3, 2024 The Federal Reserve (Fed) responded to the post-pandemic spike in inflation by rapidly raising short-term interest rates between 2022 and 2023. Since July 2023, the Fed has maintained a target range of 5.25%- 5.5%, the highest target since 2001. As inflation subsequently fell, futures markets expected the Fed to begin reducing rates this spring. Instead, rates have remained unchanged through the first half of the year—a stance that has been popularly referred to as keeping rates “high for longer.” This Insight examines why. Inflation and Monetary Policy The Fed has a statutory mandate to promote “maximum employment, stable prices, and moderate longterm interest rates.” The Fed has defined 2% inflation—as measured by the personal consumer expenditures price (PCE) index—as consistent with its price stability mandate. Economists view monetary policy as the primary policy tool for influencing inflation. External factors can lead to short-term changes in inflation, but the Fed has demonstrated in recent decades that monetary policy has the ability to guide inflation to the Fed’s desired target over the medium term. To carry out monetary policy, the Fed targets the federal funds rate (the overnight bank lending rate), as explained in CRS In Focus IF11751, Introduction to U.S. Economy: Monetary Policy. When the Fed raises the federal funds rate, it reduces interest-sensitive spending, causing overall demand (spending) to cool off and inflation to fall, all else equal. Recent Trends and Policy Inflation was mostly near the Fed’s 2% target for decades until supply and demand disruptions caused by COVID-19 and the invasion of Ukraine caused inflation to rise rapidly (see CRS Report R47273, Inflation in the U.S. Economy: Causes and Policy Options). As seen in Figure 1, inflation has exceeded 2% since March 2021 as measured both by total PCE and core PCE, which excludes volatile food and energy prices. Overall inflation peaked above 7% in June 2022—its highest level since 1981. (By Congressional Research Service https://crsreports.congress.gov IN12388 Congressional Research Service 2 contrast, unemployment has been below 5% since 2021, so the Fed has not had to focus on supporting its employment mandate.) Figure 1. Inflation and Interest Rates January 2020 to April 2024 Source: Bureau of Economic Analysis and Federal Reserve. Notes: The figure plots the 12-month change in prices and the effective federal funds rate. Inflation fell rapidly in the second half of 2022 and 2023, falling below 3% by the end of 2023 because most supply disruptions were resolved and energy prices declined rapidly for most of 2023. September 2023 was the first meeting where the Fed left rates unchanged. The Fed reasoned that lags between changes in monetary policy and their effects on the economy meant that earlier rate increases would continue to reduce inflation. In December 2023, most Fed officials anticipated that the Fed would reduce rates by a projected cumulative 0.5-1.25 percentage points in 2024. In January 2024, with new data that overall and core inflation were both below 3%, the Fed shifted its language from “additional policy firming” to “moving into better balance,” which market participants interpreted as the Fed planning to begin reducing rates in the first half of 2024. For example, after the Fed’s January meeting, futures markets predicted a 94% chance that rates would be cut by May 2024. The Fed would like to eventually reduce rates, because it believes, as articulated by the chair, that the current interest rate target is too high to be consistent with maintaining full employment and a robust expansion once inflation has returned to 2%. It would like to avoid a “hard landing,” where high interest rates trigger a recession. Therefore, the Fed’s goal is to reduce rates but not until it “has gained greater confidence that inflation is moving sustainably toward 2%.” According to this position, inflation does not have to fall to 2% before rates are cut—rather, the Fed must have confidence that inflation is heading toward 2%. It first used this language in January 2024. Since then, it has backed off near-term rate cuts because the deceleration in inflation has stalled out. Since December 2023, overall inflation has not changed, and core inflation has fallen by less than ¼ of a percentage point. Although it is close to 2%, those measures of inflation cover the past 12 months, which includes several months of very small changes to the price indices in 2023 that bring down the average. By contrast, the one-month changes in prices in most months in 2024 have been high enough—with the exception of May, which was very low—that, were they to continue in the coming months, the 12-month inflation rate would start rising again as the low inflation months from 2023 drop out of the data. In June, most Fed officials anticipated Congressional Research Service 3 IN12388 · VERSION 1 · NEW that the Fed would reduce rates by a cumulative 0.25-0.5 percentage points in 2024, but some did not anticipate that rates would be cut at all. Looking Ahead Because rates have been above 5% for over a year, the lagged effects of monetary policy are largely working through the economy at this point. It is increasingly unlikely that the current stance of monetary policy alone will cause a hard landing, and private forecasters have lowered their probability of the economy entering a recession in the near term. So far, the Fed believes that the current level of rates will eventually reduce inflation to 2% if left in place long enough. One reason that it might prove to be correct is because, as inflation has fallen and nominal (i.e., not adjusted for inflation) interest rates have stayed the same, real (i.e., inflation-adjusted) interest rates have risen. Because economic activity is primarily influenced by real rates, the same nominal rate is more contractionary today than it was in July 2023. But at some point, if the decline in inflation continues to stall out, the Fed may need to consider whether somewhat higher rates are needed to reduce inflation and how that would affect the odds of a recession. Author Information Marc Labonte Specialist in Macroeconomic Policy Disclaimer This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you wish to copy or otherwise use copyrighted material.	Only answer the question from the information provided in the prompt, and don't use any external information or prior knowledge. If you can't answer part or all of the question, say something like "There is not enough information to answer this". EVIDENCE: Why Is the Federal Reserve Keeping Interest Rates “High for Longer”? July 3, 2024 The Federal Reserve (Fed) responded to the post-pandemic spike in inflation by rapidly raising short-term interest rates between 2022 and 2023. Since July 2023, the Fed has maintained a target range of 5.25%- 5.5%, the highest target since 2001. As inflation subsequently fell, futures markets expected the Fed to begin reducing rates this spring. Instead, rates have remained unchanged through the first half of the year—a stance that has been popularly referred to as keeping rates “high for longer.” This Insight examines why. Inflation and Monetary Policy The Fed has a statutory mandate to promote “maximum employment, stable prices, and moderate longterm interest rates.” The Fed has defined 2% inflation—as measured by the personal consumer expenditures price (PCE) index—as consistent with its price stability mandate. Economists view monetary policy as the primary policy tool for influencing inflation. External factors can lead to short-term changes in inflation, but the Fed has demonstrated in recent decades that monetary policy has the ability to guide inflation to the Fed’s desired target over the medium term. To carry out monetary policy, the Fed targets the federal funds rate (the overnight bank lending rate), as explained in CRS In Focus IF11751, Introduction to U.S. Economy: Monetary Policy. When the Fed raises the federal funds rate, it reduces interest-sensitive spending, causing overall demand (spending) to cool off and inflation to fall, all else equal. Recent Trends and Policy Inflation was mostly near the Fed’s 2% target for decades until supply and demand disruptions caused by COVID-19 and the invasion of Ukraine caused inflation to rise rapidly (see CRS Report R47273, Inflation in the U.S. Economy: Causes and Policy Options). As seen in Figure 1, inflation has exceeded 2% since March 2021 as measured both by total PCE and core PCE, which excludes volatile food and energy prices. Overall inflation peaked above 7% in June 2022—its highest level since 1981. (By Congressional Research Service https://crsreports.congress.gov IN12388 Congressional Research Service 2 contrast, unemployment has been below 5% since 2021, so the Fed has not had to focus on supporting its employment mandate.) Figure 1. Inflation and Interest Rates January 2020 to April 2024 Source: Bureau of Economic Analysis and Federal Reserve. Notes: The figure plots the 12-month change in prices and the effective federal funds rate. Inflation fell rapidly in the second half of 2022 and 2023, falling below 3% by the end of 2023 because most supply disruptions were resolved and energy prices declined rapidly for most of 2023. September 2023 was the first meeting where the Fed left rates unchanged. The Fed reasoned that lags between changes in monetary policy and their effects on the economy meant that earlier rate increases would continue to reduce inflation. In December 2023, most Fed officials anticipated that the Fed would reduce rates by a projected cumulative 0.5-1.25 percentage points in 2024. In January 2024, with new data that overall and core inflation were both below 3%, the Fed shifted its language from “additional policy firming” to “moving into better balance,” which market participants interpreted as the Fed planning to begin reducing rates in the first half of 2024. For example, after the Fed’s January meeting, futures markets predicted a 94% chance that rates would be cut by May 2024. The Fed would like to eventually reduce rates, because it believes, as articulated by the chair, that the current interest rate target is too high to be consistent with maintaining full employment and a robust expansion once inflation has returned to 2%. It would like to avoid a “hard landing,” where high interest rates trigger a recession. Therefore, the Fed’s goal is to reduce rates but not until it “has gained greater confidence that inflation is moving sustainably toward 2%.” According to this position, inflation does not have to fall to 2% before rates are cut—rather, the Fed must have confidence that inflation is heading toward 2%. It first used this language in January 2024. Since then, it has backed off near-term rate cuts because the deceleration in inflation has stalled out. Since December 2023, overall inflation has not changed, and core inflation has fallen by less than ¼ of a percentage point. Although it is close to 2%, those measures of inflation cover the past 12 months, which includes several months of very small changes to the price indices in 2023 that bring down the average. By contrast, the one-month changes in prices in most months in 2024 have been high enough—with the exception of May, which was very low—that, were they to continue in the coming months, the 12-month inflation rate would start rising again as the low inflation months from 2023 drop out of the data. In June, most Fed officials anticipated Congressional Research Service 3 IN12388 · VERSION 1 · NEW that the Fed would reduce rates by a cumulative 0.25-0.5 percentage points in 2024, but some did not anticipate that rates would be cut at all. Looking Ahead Because rates have been above 5% for over a year, the lagged effects of monetary policy are largely working through the economy at this point. It is increasingly unlikely that the current stance of monetary policy alone will cause a hard landing, and private forecasters have lowered their probability of the economy entering a recession in the near term. So far, the Fed believes that the current level of rates will eventually reduce inflation to 2% if left in place long enough. One reason that it might prove to be correct is because, as inflation has fallen and nominal (i.e., not adjusted for inflation) interest rates have stayed the same, real (i.e., inflation-adjusted) interest rates have risen. Because economic activity is primarily influenced by real rates, the same nominal rate is more contractionary today than it was in July 2023. But at some point, if the decline in inflation continues to stall out, the Fed may need to consider whether somewhat higher rates are needed to reduce inflation and how that would affect the odds of a recession. Author Information Marc Labonte Specialist in Macroeconomic Policy Disclaimer This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you wish to copy or otherwise use copyrighted material. USER: What are five effects that high interest rates could have on the economy? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	true	41	13	1,165	null	376
Using only the information provided in the above context block, answer the following question:	Of the money the National Electric Vehicle Infrastructure Formula Program provides, $1 billion is distributed by which agency?	U.S. electric vehicle sales doubled between 2020 and 2021 and account for about 4% of all vehicles sold. Infrastructure to charge those vehicles exists along a range, from 120 volt plugs in many home garages to more expensive faster chargers with more than 400 volts. Market surveys have shown that consumers are concerned about the lack of an extensive charging network across the country, as well as the related concerns that some electric vehicles have a limited range before needing to be recharged. The IIJA grant programs were designed to address those concerns along major U.S. highways. In addition, the IIJA directs FHWA to develop standards for charging infrastructure funded by certain federally programs so charging is secure, provides a range of payment options, and meets certain installation requirements. The federal government has in the past provided limited financial support for installation of electric vehicle charging stations, such as through the alternative fuel infrastructure tax credit—modified by the law commonly referred to as the Inflation Reduction Act of 2022 (IRA, P.L. 117-169)—and the Congestion Mitigation Air Quality Improvement program. With just over 50,000 charging stations in October 2022—and more than 130,000 ports for charging—electric vehicle charging capacity is far below one estimate that 2.4 million charging stations that may be necessary in 2030 to sustain an electric vehicle fleet of 26 million vehicles (an estimate from one group of what may be needed to support California and other states’ zero-emission vehicle (ZEV) goals). The two $7.5 billion grant programs established by IIJA are • The National Electric Vehicle Infrastructure (NEVI) Formula Program, which is to provide $5 billion in grants, with $1 billion distributed by FHWA in each of FY2022-FY2026. All states, the District of Columbia, and Puerto Rico are eligible, and funds must be used for charging along the national highway system and primarily along highways already designated as alternative fuel corridors. Under existing FHWA guidelines, new charging stations should be spaced a maximum of 50 miles apart. A new FHWA rule sets additional standards and requirements. In September 2022, all state plans were approved, opening access to FY2022 and FY2023 NEVI funding. • The Charging and Fueling Infrastructure (CFI) grant program, which is to provide $2.5 billion over five years to strategically deploy alternative fuel infrastructure for vehicles powered by electricity and other fuels. Half of the new funding is to be used along FHWA corridors earmarked for those fuels. The other half is to be applied to uses in public building parking lots and in similar publicly accessible locations. CFI grants differ from NEVI in two ways: (a) grants are to be subject to a competitive process, unlike the formula-based NEVI; and (b) priority are to be given to applicants in rural areas, disadvantaged communities, and areas with high rates of multi-unit housing. Using only the information provided in the above context block, answer the following question: Of the money the National Electric Vehicle Infrastructure Formula Program provides, $1 billion is distributed by which agency?	"U.S. electric vehicle sales doubled between 2020 and 2021 and account for about 4% of all vehicles sold. Infrastructure to charge those vehicles exists along a range, from 120 volt plugs in many home garages to more expensive faster chargers with more than 400 volts. Market surveys have shown that consumers are concerned about the lack of an extensive charging network across the country, as well as the related concerns that some electric vehicles have a limited range before needing to be recharged. The IIJA grant programs were designed to address those concerns along major U.S. highways. In addition, the IIJA directs FHWA to develop standards for charging infrastructure funded by certain federally programs so charging is secure, provides a range of payment options, and meets certain installation requirements. The federal government has in the past provided limited financial support for installation of electric vehicle charging stations, such as through the alternative fuel infrastructure tax credit—modified by the law commonly referred to as the Inflation Reduction Act of 2022 (IRA, P.L. 117-169)—and the Congestion Mitigation Air Quality Improvement program. With just over 50,000 charging stations in October 2022—and more than 130,000 ports for charging—electric vehicle charging capacity is far below one estimate that 2.4 million charging stations that may be necessary in 2030 to sustain an electric vehicle fleet of 26 million vehicles (an estimate from one group of what may be needed to support California and other states’ zero-emission vehicle (ZEV) goals). The two $7.5 billion grant programs established by IIJA are • The National Electric Vehicle Infrastructure (NEVI) Formula Program, which is to provide $5 billion in grants, with $1 billion distributed by FHWA in each of FY2022-FY2026. All states, the District of Columbia, and Puerto Rico are eligible, and funds must be used for charging along the national highway system and primarily along highways already designated as alternative fuel corridors. Under existing FHWA guidelines, new charging stations should be spaced a maximum of 50 miles apart. A new FHWA rule sets additional standards and requirements. In September 2022, all state plans were approved, opening access to FY2022 and FY2023 NEVI funding. • The Charging and Fueling Infrastructure (CFI) grant program, which is to provide $2.5 billion over five years to strategically deploy alternative fuel infrastructure for vehicles powered by electricity and other fuels. Half of the new funding is to be used along FHWA corridors earmarked for those fuels. The other half is to be applied to uses in public building parking lots and in similar publicly accessible locations. CFI grants differ from NEVI in two ways: (a) grants are to be subject to a competitive process, unlike the formula-based NEVI; and (b) priority are to be given to applicants in rural areas, disadvantaged communities, and areas with high rates of multi-unit housing. " Using only the information provided in the above context block, answer the following question: Of the money the National Electric Vehicle Infrastructure Formula Program provides, $1 billion is distributed by which agency?	Using only the information provided in the above context block, answer the following question: EVIDENCE: U.S. electric vehicle sales doubled between 2020 and 2021 and account for about 4% of all vehicles sold. Infrastructure to charge those vehicles exists along a range, from 120 volt plugs in many home garages to more expensive faster chargers with more than 400 volts. Market surveys have shown that consumers are concerned about the lack of an extensive charging network across the country, as well as the related concerns that some electric vehicles have a limited range before needing to be recharged. The IIJA grant programs were designed to address those concerns along major U.S. highways. In addition, the IIJA directs FHWA to develop standards for charging infrastructure funded by certain federally programs so charging is secure, provides a range of payment options, and meets certain installation requirements. The federal government has in the past provided limited financial support for installation of electric vehicle charging stations, such as through the alternative fuel infrastructure tax credit—modified by the law commonly referred to as the Inflation Reduction Act of 2022 (IRA, P.L. 117-169)—and the Congestion Mitigation Air Quality Improvement program. With just over 50,000 charging stations in October 2022—and more than 130,000 ports for charging—electric vehicle charging capacity is far below one estimate that 2.4 million charging stations that may be necessary in 2030 to sustain an electric vehicle fleet of 26 million vehicles (an estimate from one group of what may be needed to support California and other states’ zero-emission vehicle (ZEV) goals). The two $7.5 billion grant programs established by IIJA are • The National Electric Vehicle Infrastructure (NEVI) Formula Program, which is to provide $5 billion in grants, with $1 billion distributed by FHWA in each of FY2022-FY2026. All states, the District of Columbia, and Puerto Rico are eligible, and funds must be used for charging along the national highway system and primarily along highways already designated as alternative fuel corridors. Under existing FHWA guidelines, new charging stations should be spaced a maximum of 50 miles apart. A new FHWA rule sets additional standards and requirements. In September 2022, all state plans were approved, opening access to FY2022 and FY2023 NEVI funding. • The Charging and Fueling Infrastructure (CFI) grant program, which is to provide $2.5 billion over five years to strategically deploy alternative fuel infrastructure for vehicles powered by electricity and other fuels. Half of the new funding is to be used along FHWA corridors earmarked for those fuels. The other half is to be applied to uses in public building parking lots and in similar publicly accessible locations. CFI grants differ from NEVI in two ways: (a) grants are to be subject to a competitive process, unlike the formula-based NEVI; and (b) priority are to be given to applicants in rural areas, disadvantaged communities, and areas with high rates of multi-unit housing. Using only the information provided in the above context block, answer the following question: Of the money the National Electric Vehicle Infrastructure Formula Program provides, $1 billion is distributed by which agency? USER: Of the money the National Electric Vehicle Infrastructure Formula Program provides, $1 billion is distributed by which agency? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	14	18	498	null	214
Please base your answer on the information provided in this document only. Do not embellish your response or add any details that are unnecessary to answer the question. Use simple words and avoid any jargon that may be foreign to the layman.	What figures are given to indicate the rising use of cannabis consumption in the United States?	Study of smoking cannabis in adults EXCERPT Abstract Background We examined the association between cannabis use and cardiovascular outcomes among the general population, among never‐tobacco smokers, and among younger individuals. Conclusions Cannabis use is associated with adverse cardiovascular outcomes, with heavier use (more days per month) associated with higher odds of adverse outcomes. Clinical Perspective What Is New? Cannabis use is associated with increased risk of myocardial infarction and stroke, with higher odds of events associated with more days of use per month, controlling for demographic factors and tobacco smoking. Similar increases in risk associated with cannabis use are found in never‐tobacco smokers. What Are the Clinical Implications? Patients should be screened for cannabis use and advised to avoid smoking cannabis to reduce their risk of premature cardiovascular disease and cardiac events. Nonstandard Abbreviations and Acronyms BRFSS Behavioral Risk Factor Surveillance System Cannabis use is increasing in the US population.1 From 2002 to 2019, past‐year prevalence of US adult cannabis use increased from 10.4% to 18.0%, whereas daily/almost daily use (300+ days per year) increased from 1.3% to 3.9%. Rising diagnoses of cannabis use disorder suggest that this increase in use is not confined to reporting of use.2, 3 At the same time, perceptions of the harmfulness of cannabis are decreasing. National surveys reported that adult belief in great risk of weekly cannabis use fell from 50% in 2002 to 28.6% in 2019.4 Despite common use, little is known about the risks of cannabis use and, in particular, the cardiovascular disease risks. Cardiovascular‐related death is the leading cause of mortality, and cannabis use could be an important, unappreciated risk factor leading to many preventable deaths.5 There are reasons to believe that cannabis use is associated with atherosclerotic heart disease. Endocannabinoid receptors are ubiquitous throughout the cardiovascular system.6 Tetrahydrocannabinol, the active component of cannabis, has hemodynamic effects and may result in syncope, stroke, and myocardial infarction.7, 8, 9 Smoking, the predominant method of cannabis use,10 may pose additional cardiovascular risks as a result of inhalation of particulate matter.11 Furthermore, studies in rats have demonstrated that secondhand cannabis smoke exposure is associated with endothelial dysfunction, a precursor to cardiovascular disease.11 Past studies on the association between cannabis use and cardiovascular outcomes have been limited by the dearth of adults with frequent cannabis use.7, 12, 13 Moreover, most studies have been in younger populations at low risk for cardiovascular disease, and therefore without sufficient power to detect an association between cannabis use and atherosclerotic heart disease outcomes.7, 12, 14 In addition, tobacco use among adults who use cannabis is common, and small sample sizes prevented analyses on the association of cannabis use with cardiovascular outcomes among nontobacco users. Any independent effects of cannabis and tobacco in the general adult population and effects of cannabis use among those who have never smoked tobacco cigarettes is of interest, because some have questioned whether cannabis has any effect beyond that of being associated with concurrent tobacco use.15, 16, 17 The National Academy of Sciences report on the health effects of cannabis use suggested that “testing the interaction between cannabis and tobacco use and performing stratified analyses to test the association of cannabis use with clinical endpoints in nonusers of tobacco” is necessary to elucidate the effect of cannabis use on cardiovascular health independent of tobacco use.12 We performed these tests and controlled for potential confounders. The Behavioral Risk Factor Surveillance System (BRFSS) is a national cross‐sectional survey performed annually by the Centers for Disease Control and Prevention. Beginning in 2016, an optional cannabis module was included supporting an analysis examining the association of cannabis use with cardiovascular outcomes.18 Although there have been 3 other studies examining the association of cannabis use with cardiovascular events using the BRFSS cannabis module,19, 20, 21 our much larger sample size enabled us to investigate whether cannabis use was associated with atherosclerotic heart disease outcomes among the general adult population, among nontobacco cigarette users, and among younger adults. Methods Study Sample We combined 2016 to 2020 BRFSS data from 27 American states and 2 territories participating in the cannabis module during at least 1 of these years (Table S1). BRFSS is a telephone survey that collects data from a representative sample of US adults on risk factors, chronic conditions, and health care access.18 The BRFSS questions used are summarized in Table S2. Because this study was based on publicly available data and exempt from institutional review board review, informed consent was not obtained. The data and corresponding materials that support the findings of this study are available from the corresponding author upon request. Our sample included those 18 to 74 years old from the BRFSS (N=434 104) who answered the question, “During the past 30 days, on how many days did you use marijuana or hashish?”, excluding (<1%) those who answered “Don't know” or refused to answer. We excluded adults >74 years old because cannabis use is uncommon in this population. Measures We quantified cannabis use as a continuous variable, days of cannabis use in the past 30 days divided by 30. Thus, daily cannabis use is scored 1, and less than daily use scores were proportionately lower. Specifically, daily use was scored as 1=30/30, 15 days per month was scored 0.5=15/30, and nonuse was scored 0=(0/30). Nonusers’ score was 0. Therefore, a 1‐unit change in our cannabis use frequency metric is equivalent to a comparison of 0 days of cannabis use within past 30 days to daily cannabis use. Demographic variables included age, sex, and self‐identified race and ethnicity. Socioeconomic status was represented by educational attainment, categorized as less than high school, high school, some college, or college graduate. Cardiovascular risk factors included tobacco cigarette use (never, former, current), current alcohol consumption (nonuse, nondaily use, daily use), body mass index, diabetes, and physical activity. Nicotine e‐cigarette use was similarly classified as never, former, or current. Outcomes were assessed when respondents were asked, “Has a doctor, nurse, or other health professional ever told you that you had any of the following….?”. Coronary heart disease (CHD) was assessed by: “(Ever told) you had angina or coronary heart disease?” The lifetime occurrence of myocardial infarction (MI): “(Ever told) you had a heart attack, also called a myocardial infarction?” Stroke: “(Ever told) you had a stroke?” Finally, we created composite indicator for cardiovascular disease, which included any CHD, MI, or stroke. Statistical Analysis Complete case‐weighted estimates of demographic and socioeconomic factors, health behaviors, and chronic conditions were calculated using survey strata, primary sampling units clusters, and sampling weights for the 5 years of combined data to obtain nationally representative results for the states using the cannabis module.22P values for bivariate analyses were calculated by the Rao‐Scott corrected χ2 test. We conducted 3 multivariable logistic analyses of the association of lifetime occurrence of CHD, MI, stroke, and the composite of the 3 with cannabis use ([days per month]/30) as a function of demographic and socioeconomic factors, health‐related behaviors, and other chronic conditions, accounting for the complex survey design. The first analysis included the entire sample 18 to 74 years old controlling for tobacco cigarette use and other covariates. The second was conducted among the respondents who had never used tobacco cigarettes. The third was conducted among respondents who had never used tobacco cigarettes or e‐cigarettes. In the first analysis, we tested for an interaction between current cannabis use (any cannabis use frequency between 1 and 30 days) and current tobacco cigarette use to see if there were synergistic effects of cannabis and conventional tobacco use by measuring the coefficient. An interaction was coded as present if frequency of cannabis use was at least 1 day per month, and conventional tobacco use was coded as current. In addition, we examined the variance inflation factors for the cannabis and tobacco use variables to ensure that they were quantifying statistically independent effects. An upper bound of 5 for the variance inflation factor was used for determination of independent effects.23 We performed supplemental analyses restricting the 3 main analyses to younger adults at risk for premature cardiovascular disease, which we defined as men <55 years old and women <65 years old. The difference in age cutoff by sex is due to the protective effect of estrogen.24 We also conducted sensitivity analyses limiting the comparison to daily versus nonusers using the same multivariate model as in the main analysis and using propensity‐score matching (details in Data S1). We used R statistical software version 4.0 (R Core Team, 2020, Vienna, Austria) and survey package to produce complex survey‐adjusted statistics.25, 26 We used the package car to estimate the survey‐adjusted variance inflation factors.27 Results Baseline Characteristics Among the 434 104 respondents 18 to 74 years old who answered the cannabis module, the weighted prevalence of daily cannabis use was 4.0%, nondaily use was 7.1% (median: 5 days per month; interquartile range, 2–14), and nonuse was 88.9%. The most common form of cannabis consumption was smoking (73.8% of current users). The mean age of the respondents was 45.4 years. About half (51.1%) were women, and the majority of the respondents were White (60.2%), whereas 11.6% were Black, 19.3% Hispanic, and 8.9% other race and ethnicity (eg, non‐Hispanic Asian, Native American, Native Hawaiian and Pacific Islander, and those self‐reporting as multiracial) (Table 1). Daily alcohol use and physical activity had a prevalence of 4.3% and 75.0%, respectively. Most of the sample had never used tobacco cigarettes (61.1%). The prevalence of CHD, MI, stroke, and the composite outcome of all 3 were 3.5% (N=20 009), 3.6% (N=20 563), 2.8% (N=14 922), and 7.4% (N=40 759), respectively. The percentage of missing values for each variable was <1% of the total sample size except for race (1.64%) and alcohol use (1.06%).	question: What figures are given to indicate the rising use of cannabis consumption in the United States? task: Please base your answer on the information provided in this document only. Do not embellish your response or add any details that are unnecessary to answer the question. Use simple words and avoid any jargon that may be foreign to the layman. document: Study of smoking cannabis in adults EXCERPT Abstract Background We examined the association between cannabis use and cardiovascular outcomes among the general population, among never‐tobacco smokers, and among younger individuals. Conclusions Cannabis use is associated with adverse cardiovascular outcomes, with heavier use (more days per month) associated with higher odds of adverse outcomes. Clinical Perspective What Is New? Cannabis use is associated with increased risk of myocardial infarction and stroke, with higher odds of events associated with more days of use per month, controlling for demographic factors and tobacco smoking. Similar increases in risk associated with cannabis use are found in never‐tobacco smokers. What Are the Clinical Implications? Patients should be screened for cannabis use and advised to avoid smoking cannabis to reduce their risk of premature cardiovascular disease and cardiac events. Nonstandard Abbreviations and Acronyms BRFSS Behavioral Risk Factor Surveillance System Cannabis use is increasing in the US population.1 From 2002 to 2019, past‐year prevalence of US adult cannabis use increased from 10.4% to 18.0%, whereas daily/almost daily use (300+ days per year) increased from 1.3% to 3.9%. Rising diagnoses of cannabis use disorder suggest that this increase in use is not confined to reporting of use.2, 3 At the same time, perceptions of the harmfulness of cannabis are decreasing. National surveys reported that adult belief in great risk of weekly cannabis use fell from 50% in 2002 to 28.6% in 2019.4 Despite common use, little is known about the risks of cannabis use and, in particular, the cardiovascular disease risks. Cardiovascular‐related death is the leading cause of mortality, and cannabis use could be an important, unappreciated risk factor leading to many preventable deaths.5 There are reasons to believe that cannabis use is associated with atherosclerotic heart disease. Endocannabinoid receptors are ubiquitous throughout the cardiovascular system.6 Tetrahydrocannabinol, the active component of cannabis, has hemodynamic effects and may result in syncope, stroke, and myocardial infarction.7, 8, 9 Smoking, the predominant method of cannabis use,10 may pose additional cardiovascular risks as a result of inhalation of particulate matter.11 Furthermore, studies in rats have demonstrated that secondhand cannabis smoke exposure is associated with endothelial dysfunction, a precursor to cardiovascular disease.11 Past studies on the association between cannabis use and cardiovascular outcomes have been limited by the dearth of adults with frequent cannabis use.7, 12, 13 Moreover, most studies have been in younger populations at low risk for cardiovascular disease, and therefore without sufficient power to detect an association between cannabis use and atherosclerotic heart disease outcomes.7, 12, 14 In addition, tobacco use among adults who use cannabis is common, and small sample sizes prevented analyses on the association of cannabis use with cardiovascular outcomes among nontobacco users. Any independent effects of cannabis and tobacco in the general adult population and effects of cannabis use among those who have never smoked tobacco cigarettes is of interest, because some have questioned whether cannabis has any effect beyond that of being associated with concurrent tobacco use.15, 16, 17 The National Academy of Sciences report on the health effects of cannabis use suggested that “testing the interaction between cannabis and tobacco use and performing stratified analyses to test the association of cannabis use with clinical endpoints in nonusers of tobacco” is necessary to elucidate the effect of cannabis use on cardiovascular health independent of tobacco use.12 We performed these tests and controlled for potential confounders. The Behavioral Risk Factor Surveillance System (BRFSS) is a national cross‐sectional survey performed annually by the Centers for Disease Control and Prevention. Beginning in 2016, an optional cannabis module was included supporting an analysis examining the association of cannabis use with cardiovascular outcomes.18 Although there have been 3 other studies examining the association of cannabis use with cardiovascular events using the BRFSS cannabis module,19, 20, 21 our much larger sample size enabled us to investigate whether cannabis use was associated with atherosclerotic heart disease outcomes among the general adult population, among nontobacco cigarette users, and among younger adults. Methods Study Sample We combined 2016 to 2020 BRFSS data from 27 American states and 2 territories participating in the cannabis module during at least 1 of these years (Table S1). BRFSS is a telephone survey that collects data from a representative sample of US adults on risk factors, chronic conditions, and health care access.18 The BRFSS questions used are summarized in Table S2. Because this study was based on publicly available data and exempt from institutional review board review, informed consent was not obtained. The data and corresponding materials that support the findings of this study are available from the corresponding author upon request. Our sample included those 18 to 74 years old from the BRFSS (N=434 104) who answered the question, “During the past 30 days, on how many days did you use marijuana or hashish?”, excluding (<1%) those who answered “Don't know” or refused to answer. We excluded adults >74 years old because cannabis use is uncommon in this population. Measures We quantified cannabis use as a continuous variable, days of cannabis use in the past 30 days divided by 30. Thus, daily cannabis use is scored 1, and less than daily use scores were proportionately lower. Specifically, daily use was scored as 1=30/30, 15 days per month was scored 0.5=15/30, and nonuse was scored 0=(0/30). Nonusers’ score was 0. Therefore, a 1‐unit change in our cannabis use frequency metric is equivalent to a comparison of 0 days of cannabis use within past 30 days to daily cannabis use. Demographic variables included age, sex, and self‐identified race and ethnicity. Socioeconomic status was represented by educational attainment, categorized as less than high school, high school, some college, or college graduate. Cardiovascular risk factors included tobacco cigarette use (never, former, current), current alcohol consumption (nonuse, nondaily use, daily use), body mass index, diabetes, and physical activity. Nicotine e‐cigarette use was similarly classified as never, former, or current. Outcomes were assessed when respondents were asked, “Has a doctor, nurse, or other health professional ever told you that you had any of the following….?”. Coronary heart disease (CHD) was assessed by: “(Ever told) you had angina or coronary heart disease?” The lifetime occurrence of myocardial infarction (MI): “(Ever told) you had a heart attack, also called a myocardial infarction?” Stroke: “(Ever told) you had a stroke?” Finally, we created composite indicator for cardiovascular disease, which included any CHD, MI, or stroke. Statistical Analysis Complete case‐weighted estimates of demographic and socioeconomic factors, health behaviors, and chronic conditions were calculated using survey strata, primary sampling units clusters, and sampling weights for the 5 years of combined data to obtain nationally representative results for the states using the cannabis module.22P values for bivariate analyses were calculated by the Rao‐Scott corrected χ2 test. We conducted 3 multivariable logistic analyses of the association of lifetime occurrence of CHD, MI, stroke, and the composite of the 3 with cannabis use ([days per month]/30) as a function of demographic and socioeconomic factors, health‐related behaviors, and other chronic conditions, accounting for the complex survey design. The first analysis included the entire sample 18 to 74 years old controlling for tobacco cigarette use and other covariates. The second was conducted among the respondents who had never used tobacco cigarettes. The third was conducted among respondents who had never used tobacco cigarettes or e‐cigarettes. In the first analysis, we tested for an interaction between current cannabis use (any cannabis use frequency between 1 and 30 days) and current tobacco cigarette use to see if there were synergistic effects of cannabis and conventional tobacco use by measuring the coefficient. An interaction was coded as present if frequency of cannabis use was at least 1 day per month, and conventional tobacco use was coded as current. In addition, we examined the variance inflation factors for the cannabis and tobacco use variables to ensure that they were quantifying statistically independent effects. An upper bound of 5 for the variance inflation factor was used for determination of independent effects.23 We performed supplemental analyses restricting the 3 main analyses to younger adults at risk for premature cardiovascular disease, which we defined as men <55 years old and women <65 years old. The difference in age cutoff by sex is due to the protective effect of estrogen.24 We also conducted sensitivity analyses limiting the comparison to daily versus nonusers using the same multivariate model as in the main analysis and using propensity‐score matching (details in Data S1). We used R statistical software version 4.0 (R Core Team, 2020, Vienna, Austria) and survey package to produce complex survey‐adjusted statistics.25, 26 We used the package car to estimate the survey‐adjusted variance inflation factors.27 Results Baseline Characteristics Among the 434 104 respondents 18 to 74 years old who answered the cannabis module, the weighted prevalence of daily cannabis use was 4.0%, nondaily use was 7.1% (median: 5 days per month; interquartile range, 2–14), and nonuse was 88.9%. The most common form of cannabis consumption was smoking (73.8% of current users). The mean age of the respondents was 45.4 years. About half (51.1%) were women, and the majority of the respondents were White (60.2%), whereas 11.6% were Black, 19.3% Hispanic, and 8.9% other race and ethnicity (eg, non‐Hispanic Asian, Native American, Native Hawaiian and Pacific Islander, and those self‐reporting as multiracial) (Table 1). Daily alcohol use and physical activity had a prevalence of 4.3% and 75.0%, respectively. Most of the sample had never used tobacco cigarettes (61.1%). The prevalence of CHD, MI, stroke, and the composite outcome of all 3 were 3.5% (N=20 009), 3.6% (N=20 563), 2.8% (N=14 922), and 7.4% (N=40 759), respectively. The percentage of missing values for each variable was <1% of the total sample size except for race (1.64%) and alcohol use (1.06%).	Please base your answer on the information provided in this document only. Do not embellish your response or add any details that are unnecessary to answer the question. Use simple words and avoid any jargon that may be foreign to the layman. EVIDENCE: Study of smoking cannabis in adults EXCERPT Abstract Background We examined the association between cannabis use and cardiovascular outcomes among the general population, among never‐tobacco smokers, and among younger individuals. Conclusions Cannabis use is associated with adverse cardiovascular outcomes, with heavier use (more days per month) associated with higher odds of adverse outcomes. Clinical Perspective What Is New? Cannabis use is associated with increased risk of myocardial infarction and stroke, with higher odds of events associated with more days of use per month, controlling for demographic factors and tobacco smoking. Similar increases in risk associated with cannabis use are found in never‐tobacco smokers. What Are the Clinical Implications? Patients should be screened for cannabis use and advised to avoid smoking cannabis to reduce their risk of premature cardiovascular disease and cardiac events. Nonstandard Abbreviations and Acronyms BRFSS Behavioral Risk Factor Surveillance System Cannabis use is increasing in the US population.1 From 2002 to 2019, past‐year prevalence of US adult cannabis use increased from 10.4% to 18.0%, whereas daily/almost daily use (300+ days per year) increased from 1.3% to 3.9%. Rising diagnoses of cannabis use disorder suggest that this increase in use is not confined to reporting of use.2, 3 At the same time, perceptions of the harmfulness of cannabis are decreasing. National surveys reported that adult belief in great risk of weekly cannabis use fell from 50% in 2002 to 28.6% in 2019.4 Despite common use, little is known about the risks of cannabis use and, in particular, the cardiovascular disease risks. Cardiovascular‐related death is the leading cause of mortality, and cannabis use could be an important, unappreciated risk factor leading to many preventable deaths.5 There are reasons to believe that cannabis use is associated with atherosclerotic heart disease. Endocannabinoid receptors are ubiquitous throughout the cardiovascular system.6 Tetrahydrocannabinol, the active component of cannabis, has hemodynamic effects and may result in syncope, stroke, and myocardial infarction.7, 8, 9 Smoking, the predominant method of cannabis use,10 may pose additional cardiovascular risks as a result of inhalation of particulate matter.11 Furthermore, studies in rats have demonstrated that secondhand cannabis smoke exposure is associated with endothelial dysfunction, a precursor to cardiovascular disease.11 Past studies on the association between cannabis use and cardiovascular outcomes have been limited by the dearth of adults with frequent cannabis use.7, 12, 13 Moreover, most studies have been in younger populations at low risk for cardiovascular disease, and therefore without sufficient power to detect an association between cannabis use and atherosclerotic heart disease outcomes.7, 12, 14 In addition, tobacco use among adults who use cannabis is common, and small sample sizes prevented analyses on the association of cannabis use with cardiovascular outcomes among nontobacco users. Any independent effects of cannabis and tobacco in the general adult population and effects of cannabis use among those who have never smoked tobacco cigarettes is of interest, because some have questioned whether cannabis has any effect beyond that of being associated with concurrent tobacco use.15, 16, 17 The National Academy of Sciences report on the health effects of cannabis use suggested that “testing the interaction between cannabis and tobacco use and performing stratified analyses to test the association of cannabis use with clinical endpoints in nonusers of tobacco” is necessary to elucidate the effect of cannabis use on cardiovascular health independent of tobacco use.12 We performed these tests and controlled for potential confounders. The Behavioral Risk Factor Surveillance System (BRFSS) is a national cross‐sectional survey performed annually by the Centers for Disease Control and Prevention. Beginning in 2016, an optional cannabis module was included supporting an analysis examining the association of cannabis use with cardiovascular outcomes.18 Although there have been 3 other studies examining the association of cannabis use with cardiovascular events using the BRFSS cannabis module,19, 20, 21 our much larger sample size enabled us to investigate whether cannabis use was associated with atherosclerotic heart disease outcomes among the general adult population, among nontobacco cigarette users, and among younger adults. Methods Study Sample We combined 2016 to 2020 BRFSS data from 27 American states and 2 territories participating in the cannabis module during at least 1 of these years (Table S1). BRFSS is a telephone survey that collects data from a representative sample of US adults on risk factors, chronic conditions, and health care access.18 The BRFSS questions used are summarized in Table S2. Because this study was based on publicly available data and exempt from institutional review board review, informed consent was not obtained. The data and corresponding materials that support the findings of this study are available from the corresponding author upon request. Our sample included those 18 to 74 years old from the BRFSS (N=434 104) who answered the question, “During the past 30 days, on how many days did you use marijuana or hashish?”, excluding (<1%) those who answered “Don't know” or refused to answer. We excluded adults >74 years old because cannabis use is uncommon in this population. Measures We quantified cannabis use as a continuous variable, days of cannabis use in the past 30 days divided by 30. Thus, daily cannabis use is scored 1, and less than daily use scores were proportionately lower. Specifically, daily use was scored as 1=30/30, 15 days per month was scored 0.5=15/30, and nonuse was scored 0=(0/30). Nonusers’ score was 0. Therefore, a 1‐unit change in our cannabis use frequency metric is equivalent to a comparison of 0 days of cannabis use within past 30 days to daily cannabis use. Demographic variables included age, sex, and self‐identified race and ethnicity. Socioeconomic status was represented by educational attainment, categorized as less than high school, high school, some college, or college graduate. Cardiovascular risk factors included tobacco cigarette use (never, former, current), current alcohol consumption (nonuse, nondaily use, daily use), body mass index, diabetes, and physical activity. Nicotine e‐cigarette use was similarly classified as never, former, or current. Outcomes were assessed when respondents were asked, “Has a doctor, nurse, or other health professional ever told you that you had any of the following….?”. Coronary heart disease (CHD) was assessed by: “(Ever told) you had angina or coronary heart disease?” The lifetime occurrence of myocardial infarction (MI): “(Ever told) you had a heart attack, also called a myocardial infarction?” Stroke: “(Ever told) you had a stroke?” Finally, we created composite indicator for cardiovascular disease, which included any CHD, MI, or stroke. Statistical Analysis Complete case‐weighted estimates of demographic and socioeconomic factors, health behaviors, and chronic conditions were calculated using survey strata, primary sampling units clusters, and sampling weights for the 5 years of combined data to obtain nationally representative results for the states using the cannabis module.22P values for bivariate analyses were calculated by the Rao‐Scott corrected χ2 test. We conducted 3 multivariable logistic analyses of the association of lifetime occurrence of CHD, MI, stroke, and the composite of the 3 with cannabis use ([days per month]/30) as a function of demographic and socioeconomic factors, health‐related behaviors, and other chronic conditions, accounting for the complex survey design. The first analysis included the entire sample 18 to 74 years old controlling for tobacco cigarette use and other covariates. The second was conducted among the respondents who had never used tobacco cigarettes. The third was conducted among respondents who had never used tobacco cigarettes or e‐cigarettes. In the first analysis, we tested for an interaction between current cannabis use (any cannabis use frequency between 1 and 30 days) and current tobacco cigarette use to see if there were synergistic effects of cannabis and conventional tobacco use by measuring the coefficient. An interaction was coded as present if frequency of cannabis use was at least 1 day per month, and conventional tobacco use was coded as current. In addition, we examined the variance inflation factors for the cannabis and tobacco use variables to ensure that they were quantifying statistically independent effects. An upper bound of 5 for the variance inflation factor was used for determination of independent effects.23 We performed supplemental analyses restricting the 3 main analyses to younger adults at risk for premature cardiovascular disease, which we defined as men <55 years old and women <65 years old. The difference in age cutoff by sex is due to the protective effect of estrogen.24 We also conducted sensitivity analyses limiting the comparison to daily versus nonusers using the same multivariate model as in the main analysis and using propensity‐score matching (details in Data S1). We used R statistical software version 4.0 (R Core Team, 2020, Vienna, Austria) and survey package to produce complex survey‐adjusted statistics.25, 26 We used the package car to estimate the survey‐adjusted variance inflation factors.27 Results Baseline Characteristics Among the 434 104 respondents 18 to 74 years old who answered the cannabis module, the weighted prevalence of daily cannabis use was 4.0%, nondaily use was 7.1% (median: 5 days per month; interquartile range, 2–14), and nonuse was 88.9%. The most common form of cannabis consumption was smoking (73.8% of current users). The mean age of the respondents was 45.4 years. About half (51.1%) were women, and the majority of the respondents were White (60.2%), whereas 11.6% were Black, 19.3% Hispanic, and 8.9% other race and ethnicity (eg, non‐Hispanic Asian, Native American, Native Hawaiian and Pacific Islander, and those self‐reporting as multiracial) (Table 1). Daily alcohol use and physical activity had a prevalence of 4.3% and 75.0%, respectively. Most of the sample had never used tobacco cigarettes (61.1%). The prevalence of CHD, MI, stroke, and the composite outcome of all 3 were 3.5% (N=20 009), 3.6% (N=20 563), 2.8% (N=14 922), and 7.4% (N=40 759), respectively. The percentage of missing values for each variable was <1% of the total sample size except for race (1.64%) and alcohol use (1.06%). USER: What figures are given to indicate the rising use of cannabis consumption in the United States? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	42	16	1,614	null	549
Provide responses in clear, concise and simple manner. The target audience has no knowledge of the subject and are not experts. You response should only rely on the provided context.	What are some of the main topics addressed as having occurred in the last fiscal year based on the information shared in the letter?	Annual Letter to Shareholders Dear Shareholders, the Global McFamily and our Customers, At McDonald’s, we are privileged to be active participants in the local communities where we live, work and serve. That means we refect the values and understand the needs of the customers and people we strive to put frst every day. This was especially prudent as we navigated the COVID-19 pandemic and societal challenges within this past year. Through it all, and with the strength of our McFamily and a values-led mindset, we did the right thing from the start. We prioritized the safety of restaurant crew and customers; we took important steps to preserve our fnancial fexibility; we leveraged the power of our supply chain; and we stood by and supported our local communities. I believe frmly that our Brand will be defned by how we respond to such challenges, both as the world’s largest restaurant company—and as good neighbors. At the onset of the pandemic, I laid out fve principles that McDonald’s used to guide our approach to this historic challenge: Supported by these principles and energized by the incredible courage and efort from people across our three-legged stool, McDonald’s delivered a resilient performance in what was the most difcult year in our history. “We’re all in this together” “Think and act with a long-term mindset” “ Be transparent with each other and our stakeholders” “Lead by example” “Stay true to our purpose” Annual Letter to Shareholders Emerging from 2020 in a position of strength While conditions were challenging in most markets, we still achieved nearly $20 billion in full year revenue and over $90 billion in full year Systemwide sales. We were well-positioned to efectively navigate such challenging circumstances because of our operating model, our focus on running great restaurants and our many competitive strengths, including our formidable Drive Thru presence. We also were wellpositioned due to the signifcant investments we’ve made in recent years to develop our digital and delivery capabilities, which proved to be a boon throughout the pandemic. The US delivered its sixth consecutive year of positive comparable sales, and average US franchisee restaurant operating cash fow reached an all-time high in 2020, after a previous all-time high in 2019. Elsewhere, Japan and Australia posted fve and seven consecutive years of positive comparable sales growth, respectively. Markets that had to signifcantly reduce operations or face closures due to government restrictions did so with remarkable agility and care. Their ability to respond quickly to the external environment was a further demonstration of our System’s unmatched execution prowess. While 2020 was a historically demanding year, it has helped McDonald’s to do everything better. We engaged Mayo Clinic to provide ongoing expertise on emerging science in COVID-19 infection prevention, and we devised new ways to safely and reliably serve our customers. This, in turn, allowed us to continue gaining market share in most major markets. We also improved on our already unrivaled Drive Thru capabilities and continued to see the enormous benefts of contactless delivery, take-away, and curbside pick-up. Meanwhile, more customers used our app than ever before, as digital sales reached nearly 20 percent of Systemwide sales across our top six markets. At the outset of the pandemic, we committed to helping every operator and partner survive the crisis. We took prudent, quick action designed to prevent not a single Owner/Operator from failing due to the pandemic. We ofered franchisees nearly $1 billion in short-term fnancial liquidity support through rent and royalty deferrals, along with timely, targeted, and temporary assistance to individual franchisees in the most precarious situations. Thanks to our quick decision-making and our robust balance sheet, the fnancial health of the McDonald’s System remains strong. Just as important, we addressed our shortterm challenges without sacrifcing our long-term priorities. We continued to invest in our Brand, including an incremental $200 million in marketing support to widen our market share gains and accelerate our recovery. We also opened nearly 1,000 new restaurants globally, modernized another 900 restaurants in the US, and together with our franchisees, we invested more than $1 billion in technology and digital initiatives. I said several times through the year that we were confdent McDonald’s would be just as strong coming out of the pandemic as we were going into it, and we are proving that in so many ways. A new, holistic growth strategy to refect the changing environment Motivated by our resilience in the face of unprecedented challenges, we began writing the next chapter for McDonald’s as we shared our new growth strategy, Accelerating the Arches. Alongside bold business objectives, the strategy articulates a clear vision of where and how we intend to make a diference in the world, refecting the changing expectations that today’s customers have of modern corporations like McDonald’s. Annual Letter to Shareholders It is especially encouraging to see the power of the three pillars coming together already. The launch of Famous Orders in the US, for example, brought together the strength of our marketing, the popularity of our core menu items and enormous digital engagement to drive signifcant sales in the third and fourth quarters of 2020. The success of this initiative was just a glimpse of what is possible and we are excited for what is to come. We already knew customer habits and expectations were changing going into 2020. The pandemic accelerated some of those changes and brought other powerful truths into focus. First, our customers’ needs are diferent than they were prior to the pandemic, so the experience we ofer must adapt. A world with less dine-in and more takeout plays to our signifcant advantage in Drive Thru and our growing capabilities in delivery and curbside pick-up. More lunch and dinner visits are well-suited to our core menu, with iconic favorites that people love. Greater dependence on technology bodes well for McDonald’s fast-growing digital experience and our inherent scale advantages. This understanding was essential as we identifed three new growth pillars to deliver our next phase of sustainable growth under Accelerating the Arches. They are easy to remember… just think M-C-D: Leading with our purpose and refreshing our values to guide our strategy The second truth is that people expect more from corporations today and are seeking brands that refect their own values. Customers want to see that the McDonald’s they visit locally matches how we act globally. They want and expect us to be a force for good everywhere. The strength of McDonald’s business entering 2020 and our resilience through the pandemic allowed us to broaden our perspective to make Accelerating the Arches a strategy focused on more than just business performance. It is rooted in our belief that our next chapter of growth depends not just on what we do, but how we do it in more than 39,000 local restaurants around the world. Meeting the needs of our customers and communities requires us to embrace a bigger, more holistic vision. Just as our timeless commitment to Quality, Service, Cleanliness, and Value has been refned over the years to make them relevant for each era, the language we use to express our purpose, mission, and values must be reinvigorated to ensure it is responsive to today’s McDonald’s is one of the world’s most recognized brands, and we invest about $4 billion per year in marketing. Working with our agency partners, we will raise our creative ambition and capitalize on evolving digital behaviors to deepen the connection with our customers to drive growth. M - Maximize our Marketing McDonald’s menu is known around the globe, and customers love favorites like the Big Mac®, Chicken McNuggets®, and of course, our World Famous Fries®. During the pandemic, we focused on these classics and were reminded not only of customers’ enduring passion for these products, but also the signifcant growth opportunities that still exist within our core menu. C - Commit to the Core Digital, Delivery and Drive Thru. Customers have always loved McDonald’s for its convenience, and new technologies ofer us the opportunity to make the McDonald’s experience even faster and easier. We will innovate in these service channels to unlock even more growth. D - Double Down on the Three Ds Annual Letter to Shareholders Serve We put our customers and people frst Integrity We do the right thing Family We get better together Community We are good neighbors Inclusion We open our doors to everyone environment. That’s especially true in an era when customers and communities expect more of us. That is why one of our priorities over the past year was to ensure our purpose, mission, and values refect the role we play in society today— while embracing the vital place these timeless ideals and principles occupy as an essential part of this special Brand we all love. In speaking to franchisees, customers and crew around the world, it became clear that McDonald’s purpose is to feed and foster communities. It also became clear in those conversations that our ability to deliver on our purpose is rooted in a refreshed set of core values: Ray Kroc used to talk constantly about our values. He knew that in a System where every restaurant is unique and locally owned, our values would be the light that guides us through every decision. These refreshed values are a foundational component of Accelerating the Arches and will guide us in achieving our business objectives while providing a common compass for how we serve our communities, and one another. With its holistic view of what McDonald’s seeks to accomplish as an organization, Accelerating the Arches will strengthen our advantages and deliver value—not only to our business, but to our communities, customers, franchisees, crew, employees, farmers and suppliers. Looking forward to another year of progress We are a stronger Brand for the challenges we faced together in 2020. Our business performance and the trust we fostered throughout our communities reinforced our confdence in McDonald’s long-term success. As a result, we were pleased to continue the company’s more than 40-year tradition of annual dividend increases. While 2020 was a year beset with obstacles, it was also a year of progress for McDonald’s, and it has emboldened us to build on the platform we created to write our next great chapter together. Supported by a bold new strategy and our enduring foundation of running great restaurants, McDonald’s will continue to strive to be a force for good in our communities while strengthening and widening the competitive advantages that help us make delicious feel-good moments easy for everyone. Thank you to our shareholders for your continued investment in McDonald’s, to our customers for giving us the opportunity to serve you and your communities, and to the people in the McDonald’s System who make this business what it is and give us the spirit to succeed. Be well. Chris Kempczinski President and CEO McDonald’s Corporation	Provide responses in clear, concise and simple manner. The target audience has no knowledge of the subject and are not experts. You response should only rely on the provided context. What are some of the main topics addressed as having occurred in the last fiscal year based on the information shared in the letter? Annual Letter to Shareholders Dear Shareholders, the Global McFamily and our Customers, At McDonald’s, we are privileged to be active participants in the local communities where we live, work and serve. That means we refect the values and understand the needs of the customers and people we strive to put frst every day. This was especially prudent as we navigated the COVID-19 pandemic and societal challenges within this past year. Through it all, and with the strength of our McFamily and a values-led mindset, we did the right thing from the start. We prioritized the safety of restaurant crew and customers; we took important steps to preserve our fnancial fexibility; we leveraged the power of our supply chain; and we stood by and supported our local communities. I believe frmly that our Brand will be defned by how we respond to such challenges, both as the world’s largest restaurant company—and as good neighbors. At the onset of the pandemic, I laid out fve principles that McDonald’s used to guide our approach to this historic challenge: Supported by these principles and energized by the incredible courage and efort from people across our three-legged stool, McDonald’s delivered a resilient performance in what was the most difcult year in our history. “We’re all in this together” “Think and act with a long-term mindset” “ Be transparent with each other and our stakeholders” “Lead by example” “Stay true to our purpose” Annual Letter to Shareholders Emerging from 2020 in a position of strength While conditions were challenging in most markets, we still achieved nearly $20 billion in full year revenue and over $90 billion in full year Systemwide sales. We were well-positioned to efectively navigate such challenging circumstances because of our operating model, our focus on running great restaurants and our many competitive strengths, including our formidable Drive Thru presence. We also were wellpositioned due to the signifcant investments we’ve made in recent years to develop our digital and delivery capabilities, which proved to be a boon throughout the pandemic. The US delivered its sixth consecutive year of positive comparable sales, and average US franchisee restaurant operating cash fow reached an all-time high in 2020, after a previous all-time high in 2019. Elsewhere, Japan and Australia posted fve and seven consecutive years of positive comparable sales growth, respectively. Markets that had to signifcantly reduce operations or face closures due to government restrictions did so with remarkable agility and care. Their ability to respond quickly to the external environment was a further demonstration of our System’s unmatched execution prowess. While 2020 was a historically demanding year, it has helped McDonald’s to do everything better. We engaged Mayo Clinic to provide ongoing expertise on emerging science in COVID-19 infection prevention, and we devised new ways to safely and reliably serve our customers. This, in turn, allowed us to continue gaining market share in most major markets. We also improved on our already unrivaled Drive Thru capabilities and continued to see the enormous benefts of contactless delivery, take-away, and curbside pick-up. Meanwhile, more customers used our app than ever before, as digital sales reached nearly 20 percent of Systemwide sales across our top six markets. At the outset of the pandemic, we committed to helping every operator and partner survive the crisis. We took prudent, quick action designed to prevent not a single Owner/Operator from failing due to the pandemic. We ofered franchisees nearly $1 billion in short-term fnancial liquidity support through rent and royalty deferrals, along with timely, targeted, and temporary assistance to individual franchisees in the most precarious situations. Thanks to our quick decision-making and our robust balance sheet, the fnancial health of the McDonald’s System remains strong. Just as important, we addressed our shortterm challenges without sacrifcing our long-term priorities. We continued to invest in our Brand, including an incremental $200 million in marketing support to widen our market share gains and accelerate our recovery. We also opened nearly 1,000 new restaurants globally, modernized another 900 restaurants in the US, and together with our franchisees, we invested more than $1 billion in technology and digital initiatives. I said several times through the year that we were confdent McDonald’s would be just as strong coming out of the pandemic as we were going into it, and we are proving that in so many ways. A new, holistic growth strategy to refect the changing environment Motivated by our resilience in the face of unprecedented challenges, we began writing the next chapter for McDonald’s as we shared our new growth strategy, Accelerating the Arches. Alongside bold business objectives, the strategy articulates a clear vision of where and how we intend to make a diference in the world, refecting the changing expectations that today’s customers have of modern corporations like McDonald’s. Annual Letter to Shareholders It is especially encouraging to see the power of the three pillars coming together already. The launch of Famous Orders in the US, for example, brought together the strength of our marketing, the popularity of our core menu items and enormous digital engagement to drive signifcant sales in the third and fourth quarters of 2020. The success of this initiative was just a glimpse of what is possible and we are excited for what is to come. We already knew customer habits and expectations were changing going into 2020. The pandemic accelerated some of those changes and brought other powerful truths into focus. First, our customers’ needs are diferent than they were prior to the pandemic, so the experience we ofer must adapt. A world with less dine-in and more takeout plays to our signifcant advantage in Drive Thru and our growing capabilities in delivery and curbside pick-up. More lunch and dinner visits are well-suited to our core menu, with iconic favorites that people love. Greater dependence on technology bodes well for McDonald’s fast-growing digital experience and our inherent scale advantages. This understanding was essential as we identifed three new growth pillars to deliver our next phase of sustainable growth under Accelerating the Arches. They are easy to remember… just think M-C-D: Leading with our purpose and refreshing our values to guide our strategy The second truth is that people expect more from corporations today and are seeking brands that refect their own values. Customers want to see that the McDonald’s they visit locally matches how we act globally. They want and expect us to be a force for good everywhere. The strength of McDonald’s business entering 2020 and our resilience through the pandemic allowed us to broaden our perspective to make Accelerating the Arches a strategy focused on more than just business performance. It is rooted in our belief that our next chapter of growth depends not just on what we do, but how we do it in more than 39,000 local restaurants around the world. Meeting the needs of our customers and communities requires us to embrace a bigger, more holistic vision. Just as our timeless commitment to Quality, Service, Cleanliness, and Value has been refned over the years to make them relevant for each era, the language we use to express our purpose, mission, and values must be reinvigorated to ensure it is responsive to today’s McDonald’s is one of the world’s most recognized brands, and we invest about $4 billion per year in marketing. Working with our agency partners, we will raise our creative ambition and capitalize on evolving digital behaviors to deepen the connection with our customers to drive growth. M - Maximize our Marketing McDonald’s menu is known around the globe, and customers love favorites like the Big Mac®, Chicken McNuggets®, and of course, our World Famous Fries®. During the pandemic, we focused on these classics and were reminded not only of customers’ enduring passion for these products, but also the signifcant growth opportunities that still exist within our core menu. C - Commit to the Core Digital, Delivery and Drive Thru. Customers have always loved McDonald’s for its convenience, and new technologies ofer us the opportunity to make the McDonald’s experience even faster and easier. We will innovate in these service channels to unlock even more growth. D - Double Down on the Three Ds Annual Letter to Shareholders Serve We put our customers and people frst Integrity We do the right thing Family We get better together Community We are good neighbors Inclusion We open our doors to everyone environment. That’s especially true in an era when customers and communities expect more of us. That is why one of our priorities over the past year was to ensure our purpose, mission, and values refect the role we play in society today— while embracing the vital place these timeless ideals and principles occupy as an essential part of this special Brand we all love. In speaking to franchisees, customers and crew around the world, it became clear that McDonald’s purpose is to feed and foster communities. It also became clear in those conversations that our ability to deliver on our purpose is rooted in a refreshed set of core values: Ray Kroc used to talk constantly about our values. He knew that in a System where every restaurant is unique and locally owned, our values would be the light that guides us through every decision. These refreshed values are a foundational component of Accelerating the Arches and will guide us in achieving our business objectives while providing a common compass for how we serve our communities, and one another. With its holistic view of what McDonald’s seeks to accomplish as an organization, Accelerating the Arches will strengthen our advantages and deliver value—not only to our business, but to our communities, customers, franchisees, crew, employees, farmers and suppliers. Looking forward to another year of progress We are a stronger Brand for the challenges we faced together in 2020. Our business performance and the trust we fostered throughout our communities reinforced our confdence in McDonald’s long-term success. As a result, we were pleased to continue the company’s more than 40-year tradition of annual dividend increases. While 2020 was a year beset with obstacles, it was also a year of progress for McDonald’s, and it has emboldened us to build on the platform we created to write our next great chapter together. Supported by a bold new strategy and our enduring foundation of running great restaurants, McDonald’s will continue to strive to be a force for good in our communities while strengthening and widening the competitive advantages that help us make delicious feel-good moments easy for everyone. Thank you to our shareholders for your continued investment in McDonald’s, to our customers for giving us the opportunity to serve you and your communities, and to the people in the McDonald’s System who make this business what it is and give us the spirit to succeed. Be well. Chris Kempczinski President and CEO McDonald’s Corporation	Provide responses in clear, concise and simple manner. The target audience has no knowledge of the subject and are not experts. You response should only rely on the provided context. EVIDENCE: Annual Letter to Shareholders Dear Shareholders, the Global McFamily and our Customers, At McDonald’s, we are privileged to be active participants in the local communities where we live, work and serve. That means we refect the values and understand the needs of the customers and people we strive to put frst every day. This was especially prudent as we navigated the COVID-19 pandemic and societal challenges within this past year. Through it all, and with the strength of our McFamily and a values-led mindset, we did the right thing from the start. We prioritized the safety of restaurant crew and customers; we took important steps to preserve our fnancial fexibility; we leveraged the power of our supply chain; and we stood by and supported our local communities. I believe frmly that our Brand will be defned by how we respond to such challenges, both as the world’s largest restaurant company—and as good neighbors. At the onset of the pandemic, I laid out fve principles that McDonald’s used to guide our approach to this historic challenge: Supported by these principles and energized by the incredible courage and efort from people across our three-legged stool, McDonald’s delivered a resilient performance in what was the most difcult year in our history. “We’re all in this together” “Think and act with a long-term mindset” “ Be transparent with each other and our stakeholders” “Lead by example” “Stay true to our purpose” Annual Letter to Shareholders Emerging from 2020 in a position of strength While conditions were challenging in most markets, we still achieved nearly $20 billion in full year revenue and over $90 billion in full year Systemwide sales. We were well-positioned to efectively navigate such challenging circumstances because of our operating model, our focus on running great restaurants and our many competitive strengths, including our formidable Drive Thru presence. We also were wellpositioned due to the signifcant investments we’ve made in recent years to develop our digital and delivery capabilities, which proved to be a boon throughout the pandemic. The US delivered its sixth consecutive year of positive comparable sales, and average US franchisee restaurant operating cash fow reached an all-time high in 2020, after a previous all-time high in 2019. Elsewhere, Japan and Australia posted fve and seven consecutive years of positive comparable sales growth, respectively. Markets that had to signifcantly reduce operations or face closures due to government restrictions did so with remarkable agility and care. Their ability to respond quickly to the external environment was a further demonstration of our System’s unmatched execution prowess. While 2020 was a historically demanding year, it has helped McDonald’s to do everything better. We engaged Mayo Clinic to provide ongoing expertise on emerging science in COVID-19 infection prevention, and we devised new ways to safely and reliably serve our customers. This, in turn, allowed us to continue gaining market share in most major markets. We also improved on our already unrivaled Drive Thru capabilities and continued to see the enormous benefts of contactless delivery, take-away, and curbside pick-up. Meanwhile, more customers used our app than ever before, as digital sales reached nearly 20 percent of Systemwide sales across our top six markets. At the outset of the pandemic, we committed to helping every operator and partner survive the crisis. We took prudent, quick action designed to prevent not a single Owner/Operator from failing due to the pandemic. We ofered franchisees nearly $1 billion in short-term fnancial liquidity support through rent and royalty deferrals, along with timely, targeted, and temporary assistance to individual franchisees in the most precarious situations. Thanks to our quick decision-making and our robust balance sheet, the fnancial health of the McDonald’s System remains strong. Just as important, we addressed our shortterm challenges without sacrifcing our long-term priorities. We continued to invest in our Brand, including an incremental $200 million in marketing support to widen our market share gains and accelerate our recovery. We also opened nearly 1,000 new restaurants globally, modernized another 900 restaurants in the US, and together with our franchisees, we invested more than $1 billion in technology and digital initiatives. I said several times through the year that we were confdent McDonald’s would be just as strong coming out of the pandemic as we were going into it, and we are proving that in so many ways. A new, holistic growth strategy to refect the changing environment Motivated by our resilience in the face of unprecedented challenges, we began writing the next chapter for McDonald’s as we shared our new growth strategy, Accelerating the Arches. Alongside bold business objectives, the strategy articulates a clear vision of where and how we intend to make a diference in the world, refecting the changing expectations that today’s customers have of modern corporations like McDonald’s. Annual Letter to Shareholders It is especially encouraging to see the power of the three pillars coming together already. The launch of Famous Orders in the US, for example, brought together the strength of our marketing, the popularity of our core menu items and enormous digital engagement to drive signifcant sales in the third and fourth quarters of 2020. The success of this initiative was just a glimpse of what is possible and we are excited for what is to come. We already knew customer habits and expectations were changing going into 2020. The pandemic accelerated some of those changes and brought other powerful truths into focus. First, our customers’ needs are diferent than they were prior to the pandemic, so the experience we ofer must adapt. A world with less dine-in and more takeout plays to our signifcant advantage in Drive Thru and our growing capabilities in delivery and curbside pick-up. More lunch and dinner visits are well-suited to our core menu, with iconic favorites that people love. Greater dependence on technology bodes well for McDonald’s fast-growing digital experience and our inherent scale advantages. This understanding was essential as we identifed three new growth pillars to deliver our next phase of sustainable growth under Accelerating the Arches. They are easy to remember… just think M-C-D: Leading with our purpose and refreshing our values to guide our strategy The second truth is that people expect more from corporations today and are seeking brands that refect their own values. Customers want to see that the McDonald’s they visit locally matches how we act globally. They want and expect us to be a force for good everywhere. The strength of McDonald’s business entering 2020 and our resilience through the pandemic allowed us to broaden our perspective to make Accelerating the Arches a strategy focused on more than just business performance. It is rooted in our belief that our next chapter of growth depends not just on what we do, but how we do it in more than 39,000 local restaurants around the world. Meeting the needs of our customers and communities requires us to embrace a bigger, more holistic vision. Just as our timeless commitment to Quality, Service, Cleanliness, and Value has been refned over the years to make them relevant for each era, the language we use to express our purpose, mission, and values must be reinvigorated to ensure it is responsive to today’s McDonald’s is one of the world’s most recognized brands, and we invest about $4 billion per year in marketing. Working with our agency partners, we will raise our creative ambition and capitalize on evolving digital behaviors to deepen the connection with our customers to drive growth. M - Maximize our Marketing McDonald’s menu is known around the globe, and customers love favorites like the Big Mac®, Chicken McNuggets®, and of course, our World Famous Fries®. During the pandemic, we focused on these classics and were reminded not only of customers’ enduring passion for these products, but also the signifcant growth opportunities that still exist within our core menu. C - Commit to the Core Digital, Delivery and Drive Thru. Customers have always loved McDonald’s for its convenience, and new technologies ofer us the opportunity to make the McDonald’s experience even faster and easier. We will innovate in these service channels to unlock even more growth. D - Double Down on the Three Ds Annual Letter to Shareholders Serve We put our customers and people frst Integrity We do the right thing Family We get better together Community We are good neighbors Inclusion We open our doors to everyone environment. That’s especially true in an era when customers and communities expect more of us. That is why one of our priorities over the past year was to ensure our purpose, mission, and values refect the role we play in society today— while embracing the vital place these timeless ideals and principles occupy as an essential part of this special Brand we all love. In speaking to franchisees, customers and crew around the world, it became clear that McDonald’s purpose is to feed and foster communities. It also became clear in those conversations that our ability to deliver on our purpose is rooted in a refreshed set of core values: Ray Kroc used to talk constantly about our values. He knew that in a System where every restaurant is unique and locally owned, our values would be the light that guides us through every decision. These refreshed values are a foundational component of Accelerating the Arches and will guide us in achieving our business objectives while providing a common compass for how we serve our communities, and one another. With its holistic view of what McDonald’s seeks to accomplish as an organization, Accelerating the Arches will strengthen our advantages and deliver value—not only to our business, but to our communities, customers, franchisees, crew, employees, farmers and suppliers. Looking forward to another year of progress We are a stronger Brand for the challenges we faced together in 2020. Our business performance and the trust we fostered throughout our communities reinforced our confdence in McDonald’s long-term success. As a result, we were pleased to continue the company’s more than 40-year tradition of annual dividend increases. While 2020 was a year beset with obstacles, it was also a year of progress for McDonald’s, and it has emboldened us to build on the platform we created to write our next great chapter together. Supported by a bold new strategy and our enduring foundation of running great restaurants, McDonald’s will continue to strive to be a force for good in our communities while strengthening and widening the competitive advantages that help us make delicious feel-good moments easy for everyone. Thank you to our shareholders for your continued investment in McDonald’s, to our customers for giving us the opportunity to serve you and your communities, and to the people in the McDonald’s System who make this business what it is and give us the spirit to succeed. Be well. Chris Kempczinski President and CEO McDonald’s Corporation USER: What are some of the main topics addressed as having occurred in the last fiscal year based on the information shared in the letter? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	30	24	1,804	null	418
"================ <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."	I've heard some people talk about the constitution and how it has racist traits. What is the three fifths part about in regard to black men and what does it mean? How is this legal and what does it mean to primarily prisons and people in jail through the legal system. I hate reading so can ou limit this to 200 words.	the 13th Amendment officially was ratified, and with it, slavery finally was abolished in America. The New York World hailed it as “one of the most important reforms ever accomplished by voluntary human agency.” The newspaper said the amendment “takes out of politics, and consigns to history, an institution incongruous to our political system, inconsistent with justice and repugnant to the humane sentiments fostered by Christian civilization.” With the passage of the 13th Amendment—which states that “[n]either slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction”—the central contradiction at the heart of the Founding was resolved. Eighty-nine years after the Declaration of Independence had proclaimed all men to be free and equal, race-based chattel slavery would be no more in the United States. While all today recognize this momentous accomplishment, many remain confused about the status of slavery under the original Constitution. Textbooks and history books routinely dismiss the Constitution as racist and pro-slavery. The New York Times, among others, continues to casually assert that the Constitution affirmed African-Americans to be worth only three-fifths of a human being. Ironically, many Americans who are resolutely opposed to racism unwittingly agree with Chief Justice Roger Taney’s claim in Dred Scott v. Sandford (1857) that the Founders’ Constitution regarded blacks as “so far inferior that they had no rights which the white man was bound to respect, and that the negro might justly and lawfully be reduced to slavery for his benefit.” In this view, the worst Supreme Court case decision in American history was actually correctly decided. The argument that the Constitution is racist suffers from one fatal flaw: the concept of race does not exist in the Constitution. Such arguments have unsettling implications for the health of our republic. They teach citizens to despise their founding charter and to be ashamed of their country’s origins. They make the Constitution an object of contempt rather than reverence. And they foster alienation and resentment among African-American citizens by excluding them from our Constitution. The received wisdom in this case is wrong. If we turn to the actual text of the Constitution and the debates that gave rise to it, a different picture emerges. The case for a racist, pro-slavery Constitution collapses under closer scrutiny. Race and the Constitution The argument that the Constitution is racist suffers from one fatal flaw: the concept of race does not exist in the Constitution. Nowhere in the Constitution—or in the Declaration of Independence, for that matter—are human beings classified according to race, skin color, or ethnicity (nor, one should add, sex, religion, or any other of the left’s favored groupings). Our founding principles are colorblind (although our history, regrettably, has not been). The Constitution speaks of people, citizens, persons, other persons (a euphemism for slaves) and Indians not taxed (in which case, it is their tax-exempt status, and not their skin color, that matters). The first references to “race” and “color” occur in the 15th Amendment’s guarantee of the right to vote, ratified in 1870. The infamous three-fifths clause, which more nonsense has been written than any other clause, does not declare that a black person is worth 60 percent of a white person. It says that for purposes of determining the number of representatives for each state in the House (and direct taxes), the government would count only three-fifths of the slaves, and not all of them, as the Southern states, who wanted to gain more seats, had insisted. The 60,000 or so free blacks in the North and the South were counted on par with whites. Contrary to a popular misconception, the Constitution also does not say that only white males who owned property could vote. The Constitution defers to the states to determine who shall be eligible to vote (Article I, Section 2, Clause 1). It is a little known fact of American history that black citizens were voting in perhaps as many as 10 states at the time of the founding (the precise number is unclear, but only Georgia, South Carolina, and Virginia explicitly restricted suffrage to whites). Slavery and the Constitution Not only does the Constitution not mention blacks or whites, but it also doesn’t mention slaves or slavery. Throughout the document, slaves are referred to as persons to underscore their humanity. As James Madison remarked during the constitutional convention, it was “wrong to admit in the Constitution the idea that there could be property in men.” The Constitution refers to slaves using three different formulations: “other persons” (Article I, Section 2, Clause 3), “such persons as any of the states now existing shall think proper to admit” (Article I, Section 9, Clause 1), and a “person held to service or labor in one state, under the laws thereof” (Article IV, Section 2, Clause 3). Although these circumlocutions may not have done much to improve the lot of slaves, they are important, as they denied constitutional legitimacy to the institution of slavery. The practice remained legal, but slaveholders could not invoke the supreme law of the land to defend its legitimacy. These formulations make clear that slavery is a state institution that is tolerated—but not sanctioned—by the national government and the Constitution. Reading the original Constitution, a visitor from a foreign land would simply have no way of knowing that race-based slavery existed in America. As Abraham Lincoln would later explain: Thus, the thing is hid away, in the Constitution, just as an afflicted man hides away a wen or a cancer, which he dares not cut out at once, lest he bleed to death.	"================ <TEXT PASSAGE> ======= the 13th Amendment officially was ratified, and with it, slavery finally was abolished in America. The New York World hailed it as “one of the most important reforms ever accomplished by voluntary human agency.” The newspaper said the amendment “takes out of politics, and consigns to history, an institution incongruous to our political system, inconsistent with justice and repugnant to the humane sentiments fostered by Christian civilization.” With the passage of the 13th Amendment—which states that “[n]either slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction”—the central contradiction at the heart of the Founding was resolved. Eighty-nine years after the Declaration of Independence had proclaimed all men to be free and equal, race-based chattel slavery would be no more in the United States. While all today recognize this momentous accomplishment, many remain confused about the status of slavery under the original Constitution. Textbooks and history books routinely dismiss the Constitution as racist and pro-slavery. The New York Times, among others, continues to casually assert that the Constitution affirmed African-Americans to be worth only three-fifths of a human being. Ironically, many Americans who are resolutely opposed to racism unwittingly agree with Chief Justice Roger Taney’s claim in Dred Scott v. Sandford (1857) that the Founders’ Constitution regarded blacks as “so far inferior that they had no rights which the white man was bound to respect, and that the negro might justly and lawfully be reduced to slavery for his benefit.” In this view, the worst Supreme Court case decision in American history was actually correctly decided. The argument that the Constitution is racist suffers from one fatal flaw: the concept of race does not exist in the Constitution. Such arguments have unsettling implications for the health of our republic. They teach citizens to despise their founding charter and to be ashamed of their country’s origins. They make the Constitution an object of contempt rather than reverence. And they foster alienation and resentment among African-American citizens by excluding them from our Constitution. The received wisdom in this case is wrong. If we turn to the actual text of the Constitution and the debates that gave rise to it, a different picture emerges. The case for a racist, pro-slavery Constitution collapses under closer scrutiny. Race and the Constitution The argument that the Constitution is racist suffers from one fatal flaw: the concept of race does not exist in the Constitution. Nowhere in the Constitution—or in the Declaration of Independence, for that matter—are human beings classified according to race, skin color, or ethnicity (nor, one should add, sex, religion, or any other of the left’s favored groupings). Our founding principles are colorblind (although our history, regrettably, has not been). The Constitution speaks of people, citizens, persons, other persons (a euphemism for slaves) and Indians not taxed (in which case, it is their tax-exempt status, and not their skin color, that matters). The first references to “race” and “color” occur in the 15th Amendment’s guarantee of the right to vote, ratified in 1870. The infamous three-fifths clause, which more nonsense has been written than any other clause, does not declare that a black person is worth 60 percent of a white person. It says that for purposes of determining the number of representatives for each state in the House (and direct taxes), the government would count only three-fifths of the slaves, and not all of them, as the Southern states, who wanted to gain more seats, had insisted. The 60,000 or so free blacks in the North and the South were counted on par with whites. Contrary to a popular misconception, the Constitution also does not say that only white males who owned property could vote. The Constitution defers to the states to determine who shall be eligible to vote (Article I, Section 2, Clause 1). It is a little known fact of American history that black citizens were voting in perhaps as many as 10 states at the time of the founding (the precise number is unclear, but only Georgia, South Carolina, and Virginia explicitly restricted suffrage to whites). Slavery and the Constitution Not only does the Constitution not mention blacks or whites, but it also doesn’t mention slaves or slavery. Throughout the document, slaves are referred to as persons to underscore their humanity. As James Madison remarked during the constitutional convention, it was “wrong to admit in the Constitution the idea that there could be property in men.” The Constitution refers to slaves using three different formulations: “other persons” (Article I, Section 2, Clause 3), “such persons as any of the states now existing shall think proper to admit” (Article I, Section 9, Clause 1), and a “person held to service or labor in one state, under the laws thereof” (Article IV, Section 2, Clause 3). Although these circumlocutions may not have done much to improve the lot of slaves, they are important, as they denied constitutional legitimacy to the institution of slavery. The practice remained legal, but slaveholders could not invoke the supreme law of the land to defend its legitimacy. These formulations make clear that slavery is a state institution that is tolerated—but not sanctioned—by the national government and the Constitution. Reading the original Constitution, a visitor from a foreign land would simply have no way of knowing that race-based slavery existed in America. As Abraham Lincoln would later explain: Thus, the thing is hid away, in the Constitution, just as an afflicted man hides away a wen or a cancer, which he dares not cut out at once, lest he bleed to death. https://www.heritage.org/the-constitution/commentary/what-the-constitution-really-says-about-race-and-slavery ================ <QUESTION> ======= I've heard some people talk about the constitution and how it has racist traits. What is the three fifths part about in regard to black men and what does it mean? How is this legal and what does it mean to primarily prisons and people in jail through the legal system. I hate reading so can ou limit this to 200 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: the 13th Amendment officially was ratified, and with it, slavery finally was abolished in America. The New York World hailed it as “one of the most important reforms ever accomplished by voluntary human agency.” The newspaper said the amendment “takes out of politics, and consigns to history, an institution incongruous to our political system, inconsistent with justice and repugnant to the humane sentiments fostered by Christian civilization.” With the passage of the 13th Amendment—which states that “[n]either slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction”—the central contradiction at the heart of the Founding was resolved. Eighty-nine years after the Declaration of Independence had proclaimed all men to be free and equal, race-based chattel slavery would be no more in the United States. While all today recognize this momentous accomplishment, many remain confused about the status of slavery under the original Constitution. Textbooks and history books routinely dismiss the Constitution as racist and pro-slavery. The New York Times, among others, continues to casually assert that the Constitution affirmed African-Americans to be worth only three-fifths of a human being. Ironically, many Americans who are resolutely opposed to racism unwittingly agree with Chief Justice Roger Taney’s claim in Dred Scott v. Sandford (1857) that the Founders’ Constitution regarded blacks as “so far inferior that they had no rights which the white man was bound to respect, and that the negro might justly and lawfully be reduced to slavery for his benefit.” In this view, the worst Supreme Court case decision in American history was actually correctly decided. The argument that the Constitution is racist suffers from one fatal flaw: the concept of race does not exist in the Constitution. Such arguments have unsettling implications for the health of our republic. They teach citizens to despise their founding charter and to be ashamed of their country’s origins. They make the Constitution an object of contempt rather than reverence. And they foster alienation and resentment among African-American citizens by excluding them from our Constitution. The received wisdom in this case is wrong. If we turn to the actual text of the Constitution and the debates that gave rise to it, a different picture emerges. The case for a racist, pro-slavery Constitution collapses under closer scrutiny. Race and the Constitution The argument that the Constitution is racist suffers from one fatal flaw: the concept of race does not exist in the Constitution. Nowhere in the Constitution—or in the Declaration of Independence, for that matter—are human beings classified according to race, skin color, or ethnicity (nor, one should add, sex, religion, or any other of the left’s favored groupings). Our founding principles are colorblind (although our history, regrettably, has not been). The Constitution speaks of people, citizens, persons, other persons (a euphemism for slaves) and Indians not taxed (in which case, it is their tax-exempt status, and not their skin color, that matters). The first references to “race” and “color” occur in the 15th Amendment’s guarantee of the right to vote, ratified in 1870. The infamous three-fifths clause, which more nonsense has been written than any other clause, does not declare that a black person is worth 60 percent of a white person. It says that for purposes of determining the number of representatives for each state in the House (and direct taxes), the government would count only three-fifths of the slaves, and not all of them, as the Southern states, who wanted to gain more seats, had insisted. The 60,000 or so free blacks in the North and the South were counted on par with whites. Contrary to a popular misconception, the Constitution also does not say that only white males who owned property could vote. The Constitution defers to the states to determine who shall be eligible to vote (Article I, Section 2, Clause 1). It is a little known fact of American history that black citizens were voting in perhaps as many as 10 states at the time of the founding (the precise number is unclear, but only Georgia, South Carolina, and Virginia explicitly restricted suffrage to whites). Slavery and the Constitution Not only does the Constitution not mention blacks or whites, but it also doesn’t mention slaves or slavery. Throughout the document, slaves are referred to as persons to underscore their humanity. As James Madison remarked during the constitutional convention, it was “wrong to admit in the Constitution the idea that there could be property in men.” The Constitution refers to slaves using three different formulations: “other persons” (Article I, Section 2, Clause 3), “such persons as any of the states now existing shall think proper to admit” (Article I, Section 9, Clause 1), and a “person held to service or labor in one state, under the laws thereof” (Article IV, Section 2, Clause 3). Although these circumlocutions may not have done much to improve the lot of slaves, they are important, as they denied constitutional legitimacy to the institution of slavery. The practice remained legal, but slaveholders could not invoke the supreme law of the land to defend its legitimacy. These formulations make clear that slavery is a state institution that is tolerated—but not sanctioned—by the national government and the Constitution. Reading the original Constitution, a visitor from a foreign land would simply have no way of knowing that race-based slavery existed in America. As Abraham Lincoln would later explain: Thus, the thing is hid away, in the Constitution, just as an afflicted man hides away a wen or a cancer, which he dares not cut out at once, lest he bleed to death. USER: I've heard some people talk about the constitution and how it has racist traits. What is the three fifths part about in regard to black men and what does it mean? How is this legal and what does it mean to primarily prisons and people in jail through the legal system. I hate reading so can ou limit this to 200 words. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	49	62	945	null	757
Only use the information provided in the below context block to asnwer the question. Your answer should be in paragraph format and no more than 200 words.	What are the key points of Section 455 of the Higher Education Act?	On August 8, 2020, President Trump signed a presidential memorandum expressing his view that payments and interest accrual on student loans should remain suspended past September 30, 2020, “until such time that the economy has stabilized, schools have re-opened, and the crisis brought on by the COVID-19 pandemic has subsided.” The memorandum directs the Secretary of Education to “continue the temporary cessation of payments and the waiver of all interest on student loans held by the Department of Education until December 31, 2020.” The memorandum cites Section 455(f)(2)(D) of the Higher Education Act (HEA), which allows eligible borrowers to defer certain federally held student loans if they experience economic hardship. Such a deferment temporarily relieves the borrower of an obligation to pay principal installments on the loan. For some (but not all) loans, a deferment also temporarily suspends the accrual of loan interest. To implement the proposed suspension of payments and interest accrual, the presidential memorandum directs the Secretary of Education “to take action pursuant to applicable law to effectuate appropriate waivers of and modifications to the requirements and conditions of economic hardship deferment described in” HEA Section 455(f)(2)(D). Under HEA Section 435(o)—which Section 455(f)(2)(D) incorporates by reference—a borrower is eligible for an economic hardship deferment if the borrower is (1) working full-time and (2) earning an amount of money that falls below a specified threshold. But HEA Sections 455(f)(2)(D) and 435(o) also authorize the Secretary of Education to promulgate regulations making additional borrowers eligible for an economic hardship deferment. The Secretary of Education previously issued regulations making economic hardship deferments available to certain borrowers who might not otherwise meet the criteria specified in Section 435(o). The presidential memorandum contemplates that the Secretary of Education will exercise available statutory authorities to further expand economic hardship deferment eligibility to borrowers adversely affected by the COVID-19 pandemic. The presidential memorandum may raise several questions for policymakers. First, as mentioned above, a deferment under Section 455(f) does not suspend interest accrual for all types of student loans. To the contrary, Section 435(f)(1)(B) states that for certain loans, interest “shall accrue and be capitalized or paid by the borrower” during the deferment period. It therefore may be uncertain whether Section 455(f), standing alone, allows the Executive to waive “all interest on student loans held by the Department of Education” as the presidential memorandum contemplates. That said, the presidential memorandum directs the Secretary of Education to take action pursuant to “applicable law” to effectuate the memorandum’s directives. The Trump Administration might attempt to argue that other provisions of federal law give the Secretary of Education the power to waive all interest on student loans held by the Department of Education, even if Section 455 does not. Second, the memorandum does not explicitly specify who will be eligible for the expanded economic hardship deferments. The memorandum appears to contemplate, however, that the Secretary of Education will make those deferments available to all borrowers who are currently covered by the CARES Act’s payment and interest suspension provisions. Third, while the presidential memorandum states that “[a]ll persons who wish to continue making student loan payments shall be allowed to do so,” it does not specify whether borrowers will need to apply for the deferments, or if the Secretary of Education will instead automatically grant deferments to eligible borrowers unless they opt out. Under existing regulations, deferment is (with limited exceptions) not automatic; a borrower must usually request a deferment and submit an application containing various documents. Although the Secretary of Education could potentially amend those regulations to automatically grant deferments, doing so could have both advantages and disadvantages. On one hand, dispensing with the requirement that borrowers file an application to receive a deferment could reduce burdens on both borrowers and the federal government. On the other hand, some borrowers might prefer not to receive an automatic deferment, preferring to continue paying off their loans. For instance, some student loan forgiveness programs—such as the Public Service Loan Forgiveness (PSLF) Program— require the borrower to make payments over an extended period to receive relief. Fourth, Section 3513 of the CARES Act affords borrowers certain types of relief that the presidential memorandum does not mention. For instance: • Section 3513(e) suspends involuntary collection on student loans covered by the CARES Act’s principal and interest suspension provisions. • Section 3513(d) affords borrowers certain consumer credit reporting protections during the suspension period. • Section 3513(c) requires the Secretary of Education to “deem each month for which a loan payment was suspended” under the CARES Act as if the borrower “had made a payment for the purpose of any loan forgiveness program or loan rehabilitation program,” such as the PSLF program. The memorandum does not expressly address these topics. Notably, however, when the Trump Administration took administrative action in March 2020 to grant relief to student loan borrowers, the Secretary of Education instructed the U.S. Treasury and collection agencies to cease involuntary collection actions and wage garnishments for at least 60 days. Also, it is presently unclear whether the Secretary of Education will give stakeholders an opportunity to comment on any regulations she might promulgate to implement the memorandum. Federal law ordinarily requires the Secretary of Education to engage in a negotiated rulemaking process with stakeholders and accept and consider public comments before a regulation governing student loans becomes effective. But the Secretary of Education may bypass these procedures when following them would be “impracticable, unnecessary, or contrary to the public interest.” Given the significant and continuing impact of COVID-19 and Section 3513’s impending expiration date, the Secretary of Education might be able to publish regulations to implement aspects of the memorandum that become effective immediately, without first accepting public comment.	What are the key points of Section 455 of the Higher Education Act? Only use the information provided in the below context block to asnwer the question. Your answer should be in paragraph format and no more than 200 words. On August 8, 2020, President Trump signed a presidential memorandum expressing his view that payments and interest accrual on student loans should remain suspended past September 30, 2020, “until such time that the economy has stabilized, schools have re-opened, and the crisis brought on by the COVID-19 pandemic has subsided.” The memorandum directs the Secretary of Education to “continue the temporary cessation of payments and the waiver of all interest on student loans held by the Department of Education until December 31, 2020.” The memorandum cites Section 455(f)(2)(D) of the Higher Education Act (HEA), which allows eligible borrowers to defer certain federally held student loans if they experience economic hardship. Such a deferment temporarily relieves the borrower of an obligation to pay principal installments on the loan. For some (but not all) loans, a deferment also temporarily suspends the accrual of loan interest. To implement the proposed suspension of payments and interest accrual, the presidential memorandum directs the Secretary of Education “to take action pursuant to applicable law to effectuate appropriate waivers of and modifications to the requirements and conditions of economic hardship deferment described in” HEA Section 455(f)(2)(D). Under HEA Section 435(o)—which Section 455(f)(2)(D) incorporates by reference—a borrower is eligible for an economic hardship deferment if the borrower is (1) working full-time and (2) earning an amount of money that falls below a specified threshold. But HEA Sections 455(f)(2)(D) and 435(o) also authorize the Secretary of Education to promulgate regulations making additional borrowers eligible for an economic hardship deferment. The Secretary of Education previously issued regulations making economic hardship deferments available to certain borrowers who might not otherwise meet the criteria specified in Section 435(o). The presidential memorandum contemplates that the Secretary of Education will exercise available statutory authorities to further expand economic hardship deferment eligibility to borrowers adversely affected by the COVID-19 pandemic. The presidential memorandum may raise several questions for policymakers. First, as mentioned above, a deferment under Section 455(f) does not suspend interest accrual for all types of student loans. To the contrary, Section 435(f)(1)(B) states that for certain loans, interest “shall accrue and be capitalized or paid by the borrower” during the deferment period. It therefore may be uncertain whether Section 455(f), standing alone, allows the Executive to waive “all interest on student loans held by the Department of Education” as the presidential memorandum contemplates. That said, the presidential memorandum directs the Secretary of Education to take action pursuant to “applicable law” to effectuate the memorandum’s directives. The Trump Administration might attempt to argue that other provisions of federal law give the Secretary of Education the power to waive all interest on student loans held by the Department of Education, even if Section 455 does not. Second, the memorandum does not explicitly specify who will be eligible for the expanded economic hardship deferments. The memorandum appears to contemplate, however, that the Secretary of Education will make those deferments available to all borrowers who are currently covered by the CARES Act’s payment and interest suspension provisions. Third, while the presidential memorandum states that “[a]ll persons who wish to continue making student loan payments shall be allowed to do so,” it does not specify whether borrowers will need to apply for the deferments, or if the Secretary of Education will instead automatically grant deferments to eligible borrowers unless they opt out. Under existing regulations, deferment is (with limited exceptions) not automatic; a borrower must usually request a deferment and submit an application containing various documents. Although the Secretary of Education could potentially amend those regulations to automatically grant deferments, doing so could have both advantages and disadvantages. On one hand, dispensing with the requirement that borrowers file an application to receive a deferment could reduce burdens on both borrowers and the federal government. On the other hand, some borrowers might prefer not to receive an automatic deferment, preferring to continue paying off their loans. For instance, some student loan forgiveness programs—such as the Public Service Loan Forgiveness (PSLF) Program— require the borrower to make payments over an extended period to receive relief. Fourth, Section 3513 of the CARES Act affords borrowers certain types of relief that the presidential memorandum does not mention. For instance: • Section 3513(e) suspends involuntary collection on student loans covered by the CARES Act’s principal and interest suspension provisions. • Section 3513(d) affords borrowers certain consumer credit reporting protections during the suspension period. • Section 3513(c) requires the Secretary of Education to “deem each month for which a loan payment was suspended” under the CARES Act as if the borrower “had made a payment for the purpose of any loan forgiveness program or loan rehabilitation program,” such as the PSLF program. The memorandum does not expressly address these topics. Notably, however, when the Trump Administration took administrative action in March 2020 to grant relief to student loan borrowers, the Secretary of Education instructed the U.S. Treasury and collection agencies to cease involuntary collection actions and wage garnishments for at least 60 days. Also, it is presently unclear whether the Secretary of Education will give stakeholders an opportunity to comment on any regulations she might promulgate to implement the memorandum. Federal law ordinarily requires the Secretary of Education to engage in a negotiated rulemaking process with stakeholders and accept and consider public comments before a regulation governing student loans becomes effective. But the Secretary of Education may bypass these procedures when following them would be “impracticable, unnecessary, or contrary to the public interest.” Given the significant and continuing impact of COVID-19 and Section 3513’s impending expiration date, the Secretary of Education might be able to publish regulations to implement aspects of the memorandum that become effective immediately, without first accepting public comment.	Only use the information provided in the below context block to asnwer the question. Your answer should be in paragraph format and no more than 200 words. EVIDENCE: On August 8, 2020, President Trump signed a presidential memorandum expressing his view that payments and interest accrual on student loans should remain suspended past September 30, 2020, “until such time that the economy has stabilized, schools have re-opened, and the crisis brought on by the COVID-19 pandemic has subsided.” The memorandum directs the Secretary of Education to “continue the temporary cessation of payments and the waiver of all interest on student loans held by the Department of Education until December 31, 2020.” The memorandum cites Section 455(f)(2)(D) of the Higher Education Act (HEA), which allows eligible borrowers to defer certain federally held student loans if they experience economic hardship. Such a deferment temporarily relieves the borrower of an obligation to pay principal installments on the loan. For some (but not all) loans, a deferment also temporarily suspends the accrual of loan interest. To implement the proposed suspension of payments and interest accrual, the presidential memorandum directs the Secretary of Education “to take action pursuant to applicable law to effectuate appropriate waivers of and modifications to the requirements and conditions of economic hardship deferment described in” HEA Section 455(f)(2)(D). Under HEA Section 435(o)—which Section 455(f)(2)(D) incorporates by reference—a borrower is eligible for an economic hardship deferment if the borrower is (1) working full-time and (2) earning an amount of money that falls below a specified threshold. But HEA Sections 455(f)(2)(D) and 435(o) also authorize the Secretary of Education to promulgate regulations making additional borrowers eligible for an economic hardship deferment. The Secretary of Education previously issued regulations making economic hardship deferments available to certain borrowers who might not otherwise meet the criteria specified in Section 435(o). The presidential memorandum contemplates that the Secretary of Education will exercise available statutory authorities to further expand economic hardship deferment eligibility to borrowers adversely affected by the COVID-19 pandemic. The presidential memorandum may raise several questions for policymakers. First, as mentioned above, a deferment under Section 455(f) does not suspend interest accrual for all types of student loans. To the contrary, Section 435(f)(1)(B) states that for certain loans, interest “shall accrue and be capitalized or paid by the borrower” during the deferment period. It therefore may be uncertain whether Section 455(f), standing alone, allows the Executive to waive “all interest on student loans held by the Department of Education” as the presidential memorandum contemplates. That said, the presidential memorandum directs the Secretary of Education to take action pursuant to “applicable law” to effectuate the memorandum’s directives. The Trump Administration might attempt to argue that other provisions of federal law give the Secretary of Education the power to waive all interest on student loans held by the Department of Education, even if Section 455 does not. Second, the memorandum does not explicitly specify who will be eligible for the expanded economic hardship deferments. The memorandum appears to contemplate, however, that the Secretary of Education will make those deferments available to all borrowers who are currently covered by the CARES Act’s payment and interest suspension provisions. Third, while the presidential memorandum states that “[a]ll persons who wish to continue making student loan payments shall be allowed to do so,” it does not specify whether borrowers will need to apply for the deferments, or if the Secretary of Education will instead automatically grant deferments to eligible borrowers unless they opt out. Under existing regulations, deferment is (with limited exceptions) not automatic; a borrower must usually request a deferment and submit an application containing various documents. Although the Secretary of Education could potentially amend those regulations to automatically grant deferments, doing so could have both advantages and disadvantages. On one hand, dispensing with the requirement that borrowers file an application to receive a deferment could reduce burdens on both borrowers and the federal government. On the other hand, some borrowers might prefer not to receive an automatic deferment, preferring to continue paying off their loans. For instance, some student loan forgiveness programs—such as the Public Service Loan Forgiveness (PSLF) Program— require the borrower to make payments over an extended period to receive relief. Fourth, Section 3513 of the CARES Act affords borrowers certain types of relief that the presidential memorandum does not mention. For instance: • Section 3513(e) suspends involuntary collection on student loans covered by the CARES Act’s principal and interest suspension provisions. • Section 3513(d) affords borrowers certain consumer credit reporting protections during the suspension period. • Section 3513(c) requires the Secretary of Education to “deem each month for which a loan payment was suspended” under the CARES Act as if the borrower “had made a payment for the purpose of any loan forgiveness program or loan rehabilitation program,” such as the PSLF program. The memorandum does not expressly address these topics. Notably, however, when the Trump Administration took administrative action in March 2020 to grant relief to student loan borrowers, the Secretary of Education instructed the U.S. Treasury and collection agencies to cease involuntary collection actions and wage garnishments for at least 60 days. Also, it is presently unclear whether the Secretary of Education will give stakeholders an opportunity to comment on any regulations she might promulgate to implement the memorandum. Federal law ordinarily requires the Secretary of Education to engage in a negotiated rulemaking process with stakeholders and accept and consider public comments before a regulation governing student loans becomes effective. But the Secretary of Education may bypass these procedures when following them would be “impracticable, unnecessary, or contrary to the public interest.” Given the significant and continuing impact of COVID-19 and Section 3513’s impending expiration date, the Secretary of Education might be able to publish regulations to implement aspects of the memorandum that become effective immediately, without first accepting public comment. USER: What are the key points of Section 455 of the Higher Education Act? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	27	13	948	null	270
[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 just adopted a German Shepard puppy through a local pet rescue. I also own a small business with inventory in an outbuilding on my property. Can I deduct the adoption fee and all of the expenses for this dog if I am using him a few hours a day as a guard dog?	When you’re trying to score a break at tax time, maxing out your deductions can potentially lower your bill or result in a bigger tax return. Apart from the standard write-offs for things like mortgage interest or business travel, you may be able to claim more unusual expenses, including the cost of taking care of a pet. The IRS has certain rules about when pet expenses are tax-deductible, so if you’ve got some furry friends at home, here are a few scenarios where you might benefit. Consider working with a financial advisor as you work on a budget, whether that includes a pet or not. You Require a Pet for Medical Reasons Service animals can take many different forms, including dogs, cats and even miniature ponies. If you’re required to have a guide, service or therapy animal because you have a diagnosed medical condition, such as blindness, epilepsy or post-traumatic stress disorder, you may be able to deduct the cost of its care as a medical expense on your taxes. In order to meet the IRS standards your pet must be certified and trained as a service animal. The types of costs you can deduct include grooming, food, veterinary care and training. You might also be able to claim vet bills on taxes for pets you foster, provided that the nonprofit organization hasn’t reimbursed you and the organization is registered with the IRS. Find out now: How much do I need to save for retirement? You Use a Guard Dog for Your Business While you can’t technically put a dog on the payroll, you may still be able to deduct the cost of its care as a business expense if it’s used primarily to guard your premises and inventory. The IRS doesn’t allow you to write off the cost of buying the dog itself, but you can use the deduction for things like food, training, boarding and medical care. Keep in mind that it only applies to the dog’s working hours, not expenses incurred during the animal’s down time. You Foster Pets in Your Home Volunteering with a service animal agency or pet rescue organization is a great way to give back, and it can also pay off at tax time. If you foster pets, either in your home or on your property, you may be eligible to claim the deduction for unreimbursed expenses. That covers food, shelter, veterinary bills, grooming costs, litter and bedding materials. These expenses would qualify as charitable donations, which are deductible up to 50 percent of your adjusted gross income. You’re a Professional Breeder SmartAsset: When Are Pet Expenses Tax-Deductible? If breeding and selling dogs, cats or other animals is your primary occupation, there’s good news: not only can you deduct food, medical bills and boarding costs, but you can also write off any other ordinary and necessary expenses that running your business entails. This includes things like advertising, costs relating to the business use of your home, and travel expenses. If you breed animals as a hobby, you only qualify for the deduction if your expenses exceed 2 percent of your adjusted gross income and you itemize. You’re a Law Enforcement Dog Handler Some of the cost that goes along with maintaining a police dog may also qualify for a tax deduction if you’re not reimbursed for these expenses through your job. If the dog lives in your home when not on-duty and you’re responsible for buying its food or purchasing a kennel, you can generally claim them as a job-related expense. The Main Rule for Cutting Your Tax Bill The No. 1 rule when it comes to claiming deductions for pet care is to make sure you’re documenting your expenses carefully. If you include something that you know is deductible but you don’t have documentation to support it, you may run into trouble if you’re audited. You don’t want to end up in the doghouse with Uncle Sam, so hanging on to all of your receipts is a must. Bottom Line SmartAsset: When Are Pet Expenses Tax-Deductible? Contrary to what many people may think, it is very possible to claim deductions for your pet-related expenses. Just be sure to keep careful and complete records of what you spend and why you spent it. Was it for a work-related matter? Or was it for non-compensated activity like fostering pets? Keep in mind that moving expenses are no longer deductible. Tips on Taxes A financial advisor can offer valuable insight and guidance as you explore ways to reduce your taxes, including by deducting pet-related expenses. Finding a financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with up to three financial advisors who serve your area, and you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now. Income in America is taxed by the federal government, most state governments and many local governments. The federal income tax system is progressive, so the rate of taxation increases as income increases. Use our free income tax calculator to give you a quick estimate of what you’ll owe.	[question] I just adopted a German Shepard puppy through a local pet rescue. I also own a small business with inventory in an outbuilding on my property. Can I deduct the adoption fee and all of the expenses for this dog if I am using him a few hours a day as a guard dog? ===================== [text] When you’re trying to score a break at tax time, maxing out your deductions can potentially lower your bill or result in a bigger tax return. Apart from the standard write-offs for things like mortgage interest or business travel, you may be able to claim more unusual expenses, including the cost of taking care of a pet. The IRS has certain rules about when pet expenses are tax-deductible, so if you’ve got some furry friends at home, here are a few scenarios where you might benefit. Consider working with a financial advisor as you work on a budget, whether that includes a pet or not. You Require a Pet for Medical Reasons Service animals can take many different forms, including dogs, cats and even miniature ponies. If you’re required to have a guide, service or therapy animal because you have a diagnosed medical condition, such as blindness, epilepsy or post-traumatic stress disorder, you may be able to deduct the cost of its care as a medical expense on your taxes. In order to meet the IRS standards your pet must be certified and trained as a service animal. The types of costs you can deduct include grooming, food, veterinary care and training. You might also be able to claim vet bills on taxes for pets you foster, provided that the nonprofit organization hasn’t reimbursed you and the organization is registered with the IRS. Find out now: How much do I need to save for retirement? You Use a Guard Dog for Your Business While you can’t technically put a dog on the payroll, you may still be able to deduct the cost of its care as a business expense if it’s used primarily to guard your premises and inventory. The IRS doesn’t allow you to write off the cost of buying the dog itself, but you can use the deduction for things like food, training, boarding and medical care. Keep in mind that it only applies to the dog’s working hours, not expenses incurred during the animal’s down time. You Foster Pets in Your Home Volunteering with a service animal agency or pet rescue organization is a great way to give back, and it can also pay off at tax time. If you foster pets, either in your home or on your property, you may be eligible to claim the deduction for unreimbursed expenses. That covers food, shelter, veterinary bills, grooming costs, litter and bedding materials. These expenses would qualify as charitable donations, which are deductible up to 50 percent of your adjusted gross income. You’re a Professional Breeder SmartAsset: When Are Pet Expenses Tax-Deductible? If breeding and selling dogs, cats or other animals is your primary occupation, there’s good news: not only can you deduct food, medical bills and boarding costs, but you can also write off any other ordinary and necessary expenses that running your business entails. This includes things like advertising, costs relating to the business use of your home, and travel expenses. If you breed animals as a hobby, you only qualify for the deduction if your expenses exceed 2 percent of your adjusted gross income and you itemize. You’re a Law Enforcement Dog Handler Some of the cost that goes along with maintaining a police dog may also qualify for a tax deduction if you’re not reimbursed for these expenses through your job. If the dog lives in your home when not on-duty and you’re responsible for buying its food or purchasing a kennel, you can generally claim them as a job-related expense. The Main Rule for Cutting Your Tax Bill The No. 1 rule when it comes to claiming deductions for pet care is to make sure you’re documenting your expenses carefully. If you include something that you know is deductible but you don’t have documentation to support it, you may run into trouble if you’re audited. You don’t want to end up in the doghouse with Uncle Sam, so hanging on to all of your receipts is a must. Bottom Line SmartAsset: When Are Pet Expenses Tax-Deductible? Contrary to what many people may think, it is very possible to claim deductions for your pet-related expenses. Just be sure to keep careful and complete records of what you spend and why you spent it. Was it for a work-related matter? Or was it for non-compensated activity like fostering pets? Keep in mind that moving expenses are no longer deductible. Tips on Taxes A financial advisor can offer valuable insight and guidance as you explore ways to reduce your taxes, including by deducting pet-related expenses. Finding a financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with up to three financial advisors who serve your area, and you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now. Income in America is taxed by the federal government, most state governments and many local governments. The federal income tax system is progressive, so the rate of taxation increases as income increases. Use our free income tax calculator to give you a quick estimate of what you’ll owe. https://smartasset.com/personal-finance/when-are-pet-expenses-tax-deductible ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.	[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: When you’re trying to score a break at tax time, maxing out your deductions can potentially lower your bill or result in a bigger tax return. Apart from the standard write-offs for things like mortgage interest or business travel, you may be able to claim more unusual expenses, including the cost of taking care of a pet. The IRS has certain rules about when pet expenses are tax-deductible, so if you’ve got some furry friends at home, here are a few scenarios where you might benefit. Consider working with a financial advisor as you work on a budget, whether that includes a pet or not. You Require a Pet for Medical Reasons Service animals can take many different forms, including dogs, cats and even miniature ponies. If you’re required to have a guide, service or therapy animal because you have a diagnosed medical condition, such as blindness, epilepsy or post-traumatic stress disorder, you may be able to deduct the cost of its care as a medical expense on your taxes. In order to meet the IRS standards your pet must be certified and trained as a service animal. The types of costs you can deduct include grooming, food, veterinary care and training. You might also be able to claim vet bills on taxes for pets you foster, provided that the nonprofit organization hasn’t reimbursed you and the organization is registered with the IRS. Find out now: How much do I need to save for retirement? You Use a Guard Dog for Your Business While you can’t technically put a dog on the payroll, you may still be able to deduct the cost of its care as a business expense if it’s used primarily to guard your premises and inventory. The IRS doesn’t allow you to write off the cost of buying the dog itself, but you can use the deduction for things like food, training, boarding and medical care. Keep in mind that it only applies to the dog’s working hours, not expenses incurred during the animal’s down time. You Foster Pets in Your Home Volunteering with a service animal agency or pet rescue organization is a great way to give back, and it can also pay off at tax time. If you foster pets, either in your home or on your property, you may be eligible to claim the deduction for unreimbursed expenses. That covers food, shelter, veterinary bills, grooming costs, litter and bedding materials. These expenses would qualify as charitable donations, which are deductible up to 50 percent of your adjusted gross income. You’re a Professional Breeder SmartAsset: When Are Pet Expenses Tax-Deductible? If breeding and selling dogs, cats or other animals is your primary occupation, there’s good news: not only can you deduct food, medical bills and boarding costs, but you can also write off any other ordinary and necessary expenses that running your business entails. This includes things like advertising, costs relating to the business use of your home, and travel expenses. If you breed animals as a hobby, you only qualify for the deduction if your expenses exceed 2 percent of your adjusted gross income and you itemize. You’re a Law Enforcement Dog Handler Some of the cost that goes along with maintaining a police dog may also qualify for a tax deduction if you’re not reimbursed for these expenses through your job. If the dog lives in your home when not on-duty and you’re responsible for buying its food or purchasing a kennel, you can generally claim them as a job-related expense. The Main Rule for Cutting Your Tax Bill The No. 1 rule when it comes to claiming deductions for pet care is to make sure you’re documenting your expenses carefully. If you include something that you know is deductible but you don’t have documentation to support it, you may run into trouble if you’re audited. You don’t want to end up in the doghouse with Uncle Sam, so hanging on to all of your receipts is a must. Bottom Line SmartAsset: When Are Pet Expenses Tax-Deductible? Contrary to what many people may think, it is very possible to claim deductions for your pet-related expenses. Just be sure to keep careful and complete records of what you spend and why you spent it. Was it for a work-related matter? Or was it for non-compensated activity like fostering pets? Keep in mind that moving expenses are no longer deductible. Tips on Taxes A financial advisor can offer valuable insight and guidance as you explore ways to reduce your taxes, including by deducting pet-related expenses. Finding a financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with up to three financial advisors who serve your area, and you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now. Income in America is taxed by the federal government, most state governments and many local governments. The federal income tax system is progressive, so the rate of taxation increases as income increases. Use our free income tax calculator to give you a quick estimate of what you’ll owe. USER: I just adopted a German Shepard puppy through a local pet rescue. I also own a small business with inventory in an outbuilding on my property. Can I deduct the adoption fee and all of the expenses for this dog if I am using him a few hours a day as a guard dog? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	28	54	868	null	13
"================ <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."	Can you explain to me why staphylococcus aureus is a pathogen that is of particular worry for humans? What disease does it cause? What are the reasons behinds its success?	Staphylococcus aureus is a Gram-positive, nonmotile, coagulase-positive coccoid bacterium of the Firmicutes phylum. Although the Staphylococcus genus includes 52 species and 28 subspecies (List of Prokaryotic names with Standing in Nomenclature), S. aureus is by far the most clinically relevant. S. aureus is found in the human commensal microbiota of the nasal mucosa in 20–40% of the general population1,2. The reported prevalence varies owing to differences in the size and demographics of the study populations, quality of sampling and culture techniques utilized3. When the cutaneous and mucosal barriers are disrupted, for example, owing to chronic skin conditions, wounds or surgical intervention, S. aureus can gain access to the underlying tissues or the bloodstream and cause infection. Persons with invasive medical devices (such as peripheral and central venous catheters) or compromised immune systems are particularly vulnerable to S. aureus infection4. Methicillin-resistant S. aureus (MRSA) was first described in England in 1961 (Ref.5), soon after methicillin was introduced into clinical practice. Methicillin was initially widely used; however, because of its toxicity, it is now no longer marketed for human use and has largely been replaced by similar, more-stable penicillins such as oxacillin, flucloxacillin and dicloxacillin6. Nevertheless, the term methicillin-resistant S. aureus continues to be used. In the decade following its initial description, MRSA was responsible for hospital outbreaks (health-care-associated MRSA (HA-MRSA)) in many parts of the world7. A substantial change in MRSA epidemiology was observed when it was detected in individuals without previous health-care contact (referred to as community-associated MRSA (CA-MRSA)), notably among indigenous populations in Australia in the 1980s8 and otherwise healthy persons, including children, in the United States in the 1990s9. Since the mid-2000s, it has also been associated with livestock exposure (livestock-associated MRSA (LA-MRSA))10. Several S. aureus clones (that is, bacteria that are indistinguishable from each other by a variety of genetic tests (for example, pulsed-field gel electrophoresis, multilocus enzyme electrophoresis or ribotyping) or that are so similar that they are presumed to be derived from a common parent11) have developed into MRSA by uptake via horizontal gene transfer of staphylococcal cassette chromosome mec (SCCmec)12, a mobile genetic element that encodes the genes mecA or mecC, which confer resistance to methicillin and, therefore, to most β-lactam antibiotics. MRSA is often also resistant to multiple other antibiotic classes. Indeed, S. aureus has the remarkable ability to acquire resistance to any antibiotic7, which has major implications for current as well as future treatment options for this pathogen. Individuals with MRSA colonization or carriage (that is, the presence of bacteria that do not cause a detectable host immune response, cellular damage or clinical signs and symptoms of infection) have an increased risk of subsequent infection and are an important source of person-to-person transmission. Health-care facilities host persons who are predisposed to infection (for example, owing to invasive procedures and/or immune compromise) and are environments with high antibiotic selection pressure (which can contribute to the selection of antimicrobial resistance in bacteria) and frequent contact between individuals. These conditions have facilitated the epidemic spread of MRSA in hospitals; MRSA is now endemic in many health-care facilities throughout the world and, as a consequence, it has become a major focus for infection control efforts globally.	"================ <TEXT PASSAGE> ======= Staphylococcus aureus is a Gram-positive, nonmotile, coagulase-positive coccoid bacterium of the Firmicutes phylum. Although the Staphylococcus genus includes 52 species and 28 subspecies (List of Prokaryotic names with Standing in Nomenclature), S. aureus is by far the most clinically relevant. S. aureus is found in the human commensal microbiota of the nasal mucosa in 20–40% of the general population1,2. The reported prevalence varies owing to differences in the size and demographics of the study populations, quality of sampling and culture techniques utilized3. When the cutaneous and mucosal barriers are disrupted, for example, owing to chronic skin conditions, wounds or surgical intervention, S. aureus can gain access to the underlying tissues or the bloodstream and cause infection. Persons with invasive medical devices (such as peripheral and central venous catheters) or compromised immune systems are particularly vulnerable to S. aureus infection4. Methicillin-resistant S. aureus (MRSA) was first described in England in 1961 (Ref.5), soon after methicillin was introduced into clinical practice. Methicillin was initially widely used; however, because of its toxicity, it is now no longer marketed for human use and has largely been replaced by similar, more-stable penicillins such as oxacillin, flucloxacillin and dicloxacillin6. Nevertheless, the term methicillin-resistant S. aureus continues to be used. In the decade following its initial description, MRSA was responsible for hospital outbreaks (health-care-associated MRSA (HA-MRSA)) in many parts of the world7. A substantial change in MRSA epidemiology was observed when it was detected in individuals without previous health-care contact (referred to as community-associated MRSA (CA-MRSA)), notably among indigenous populations in Australia in the 1980s8 and otherwise healthy persons, including children, in the United States in the 1990s9. Since the mid-2000s, it has also been associated with livestock exposure (livestock-associated MRSA (LA-MRSA))10. Several S. aureus clones (that is, bacteria that are indistinguishable from each other by a variety of genetic tests (for example, pulsed-field gel electrophoresis, multilocus enzyme electrophoresis or ribotyping) or that are so similar that they are presumed to be derived from a common parent11) have developed into MRSA by uptake via horizontal gene transfer of staphylococcal cassette chromosome mec (SCCmec)12, a mobile genetic element that encodes the genes mecA or mecC, which confer resistance to methicillin and, therefore, to most β-lactam antibiotics. MRSA is often also resistant to multiple other antibiotic classes. Indeed, S. aureus has the remarkable ability to acquire resistance to any antibiotic7, which has major implications for current as well as future treatment options for this pathogen. Individuals with MRSA colonization or carriage (that is, the presence of bacteria that do not cause a detectable host immune response, cellular damage or clinical signs and symptoms of infection) have an increased risk of subsequent infection and are an important source of person-to-person transmission. Health-care facilities host persons who are predisposed to infection (for example, owing to invasive procedures and/or immune compromise) and are environments with high antibiotic selection pressure (which can contribute to the selection of antimicrobial resistance in bacteria) and frequent contact between individuals. These conditions have facilitated the epidemic spread of MRSA in hospitals; MRSA is now endemic in many health-care facilities throughout the world and, as a consequence, it has become a major focus for infection control efforts globally. https://www.nature.com/articles/nrdp201833 ================ <QUESTION> ======= Can you explain to me why staphylococcus aureus is a pathogen that is of particular worry for humans? What disease does it cause? What are the reasons behinds its success? ================ <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: Staphylococcus aureus is a Gram-positive, nonmotile, coagulase-positive coccoid bacterium of the Firmicutes phylum. Although the Staphylococcus genus includes 52 species and 28 subspecies (List of Prokaryotic names with Standing in Nomenclature), S. aureus is by far the most clinically relevant. S. aureus is found in the human commensal microbiota of the nasal mucosa in 20–40% of the general population1,2. The reported prevalence varies owing to differences in the size and demographics of the study populations, quality of sampling and culture techniques utilized3. When the cutaneous and mucosal barriers are disrupted, for example, owing to chronic skin conditions, wounds or surgical intervention, S. aureus can gain access to the underlying tissues or the bloodstream and cause infection. Persons with invasive medical devices (such as peripheral and central venous catheters) or compromised immune systems are particularly vulnerable to S. aureus infection4. Methicillin-resistant S. aureus (MRSA) was first described in England in 1961 (Ref.5), soon after methicillin was introduced into clinical practice. Methicillin was initially widely used; however, because of its toxicity, it is now no longer marketed for human use and has largely been replaced by similar, more-stable penicillins such as oxacillin, flucloxacillin and dicloxacillin6. Nevertheless, the term methicillin-resistant S. aureus continues to be used. In the decade following its initial description, MRSA was responsible for hospital outbreaks (health-care-associated MRSA (HA-MRSA)) in many parts of the world7. A substantial change in MRSA epidemiology was observed when it was detected in individuals without previous health-care contact (referred to as community-associated MRSA (CA-MRSA)), notably among indigenous populations in Australia in the 1980s8 and otherwise healthy persons, including children, in the United States in the 1990s9. Since the mid-2000s, it has also been associated with livestock exposure (livestock-associated MRSA (LA-MRSA))10. Several S. aureus clones (that is, bacteria that are indistinguishable from each other by a variety of genetic tests (for example, pulsed-field gel electrophoresis, multilocus enzyme electrophoresis or ribotyping) or that are so similar that they are presumed to be derived from a common parent11) have developed into MRSA by uptake via horizontal gene transfer of staphylococcal cassette chromosome mec (SCCmec)12, a mobile genetic element that encodes the genes mecA or mecC, which confer resistance to methicillin and, therefore, to most β-lactam antibiotics. MRSA is often also resistant to multiple other antibiotic classes. Indeed, S. aureus has the remarkable ability to acquire resistance to any antibiotic7, which has major implications for current as well as future treatment options for this pathogen. Individuals with MRSA colonization or carriage (that is, the presence of bacteria that do not cause a detectable host immune response, cellular damage or clinical signs and symptoms of infection) have an increased risk of subsequent infection and are an important source of person-to-person transmission. Health-care facilities host persons who are predisposed to infection (for example, owing to invasive procedures and/or immune compromise) and are environments with high antibiotic selection pressure (which can contribute to the selection of antimicrobial resistance in bacteria) and frequent contact between individuals. These conditions have facilitated the epidemic spread of MRSA in hospitals; MRSA is now endemic in many health-care facilities throughout the world and, as a consequence, it has become a major focus for infection control efforts globally. USER: Can you explain to me why staphylococcus aureus is a pathogen that is of particular worry for humans? What disease does it cause? What are the reasons behinds its success? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	49	30	530	null	492
List five similarities and three differences. Use only the Context block contained in the prompt to respond.	What are the differences between law clerk duties for a district judge and a bankruptcy judge?	G. U.S. Trustees and Private Trustees The U.S. Trustee Program is part of the federal government’s Department of Justice, not a part of the courts. It was established to handle the administrative functions of bankruptcy cases and to ensure the integrity of the bankruptcy system across the nation. The program operates with twenty-one regional offices and ninety-four field offices, which are headed by U.S. trustees and assistant U.S. trustees, respectively. See 28 U.S.C. §§ 581–589b. In the six judicial districts in Alabama and North Carolina, the Bankruptcy Administrator Program, rather than the U.S. Trustee Program, handles the administrative functions. See § 302(d) (3)(1) of the Bankruptcy Judges, United States Trustees, and Family Farmer Act of 1986, P.L. 99-554, 100 Stat. 3119, 3123, and § 317(b) of the Federal Courts Study Committee Implementation Act of 1990. The functions of the U.S. trustees are enumerated in 28 U.S.C. § 581(a), and primarily include (1) appointing and supervising the private trustees who collect and disburse funds to creditors in Chapter 7, 12, and 13 cases; (2) ensuring compliance with the Bankruptcy Code with respect to information provided in schedules, disclosure statements, reorganization plans, and other filings; (3) reviewing fee applications of professionals, such as attorneys and accountants, who serve in Chapter 11 reorganization cases; and (4) monitoring bankruptcy cases for fraud and referring criminal matters to the U.S. attorney for prosecution. Trustees do not have independent enforcement powers; rather, they must request the court to rule on matters of administration for which there is no voluntary compliance. The U.S. trustee is responsible for establishing a panel of private trustees to serve in Chapter 7 cases. When a bankruptcy petition is filed under Chapter 7, the U.S. trustee appoints a disinterested person from this panel to serve as interim trustee. At the first meeting of creditors, the creditors may elect another person as trustee, although such elections are rare. The U.S. trustee is also responsible 44 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.A for appointing one or more “standing” trustees to administer all Chapter 12 and 13 cases filed in a geographic region. In Chapter 11 cases, no trustee is appointed unless the court orders the appointment after notice and a hearing. If the court orders an appointment, the U.S. trustee designates the person who will serve, unless a party-in-interest timely requests that the trustee be elected by the creditors. In Chapter 7, 12, and 13 cases, the U.S. trustee may act as trustee if a private trustee is unavailable, although this is rarely done. The code does not provide for the appointment of a trustee in Chapter 9 cases. 28 U.S.C. § 586, 11 U.S.C. §§ 701–704, 1202, 1104–1106, 1302. § 3.4 Appeals A. Processing Appeals The steps in an appeal are as follows: 1. Filing a notice of appeal 2. Preparing the record on appeal 3. Docketing the appeal 4. Filing the appellant’s brief 5. Filing the appellee’s brief 6. Filing the appellant’s reply brief 7. Deciding if the court dispenses with oral argument, or scheduling of oral argument 8. Hearing oral argument 9. Deliberating by the court 10. Filing the opinion 11. Filing a petition for rehearing 12. Issuing the mandate (the final stage in the appellate process unless the party applies to the Supreme Court for a writ of certiorari) The Federal Rules of Appellate Procedure establish certain procedural uniformity among the thirteen courts of appeals. However, there are still some differences in the procedures in the various circuits. Each court has local rules and internal operating procedures that describe the precise procedure to be followed 45 Law Clerk Handbook Federal Judicial Center § 3.4.B when there is any variation from the rules and, in some instances, that elaborate on or amplify the rules. See section 4.2. B. Notice of Appeal The timely filing of a notice of appeal is a jurisdictional requirement for any appeal. Appeals may be filed to challenge decisions of the district court, an administrative agency, or a bankruptcy appellate panel. Appeals of agency decisions may be classified as original proceedings in the court of appeals. The notice of appeal is filed in the district court. The purpose of the notice is to inform opposing counsel and the court that an appeal is being taken. The clerk of that court is required by Federal Rule of Appellate Procedure 3(d) to forward a copy of the notice to the clerk of the court of appeals. The time for filing commences when the judgment or order is entered in the district court from which the appeal is taken. The running of that time is tolled by the filing of certain posttrial motions in the district court, and the filing of such motions after a notice of appeal has been filed may vitiate the notice, requiring a new notice of appeal to be filed after the motion is decided. Fed. R. App. P. 4(a). Rule 4 provides the following time periods for filing notices of appeal: • private civil cases: 30 days • civil cases in which the United States is a party: 60 days • criminal cases: 10 days • criminal cases in which appeal by the government is authorized by statute (such as appeals from sentences under the 1984 Sentencing Reform Act): 30 days Upon receipt of the notice of appeal, courts of appeals take steps to ensure that all procedural requirements have been met. The clerk’s office may send counsel a case-opening letter to establish schedules for record preparation and briefing. Circuit mediators may conduct initial mediation/settlement conferences to discuss the issues in the case, with a view to eliminating the briefing of frivolous issues and to discuss the possibility of settlement. See Mediation & Conference Programs in the Federal Courts of Appeals: A Sourcebook for Judges and Lawyers (Federal Judicial Center, 2d ed. 2006). 46 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.D C. Record Preparation For an appellate court to review the proceedings in a trial court, appellate judges must have a record available of what occurred in the trial court. Local court rules prescribe the requirements for counsel to provide the district court with the record or excerpts of the record (sometimes referred to as a short record), which may include original papers and exhibits filed in the trial court plus a reporter’s transcript of any relevant proceedings. The Sentencing Reform Act requires that the record in a criminal case must also include “(1) that portion of the record . . . that is designated as pertinent by either of the parties; (2) the presentence report; and (3) the information submitted during the sentencing proceeding.” 18 U.S.C. § 3742(d). This information will often be under seal, because it is confidential. The Federal Rules prescribe time limits (deadlines) for providing the record on appeal to the court of appeals. During this time, the appellant must order a transcript of proceedings if one is needed and make arrangements to pay the court reporter for services or, in courts using electronic sound recording for the official record, the clerk of court. The district court clerk assembles the other papers or electronic files that constitute the record on appeal. The district court has the power to extend for an additional fifty days the time for preparing and sending the record on appeal, after which the court of appeals itself may grant extensions. Additional time may be needed if the court reporter has not finished transcribing the proceedings or if counsel has failed to order the transcript in a timely manner. To prevent undue delay, the appellate courts have the discretion to refuse to grant time extensions and may impose sanctions on the appellant or the reporter for unreasonable delays in preparing the record on appeal. D. Docketing the Appeal When the record is completed, or earlier if desired, the appellant must docket the appeal. This is primarily a clerical process and is performed in the office of the clerk of the court of appeals. Unless the appellant is exempt from payment, a docket fee is charged. The clerk of court opens an appropriate file and record and sends a notice to the parties. Frequently, docketing takes place when the record on appeal is filed. The filing of the record provides the base date for most subsequent proceedings in the case. 47 Law Clerk Handbook Federal Judicial Center § 3.4.E E. Briefs and Joint Appendices Because the appellant has the burden of establishing that the trial court erred, it files the opening brief. The appellee then files a brief in response; if the appellant wishes, the appellant may file a reply brief responding to new matters raised in the appellee’s brief. The Federal Rules of Appellate Procedure establish standards for format, color of brief covers, content, methods of reproduction, number of copies, and times for filing of briefs. The local rules for a circuit may impose further requirements. The schedule for filing briefs is as follows: • appellant’s brief: 40 days after filing the record • appellee’s brief: 30 days after service of appellant’s brief • reply brief: 14 days after service of appellee’s brief Some courts of appeals have modified the requirements and standards of the federal rules in certain cases or classes of cases. One of the more common modifications permits parties appealing in forma pauperis to file fewer copies of their briefs. While the briefs are being prepared, the parties are required to determine which portions of the record on appeal are relevant to the issues raised; the appellant is required to reproduce these portions as an appendix to the briefs. There may be only one appendix containing the portions relied on by both the appellant and the appellee, which would be referred to as a joint appendix. If any relevant material is omitted from the appendix, the court is free to refer to the original record. Multiple copies of the appendix may be filed so that each judge and, if needed, each law clerk may have one. Some courts of appeals have eliminated the requirement of an appendix and permit the substitution of photocopies of relatively few parts of the record, usually called record excerpts. The local rules of those courts describe the substitute requirements. Local rules also address procedures for electronic filing. You should become familiar with the rules and procedures in your court. F. Oral Argument If the court does not decide a case exclusively on the basis of the briefs and written record (see section 4.6.B on screening cases to select those appeals to be decided without oral argument), the parties are given an opportunity to present their arguments to the court orally. Federal Rule of Appellate Procedure 34 permits the court to fix the time allowed for oral argument. Courts may allow counsel to file a request in advance for additional time, and the courts have the discretion whether to grant these requests. Generally, not more than two attorneys are 48 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.G permitted to argue for each side. Some court rules encourage argument by only one attorney for each party. Many appellate judges require their law clerks to prepare a memorandum on each case (called a bench memo) for the judge to review before hearing oral arguments. In some circuits, the law clerk for one judge may prepare a memorandum to be circulated among the three judges on the panel prior to oral argument. The judges will study the briefs before oral argument. The appellant begins the argument. Because the judges have read the briefs and are therefore familiar with the issues, they sometimes begin questioning the attorney shortly after the argument begins. After the appellant’s argument is completed, the appellee responds, followed by any reply by the appellant (if the appellant reserved time for rebuttal). Although the arguments are recorded, so that the judges and their law clerks may later review them, some circuit judges may request one of their law clerks to attend oral argument and take notes of important matters, citations of new authorities, and concessions made during the argument. Most cases are heard by a panel of three judges, but a case may be heard en banc in cases involving a question of exceptional importance or in order to secure or maintain uniformity of decisions. A case heard en banc is heard by all of the active judges on the court and any senior judge of the circuit who sat on the panel that originally heard the case (or, in the Ninth Circuit, by a limited en banc, consisting of the chief judge and ten additional judges selected by lot). En banc hearings are held only when ordered by a majority of the active judges on the court. Some courts hold hearings in only one location, but most hold court in a number of locations within the circuit. G. Deliberation After a case has been argued and submitted to the court, the panel of judges who heard the argument meets to arrive at a decision. In most courts, these meetings are held immediately after the completion of each day’s arguments. Appellate courts perform three distinct functions. First, they decide the controversies before them. Second, they supervise the courts within their jurisdiction. Third, they determine the growth and development of the common law and the interpretation of federal statutory and constitutional law within their jurisdiction. Each of these functions can become important during the decisional phase of an appeal because the court must not only reach the correct result but also explain in its opinion the rationale for its decision. 49 Law Clerk Handbook Federal Judicial Center § 3.4.H In most cases, the court arrives at a tentative decision at the first meeting. At that time, the presiding judge (the senior active circuit judge sitting on the panel) assigns the case to one member of the panel, who later writes an opinion to be submitted to the others for approval. When the judges do not reach agreement so readily, panel members may exchange memoranda about the case and schedule additional meetings or telephone conferences for further discussion. Law clerks for appellate judges should know and follow the court’s internal rules and its customs concerning communications between chambers. H. Opinion and Judgment The final product of the court in most appeals is a written opinion setting forth the decision and the reasoning behind it. The increased number of cases and the burden of writing formal opinions in every case has caused appellate courts to use alternatives to formal opinions (such as memorandum, order, or summary opinions) in many cases, such as those involving only the application of settled principles to a specific fact situation. Local rules or policies may guide the members of the court in deciding which cases deserve full opinions and which opinions should be published. When a panel has agreed on an opinion, the authoring judge electronically transmits it to the clerk of court for public docketing and release. All courts post opinions on the court’s public website. In some courts, before opinions are released, they are circulated to all active judges on the court with a time limit for making suggestions. Sometimes when a judge or a group of judges disagrees with the majority decision reached by their colleagues and they feel strongly enough about it, the judge or judges will write a dissenting opinion explaining what aspects of the decision they disagree with and why. Even though they express opinions that did not prevail, dissents can contribute to the legal debate over the issues at hand and provide judges in similar cases with different perspectives. I. Rehearing The party who loses an appeal may file a petition for rehearing within fourteen days after judgment is entered. That petition attempts to persuade the panel that the decision was erroneous and should be withdrawn or revised. The prevailing party may not file a response to the petition unless one is requested by the court. Most petitions for rehearing are denied. The losing party may also move for a rehearing en banc. That motion is circulated to all members of the original panel and all active judges who did not sit 50 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.K on the panel. Only the active circuit judges and any senior judge who was a member of the original panel may request a vote on the suggestion to rehear the appeal en banc, and only the active circuit judges may vote on whether the appeal should be reheard en banc; if a rehearing en banc is granted, only active circuit judges and senior circuit judges from the circuit who were members of the original panel may sit on the rehearing. By local rule, a circuit may impose time limitations within which a member of the court may request an answer to a petition for rehearing or rehearing en banc or a vote on such a petition. J. Mandate The mandate is the document by which the court of appeals formally notifies the district court of its decision and by which jurisdiction for any necessary additional proceedings is conferred upon the district court. The mandate is issued by the clerk of court seven calendar days after the time to file a petition for rehearing expires, or seven calendar days after entry of an order denying a timely petition for panel rehearing, petition for rehearing en banc, or motion for stay of mandate, whichever is later. These times may be shortened or lengthened by court order. Fed. R. App. P. 41(b). The losing party may request by motion that the issuance of the mandate be stayed in order to maintain the status quo during the pendency of an application for a writ of certiorari to the Supreme Court. The court of appeals may require that a bond be posted as a condition to staying the issuance of the mandate. K. Motions During the course of an appeal, the parties may file a variety of motions. Most of these are procedural and, to the extent permitted by the Federal Rules of Appellate Procedure, some courts have authorized their clerks of court or other court unit executives to act on motions, for example, motions • for extensions of time to perform any of the acts required by local rules or the Federal Rules of Appellate Procedure • for relief from specific requirements of the local rules or the Federal Rules of Appellate Procedure • for permission to alter the form or content of the record on appeal; • for leave to file amicus curiae briefs • for delay in the issuance of the mandate • for voluntary dismissal of the appeal 51 Law Clerk Handbook Federal Judicial Center § 3.4.L Motions requiring action by a judge or panel of judges are those • on issues relating to criminal cases or suits for postconviction relief such as motions for appointment of counsel, leave to appeal in forma pauperis, certificates of probable cause, and bail pending appeal • for stays or injunctions pending appeal • for leave to file interlocutory appeals • for issues relating to stays granted in the district court • for permission to file a brief containing more pages than the number fixed by the rules • for issues relating to the time allowed for oral argument • to dismiss an appeal filed by the appellee In most courts, the staff attorney’s office is responsible for reviewing motions and referring them to judges for appropriate disposition. L. Emergency Proceedings Both district courts and courts of appeals are frequently asked to make decisions on an emergency basis. In the appellate courts, these occasions usually arise when a litigant or a lower court is about to take some action that may cause irreparable injury. The potentially aggrieved party seeks redress by motion for stay or injunction pending appeal or by petition for writ of mandamus or prohibition. In the district courts, these matters usually arise through a request for a temporary restraining order. Each court has developed internal procedures for handling these matters efficiently, but the procedures vary among courts. Courts have also established special procedures for handling emergency appeals of capital (death penalty) cases. Law clerks should become familiar with the procedures established by the local rules and the judge’s own practices. § 3.5 Courts of Specialized Jurisdiction You may also encounter litigation from one of the various special courts established by Congress. The term special courts derives from their specialized jurisdiction. 52 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.5.D A. Court of Appeals for the Federal Circuit The Court of Appeals for the Federal Circuit, based in Washington, D.C., has jurisdiction over appeals from the following: district courts in cases involving patents and certain claims against the United States; the U.S. Court of Federal Claims; the Court of International Trade; the Court of Veterans Appeals; the Merit Systems Protection Board; the Patent and Trademark Office; the boards that decide government contract issues; and a few other Article I agencies. B. Court of International Trade The Court of International Trade, based in New York City, hears cases concerning the value or classification of imports. Its judges may sit by designation on other Article III courts. C. U.S. Judicial Panel on Multidistrict Litigation This panel was created to consider transferring civil actions involving one or more common questions of fact pending in different districts to a single district for coordinated or consolidated pretrial proceedings. The panel consists of seven district and circuit judges who are appointed by the Chief Justice and sit on the panel in addition to their regular judicial assignments. The panel maintains a roster of transferee judges to whom it assigns the cases it certifies for transfer. For discussion of multidistrict litigation problems, see section 3.1.F. D. Foreign Intelligence Surveillance Court The Foreign Intelligence Surveillance Court (FISC), or the FISA court, as it is popularly called (after the Act that created it), is composed of eleven federal judges, selected by the Chief Justice to a nonrenewable seven-year term. The court’s job is to review applications for governmental surveillance of persons within the United States whom the government suspects of having connections to foreign governments and/or terrorist organizations. A Foreign Intelligence Court of Review was also established to review applications denied by the FISA court. 53 Law Clerk Handbook Federal Judicial Center § 3.6 § 3.6 Article I Courts Congress has created many tribunals to assist it in meeting its legislative responsibilities under Article I of the Constitution. These courts do not exercise judicial power conferred by Article III, and the judges are appointed for fixed terms rather than given life tenure. They include the many administrative law judges serving in the executive agencies who hear disputes over claims and benefits, subject to review by agency officials. A. U.S. Tax Court The U.S. Tax Court has jurisdiction over controversies involving deficiencies determined by the commissioner of internal revenue in income, estate, and gift taxes, as well as other tax-related disputes between taxpayers and the Internal Revenue Service. The principal office of the court is located in Washington, D.C., and it conducts trial sessions in other cities throughout the United States. B. U.S. Court of Federal Claims The U.S. Court of Federal Claims was originally called the U.S. Claims Court. The court has jurisdiction over claims brought against the U.S. government. The court is located in Washington, D.C.; however, its jurisdiction is nationwide, enabling it to conduct trials in locations convenient to the parties involved in the case. C. U.S. Court of Appeals for the Armed Forces Congress established the U.S. Court of Appeals for the Armed Forces as an appellate criminal court, hearing all cases involving military courts-martial. It is located in Washington, D.C. D. U.S. Court of Appeals for Veterans Claims The U.S. Court of Appeals for Veterans Claims has exclusive jurisdiction to review the decisions of the Board of Veterans Appeals. The court’s principal location is in Washington, D.C., but it may hold court anywhere in the United States. 54 fjc.dcn • fjc.gov 4 Chambers and Case Management § 4.1 Chambers Administration This chapter gives you a broad overview of some of your responsibilities as a law clerk in maintaining a well-run chambers. These responsibilities include helping to ensure chambers security; answering telephones and mail; maintaining the judge’s motion, hearing, and trial calendars; and other miscellaneous matters. Discussing all such duties would, of course, be impossible, and some judges have chambers manuals detailing how they expect their chambers to operate. Understanding and accommodating your judge’s preferences is key to maintaining an efficient chambers, and regardless of the general guidance offered in this chapter, you should always follow the particular policies and practices of your judge. Effective management is essential to the efficient administration of justice. While judicial assistants often have principal responsibility for managing various aspects of chambers administration, as a law clerk you should be familiar with the standard operating procedures in your chambers and be available to pitch in when needed. A. Security The safety and security of federal buildings and the people who work in and visit them are major concerns for the U.S. Marshals Service (USMS). Attorneys and other members of the public must pass through magnetometers and have their briefcases and other items screened by an X-ray machine to enter most courthouses and other federal buildings. In addition, all judges’ chambers are equipped 55 Law Clerk Handbook Federal Judicial Center § 4.1.A with an entry control system that consists of a security camera and monitor and a door release strike. Courthouse employees may be issued keycards enabling them to enter the courthouse without passing through metal detectors and to access secured, nonpublic sectors of the building, including judges’ chambers, depending on the individual court’s access-control security plans. Employees may also have after-hours and weekend access to the building through use of these keycards, which should be kept in a secure place and reported immediately if lost. All courthouse employees should carefully follow security procedures and report potential problems to the USMS. The U.S. Marshals Service is principally responsible for security of the court and its personnel, though most courthouse security functions are performed by court security officers (CSOs), who are funded by the judiciary’s Court Security Program and by the Federal Protective Service on a limited basis. Become familiar with the court’s Occupant Emergency Plan and other related USMS security plans in your courthouse, and help to maintain a secure chambers. Do not let unauthorized strangers into secure areas of the courthouse, and report suspicious mail or threatening phone calls. During security-sensitive proceedings, a judge may request that a deputy from the U.S. Marshals Service or a CSO be present in the courtroom. Because federal judges are occasionally the targets of terrorists or disgruntled litigants, be careful when opening mail. Mail received in the courthouse is routinely screened by the USMS before distribution to chambers and offices. Still, it pays to be alert to suspicious-looking items. Common recognition points for letter and package bombs include the following: • foreign mail, air mail, and special delivery • restrictive markings (e.g., confidential, personal) • excessive postage • handwritten or poorly typed addresses • incorrect titles • titles, but no names • misspelled common words • oily stains or discolorations • no return addresses • rigid envelopes • lopsided or uneven envelopes 56 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.C • protruding wires or tinfoil • excessive securing material such as masking tape or string • drawings, diagrams, or illustrations If a letter or package arouses attention, do not attempt to open it. Instead, immediately notify the marshals’ office or a CSO. B. Telephone Practices for dealing with incoming calls (e.g., how to answer the telephone, how to take messages, and when and if to transfer a call to the judge) will vary from chambers to chambers. In general, however, answer calls promptly, identify the office (e.g., “Judge Smith’s chambers”), and treat all callers courteously. And, of course, hold personal calls to a minimum, both in length and in number. See section 2.2.A.1 on communication with the media. C. Correspondence, Email, and Other Mail In addition to correspondence by U.S. postal and messenger service, many chambers now correspond by email with a wide variety of people, including counsel. While email has in some ways made communicating easier and more efficient, it has also made it even more important to stay on top of organizing and processing the mail. Email also presents serious potential problems relating to the accidental forwarding of messages, either to unintended parties or containing information not intended for the recipient. And bear in mind how easily emails can be broadly disseminated through forwarding and posting on websites and social media. Take special care to avoid sending and forwarding email messages that may result in embarrassment, a breach of confidence, or worse, and review and carefully proofread any outgoing messages (and fight the temptation not to proofread email as carefully as paper correspondence). Most chambers have practices and procedures for handling incoming and outgoing mail, including email (whether and when to delete email messages, how to store important messages for future reference, and other matters of email retention and organization). Quickly become familiar with these practices to help mitigate complications arising from the enormous number of emails that many chambers receive. Depending on office procedure, either a judicial assistant or a law clerk will open and review correspondence and make an initial decision concerning how 57 Law Clerk Handbook Federal Judicial Center § 4.1.C it should be handled. Many judges receive their own emails directly, though some may ask staff to review messages first. Incoming mail and emails should be reviewed as soon as they are received because they may relate to matters scheduled for that day. When correspondence referring to a pending suit is forwarded to any counsel of record over the signature of the judge, law clerk, or judicial assistant, copies should be sent to all other counsel of record to avoid inappropriate ex parte contact. Appellate judges seldom correspond directly with counsel on case-related matters, because appellate judges work on cases as part of a panel or court rather than individually. Instead, appellate judges will send instructions to the clerk of court on how to respond to counsel. Correspondence from the general public that is not related to a case is still important because citizens have a right to courteous treatment. Also, the public’s opinions about the fairness, responsiveness, and effectiveness of the judiciary are influenced by the promptness and appropriateness of the court’s answers. In the district court, some of the correspondence from the public involves requests to be excused from jury service. That subject is dealt with in section 4.3.D.2. Some correspondence contains character references on behalf of an offender who is scheduled for sentencing. Judges differ in their handling of such correspondence. Many simply acknowledge receipt of the letter and refer the letter to the probation office. Other correspondence from the public may express reactions to a judge’s ruling. Whether positive or negative, expressions of opinion by members of the public generally call only for courteous acknowledgment, not for an explanation or justification of the judge’s action. If a letter requests information about a ruling, many judges simply acknowledge receipt of the letter and send a copy of the opinion, if there is one. If more information is requested, many judges refer the writer to the record in the clerk of court’s office. Some judges may wish to respond to a letter that indicates a misunderstanding concerning a significant fact, proceeding, or legal conclusion. Judges who adopt this policy may ask law clerks to prepare a draft of a response for the judge to review. The response should not be argumentative or defensive; it should merely state the relevant facts or legal conclusion as necessary to alleviate the misunderstanding. Prisoners and persons who have been convicted and are awaiting sentence frequently write district and appellate judges. Handle the correspondence of a prisoner represented by counsel the same way as that of any other litigant. Ask your judge how to handle correspondence from prisoners who are proceeding pro se. In some instances, this correspondence may be handled by district court pro se law clerks or, in the appellate courts, either the clerk’s office or staff attor58 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.D ney’s office. In other instances, your judge may have a form letter explaining, for example, that federal law prohibits judges from giving legal advice and suggesting that the prisoner communicate with a lawyer, or a form letter for responding to requests for transfers to another penal institution (which only the Bureau of Prisons can grant). You should never write anything in a letter that would give a prisoner false hope or could compromise the position of the court. D. Internet and Electronic Research New law clerks will receive a Westlaw and/or a LexisNexis password, which may come with additional electronic research training and certain usage guidelines. All computer-assisted legal research (CALR) use via judiciary contracts is to be limited to official judiciary-related research purposes. In addition to these research services, the Internet also offers more informal avenues of research, including access to nearly every newspaper and magazine in the country, as well as to government and law school websites, Internet search engines, and myriad other sources. Contact the circuit library CALR coordinator for assistance with CALR access or training. The CALR coordinators and reference librarians are also available to assist with your research questions. Become familiar with fjc.dcn (http://fjc.dcn), the Federal Judicial Center’s site on the judiciary’s intranet. It provides access to manuals, monographs, desk references, and other publications, as well as to web-based training and orientation programs, streaming media programs, discussion forums, and other resources. JNet (http://jnet.ao.dcn), the intranet site maintained by the Administrative Office of the U.S. Courts, offers information and forms on a range of topics relevant to judicial employees, including benefits, court security, emergency preparedness, human resources, information technology, legal and general research, and travel. The Internet has also posed some serious security and usage challenges for employees and information technology departments in courthouses across the country. The judiciary provides you with a computer and Internet access to help you do your work. Depending on the policy in your court or chambers, you may use it on a limited basis for personal needs if doing so does not interfere with your work and does not cause congestion, delay, or disruption of service to any government system. You should not do anything on your office computer that would embarrass you or the court if it were made public. 59 Law Clerk Handbook Federal Judicial Center § 4.1.E E. Electronic Filing The federal judiciary’s Case Management/Electronic Case Filing (CM/ECF) system allows courts to maintain case documents in electronic form and provides enhanced and updated docket management services. It also gives each court the option to permit case documents—pleadings, motions, petitions—to be filed electronically with the court. CM/ECF uses an Internet connection and a browser and accepts documents in Portable Document Format (PDF). It is easy to use. Filers prepare documents using conventional word-processing software and save them as PDF files. After logging on to the court’s website with a court-issued password, the filer enters basic information about the case and document being filed, attaches the document, and submits it to the court. CM/ECF automatically generates a notice verifying that the court received the filing, and it also sends an email to other parties in the case notifying them of the filing. There are no added fees for filing documents using CM/ECF, but existing document filing fees do apply. Litigants receive one free copy of documents filed electronically in their cases, which they can save or print for their files. Public electronic access to court data is available through the Public Access to Court Electronic Records (PACER) program. Additional copies are available for a small fee to attorneys and the general public for viewing or downloading. The process for receiving and reviewing daily filings in the cases filed before the judge may vary among courts and chambers; you should quickly learn the process in your chambers and your role in implementing and maintaining it. Although familiarity with the workings of the system is helpful, you should refer counsel’s questions to docketing clerks or others in the clerk’s office who deal with the system on a daily basis. F. Judge’s Chambers Calendar The judicial assistant is usually in charge of maintaining the chambers calendar covering the judge’s scheduled court proceedings and other activities. If the calendar is maintained online, other staff on the chambers network may also have limited access to the judge’s schedule. In appellate courts, the clerk of court advises the judge of panel assignments and hearing dates. The judicial assistant, in consultation with the judge, will then schedule all other engagements and commitments around the hearings. In trial courts, the judicial assistant usually confers with the judge and then typically advises the courtroom deputy in charge of scheduling the court calendar of the dates on which trials and hearings are to 60 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.H be set. The judicial assistant then schedules the judge’s remaining commitments around the trials and hearings. Some judges choose not to have a judicial assistant, which allows them to have an additional law clerk. In these instances, a law clerk may maintain the chambers calendar. G. Opening Court In district courts, a law clerk or courtroom deputy usually opens court. One common method is for the clerk or deputy to rap on the door before the judge enters, open the door, then call out, “All rise.” The judge then enters and walks to the bench. The law clerk or deputy walks to the front of the bench and says: “The United States District Court for the ____ District of ____ is now in session. The Honorable ______ presiding.” The judge usually stands during this call, then says, “Please be seated,” and sits. H. Maintaining the Library; Office Supplies, Equipment, and Furniture Many chambers maintain their own libraries, though electronic databases and Internet research reduce the need for access to hard-copy sources and have enabled chambers in the same courthouse to share libraries. In any event, the employee who maintains the library, either a law clerk or a judicial assistant, should regularly file any advance sheets, pocket parts, slip opinions, replacement volumes, and inserts for loose-leaf services that arrive in the mail. File materials daily so that library maintenance does not become burdensome and the materials are current. Procurement and ordering of all law books is done by the circuit library; contact the librarian if you have questions. Promptly rubber-stamp every incoming library book to identify it as U.S. property. Keep track of books borrowed by attorneys for courtroom use and make sure that books are not taken outside the chambers and courtroom. Promptly reshelve books used during the course of research. They will then be easier to find, and the library will be neater. Also be sure that legal pads, book markers, pencils, and pens are always available in the library. Requests for supplies, equipment, and furniture ordinarily are handled in the clerk of court’s office. 61 Law Clerk Handbook Federal Judicial Center § 4.1.I I. Maintaining Office Records and Files You may have to maintain some of the records in your judge’s office, including the following: • case files • trial schedules or calendars • “tickler” records to remind the judge about future case activities • indices to the judge’s prior decisions • indices to slip opinions • work papers relating to cases in progress Such materials may be stored in hard copy, electronically, or both. Some chambers may also maintain office form books, either in hard copy or electronically. The form books may contain office procedure checklists and frequently used forms, such as samples of letters, orders, opinions, jury charges, minute entries, and office or file memoranda written by prior law clerks. The books describe the format and method for written documents issued by the judge or presented to the judge by chambers staff. The form books provide continuity and consistency in office administration and can help educate new law clerks. If case records are being used in the judge’s chambers, make sure that the records are not misplaced and are returned to the office of the clerk of court as soon as the judge or staff member has finished with them. J. Statistical Reporting The JS-10 form, “Monthly Report of Trials and Other Court Activity,” is a report of the trials and nontrial proceedings that a district judge conducted during the month. The clerk of the district court submits a JS-10 form to the Administrative Office for each active or senior district judge, plus any visiting district judges or appellate judges, who conducted trials or proceedings in the district during the month. The form reports both the number and type of trials and proceedings and the amount of time the judge spent conducting them. Some judges fill out the forms themselves, but usually a member of the chambers staff or the courtroom deputy fills out the form for the judge. The CM/ECF systems in some courts can automatically generate the JS-10 reports based on additional information about the trials and proceedings entered during the normal docketing process. Data on magistrate judge workloads and activities are collected through the MJSTAR 62 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.L function in district CM/ECF systems, which stores that data in the NewStats database. This includes not only the number of tasks completed by magistrate judges, but the time burden of many of these duties, including time spent with attorneys and parties. Bankruptcy courts report trials and other court activity on a monthly basis using the B-102 form. Courts of appeals use the JS-30 form to report the number of appellate cases, interlocutory appeals, and petitions for rehearing each month. K. Out-of-Town Trips Some judges must travel to other cities to attend court sessions and may require a chambers staff member to travel with them if the court to which they are traveling does not provide staffing. Judges may also travel on court-related business. Judicial assistants usually arrange travel (although when the judge has chosen to have an additional law clerk in lieu of a judicial assistant, a law clerk may have to make travel arrangements). If your judge is traveling to hold court in another location, prepare for the judge to take along necessary case files and materials; any personal notes or memoranda relating to the cases to be heard; the judge’s robe; paper, pencils, stationery, and other needed supplies (if the site for the out-of-town session is one frequently used by the court, there may be a permanent stock of stationery and supplies); necessary equipment such as a gavel, recording or dictating equipment, and a laptop or tablet computer; the briefs and any other case materials; and mailing labels and envelopes for returning material that the judge does not wish to carry back. Judges and chambers staff who travel on court business will be reimbursed for transportation, food, lodging, and related expenses according to the detailed rules set forth in the Guide to Judiciary Policy. These rules generally reimburse either a flat dollar amount per day, regardless of actual expenses, or itemized actual expenses not in excess of a fixed dollar amount. The judicial assistant should have forms for travel reimbursement—these forms can also be found on JNet. Judges must also report travel not related to cases under regulations found in Volume 19, section 270, of the Guide to Judiciary Policy. L. Assisting with Judges’ Extrajudicial Activities Many judges engage in teaching, writing, lecturing, and other extrajudicial activities. While law clerks may be called on to assist judges in these activities, the Code of Conduct for United States Judges says that judges should not use staff “to any 63 Law Clerk Handbook Federal Judicial Center § 4.1.M substantial degree” to engage in extrajudicial activities to improve the law, the legal system, and the administration of justice; and judges should not use staff to engage in other extrajudicial activities, “except for uses that are de minimis.” M. Preserving Chambers Papers for Historical Purposes The chambers papers of a district or appellate court judge have historical significance as an essential supplement to the official court record. Many papers in judges’ chambers are widely considered valuable, such as correspondence and background material concerning a case, including memoranda between judges and law clerks and judges on an appeals panel; drafts of orders and opinions (particularly draft opinions that have handwritten comments on them, or that have been circulated to other judges and returned with their comments); and correspondence/memoranda concerning court administration, legal activities in the community, and issues of governance, politics, and law. Chambers papers are the personal property of the judge. Each judge has the prerogative to make final decisions about the preservation of chambers papers and the terms of access. Judges can preserve their personal papers and make them available for eventual study by donating them to a manuscript repository. An FJC publication, A Guide to the Preservation of Federal Judges’ Papers (3d ed. 2018), reviews the organization and preservation of historically significant records created by federal judges. The Federal Judicial History Office at the FJC will also provide assistance on issues concerning judges’ papers. N. Rules Regarding the Media in Court Guidelines for allowing cameras and electronic reproduction equipment in the courtroom are published in Volume 10 of the Guide to Judiciary Policy. The guidelines allow the photographing, recording, or broadcasting of appellate arguments. In trial courts, a presiding judge may authorize broadcasting, televising, recording, or taking photographs in the courtroom during ceremonial proceedings. For nonceremonial proceedings, such activities may be allowed for presenting evidence, perpetuating a record of the proceedings, and for security or judicial administration purposes. Federal Rule of Criminal Procedure 53 prohibits photographing and radio broadcasting of criminal proceedings. Some circuit judicial councils have adopted specific instructions for the use of cameras in the courtroom. Although local rules restrict the means by which news may be reported (e.g., no cameras or broadcasting from the trial courtroom 64 Chambers and Case Management fjc.dcn • fjc.gov § 4.2 or environs), “there is nothing that proscribes the press from reporting events that transpire in the courtroom.” § 4.2Local Court Rules and Administrative Policies Section 2071 of Title 28 of the U.S. Code authorizes federal courts to adopt their own rules, which must be consistent with the national rules and available to the public; it also authorizes the circuit judicial council to abrogate district and bankruptcy courts’ local rules, and authorizes the Judicial Conference to abrogate rules of courts of appeals. Federal Rules of Appellate Procedure 47, Bankruptcy Procedure 9029, Civil Procedure 83, and Criminal Procedure 57 provide additional requirements for local rule adoption and characteristics. The local rules of almost all courts follow the same numbering sequence as the corresponding national rules. These local rules include the procedures for setting cases for trial, scheduling pretrial conferences, setting motions for oral argument, serving memoranda of law, and other details relating to trial. They may also state the procedure for admission of attorneys to practice in the specific district or circuit, the term of the court, the functions of the clerk of court, the rules for filing motions, and more specific data, such as the number of copies required to be filed, limitations on the length of memoranda, the time within which memoranda must be filed, and restrictions on page length, typeface, and margin size. Each court of appeals has local rules concerning procedures for ordering transcripts; filing and docketing the appeal; calendaring; motions; summary disposition of appeals; setting cases for oral argument; time limits on oral argument; petitions for rehearing; petitions for en banc consideration; and stay of mandate. The local rules and internal operating procedures of the courts of appeals are printed in the United States Code Annotated following Title 28 of the Judicial Code, and are available on the courts’ websites. A court’s local rules and any internal operating procedures it adopts establish specific procedures for the court and litigants to follow. You should get these rules and procedures from the court’s website or the clerk’s office and become familiar with them. Keep them available for reference and be on the lookout for any modifications the court may adopt. 65 Law Clerk Handbook Federal Judicial Center § 4.3 § 4.3 Case Management: The Trial Court Many judges believe that the responsibility for moving a case through the trial court is not solely that of the attorneys, and the function of the court is not simply to be available if and when counsel want a hearing. The disposition of all cases as speedily and economically as is consistent with justice is paramount. The Federal Rules of Civil Procedure are to be “construed to secure the just, speedy, and inexpensive determination of every action.” Fed. R. Civ. P. 1. The courts are also required to report semiannually (on April 30 and September 30) for each judge the motions that have been pending and the bench trials that have been submitted for more than six months, and cases that have not been terminated within three years of filing, for publication by the Administrative Office. 28 U.S.C. § 476. Effective docket control means that, early in a case, the judge assumes responsibility for guiding the case to a conclusion. This may include establishing deadlines for filing motions, a time limit for discovery, a date for counsel to take the next step in its prosecution, and a trial date. For specific techniques of case management, consult the Civil Litigation Management Manual. See also Schwarzer & Hirsch, The Elements of Case Management (Federal Judicial Center, 3d ed. 2017). Note that many of the same considerations apply in criminal cases, with the additional complication of computations required by the Speedy Trial Act. 18 U.S.C. §§ 3161–3174. Law clerks should be familiar with the requirements of the Act, since failure to bring a case to trial within the Act’s time limits can have serious repercussions. A. Office Status Sheets Some judges maintain an office status sheet and post it where it is accessible to chambers staff. Its purpose is to keep the judge, the law clerks, and judicial assistants apprised of legal matters under advisement and awaiting disposition. When a matter has been taken under advisement, the assistant or law clerk assigned to the case should indicate it on the status sheet. Keep a personal status list, which can be revised each week, listing all matters for which you are responsible. It will help you make effective use of your time and remember all pending assignments. Some judges require their law clerks to submit personal status lists weekly. Some judges require their judicial assistants to keep a list of all pending matters, the initials or name of the law clerk assigned to work on the matter, and 66 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.C any other pertinent information. If so, keep the assistant advised of all matters assigned, matters completed, and other relevant status information. CM/ECF helps judges use computer technology for docket control and to maintain case inventories and case-status records. Other systems may also be employed. Regardless of which system is used, it is important that it be regularly maintained and continually monitored. B. Calendaring Systems Multijudge trial courts need a system for determining which judge is responsible for each case. In an individual calendar system, each case is randomly assigned to a particular judge at the time it is filed, or soon thereafter, and that judge has complete responsibility for the case until it is terminated. There are also standard procedures for reassigning cases from which the original judge is disqualified, for ensuring that related cases are all assigned to the same judge, and for special assignment of unusual and protracted cases. Local rules usually describe these procedures. C. Trial Scheduling A single trial may be set for a specific date, or the court may set multiple cases for trial on the same day. Some courts use the trailing calendar or trailing docket, in which the court schedules a number of cases for trial beginning on a stated date. The cases are tried in the order reflected by the schedule. Counsel must obtain information from the court and from the attorneys whose cases precede them on the calendar about the progress of those cases, so that they can go to trial whenever the court reaches their case. Most civil cases do not go to trial but are disposed of in some other manner, including dispositive motions and settlement. Judges differ in their approach to encouraging settlement, but the decision whether to settle or proceed to trial is the parties’ alone. If settlement is to be reached, negotiations should be completed in a timely manner. Last-minute settlements may disrupt the court’s schedule, leaving the judges, and sometimes jurors, with unscheduled time. The trailing calendar and other multiple-case-setting devices alleviate some problems caused by last-minute settlement by providing substitute cases to replace those that do not go to trial. Although this resolves the court’s problems, it does not resolve the problems that eve-of-trial settlements cause litigants and counsel. 67 Law Clerk Handbook Federal Judicial Center § 4.3.D Criminal cases take priority on the court’s calendar because they must be tried within the time limits set forth in the Speedy Trial Act. While criminal cases do not settle, the vast majority of them are disposed of by way of plea bargaining and guilty pleas, which again make multiple-case-setting an important calendaring device for the court. D. Jury Management 1. Random Juror Selection The selection of grand and petit jurors in both criminal and civil cases is governed by 28 U.S.C. §§ 1861–1878, under which each district must have a jury selection plan that has been approved by a panel comprising the circuit judicial council and the chief district judge or the chief judge’s designee. The statutory goal of the selection process is to ensure “grand and petit juries selected at random from a fair cross section of the community in the district or division wherein the court convenes” (28 U.S.C. § 1861), and to avoid excluding any citizen “from service as a grand or petit juror . . . on account of race, color, religion, sex, national origin, or economic status” (28 U.S.C. § 1862). The clerk of court usually manages the process of selecting prospective jurors, under the supervision and control of the court. Although the jury selection process may differ slightly in each district, it is generally as follows: 1. The clerk’s office performs a random selection of prospective jurors’ names by computer or manually, using voter registration lists or other sources specified by the court’s plan, and places the names selected in a master jury wheel, which is usually a computer file. The minimum number of names in the master jury wheel must be one-half of 1% of the number on the source lists, or 1,000, whichever is less. 2. As needed by the court, the clerk’s office draws names publicly at random from the master jury wheel and sends jury-qualification questionnaires to those persons whose names are drawn. 3. From the responses to the questionnaires, a determination is made as to which persons are qualified for jury service and which persons are disqualified, exempt, or excused. 4. The names of those determined to be qualified are placed in a second jury wheel consisting of qualified jurors. 5. As needed, the clerk’s office selects names from the qualified jury wheel and prepares lists of the names selected. 68 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.D.2 6. The clerk’s office issues summonses to the necessary number of persons needed for the jury venire several weeks in advance of each trial calendar advising those summoned of the time and place to report for jury service. Some district courts qualify and summons jurors in one step and do not establish a qualified jury wheel. 2. Exemptions, Disqualifications, and Excuses A person is qualified for jury service unless the person • is not a citizen of the United States • is unable to read, write, and understand English with a degree of proficiency sufficient to complete the juror-qualification form satisfactorily • is incapable of rendering satisfactory service because of mental or physical infirmity • is charged with or has been convicted in a state or federal court of record of a crime punishable by imprisonment for more than one year without subsequent restoration of civil rights 28 U.S.C. § 1865. Some district courts have adopted other grounds for exemptions, which are specified in the court’s jury selection plan. Section 1863 of Title 18 requires the plan to provide for the exemption of members of the armed forces in active service; members of state or local fire or police departments; and public officers of the federal, state, and local governments who are actively engaged in the performance of official duties. Jury service is a citizen’s duty as well as a privilege, and courts do not readily grant excuses. A person may, however, be excused from jury service temporarily if the plan states that such service would result in undue hardship or extreme inconvenience. In such a case, the name of an excused juror is placed back in the qualified jury wheel. If a prospective juror approaches you about an excuse, do not express any opinion regarding the request, but simply refer the requester to the clerk’s office or jury administrator for action. Treat persons called for jury service with courtesy; they are providing an important service to the court and the public. Judges in multijudge courthouses often begin jury trials at different hours to obtain maximum use of people summoned for jury service, sending persons examined and not selected to another courtroom so they can be examined for 69 Law Clerk Handbook Federal Judicial Center § 4.3.D.3 selection on another jury, and sometimes using jurors who have served in one trial in a succeeding trial. When prospective jury panels report for possible selection in a case, they should be segregated from other people in the courtroom. Law clerks may be responsible for clearing a portion of the spectator section for the jury panel’s exclusive use. 3. Juror Orientation Most courts conduct a juror orientation program to inform jurors of their responsibilities and to explain the trial process. Orientation videos, including the Federal Judicial Center’s Called to Serve, are available in most courts. 4. Voir Dire In most courts, the judge personally conducts voir dire examination. Federal Rule of Civil Procedure 47 and Federal Rule of Criminal Procedure 24, however, authorize the judge to permit the lawyers to conduct voir dire. If the judge conducts voir dire, the rules authorize counsel to submit specific questions or areas of inquiry that they want the judge to probe. In some courts, magistrate judges conduct voir dire. The law in most circuits permits this in civil cases, though some require consent of the parties. The Supreme Court has held that a magistrate judge may conduct voir dire in a criminal case if the defendant consents (Peretz v. United States, 501 U.S. 923 (1991)), but not if the defendant objects (Gomez v. United States, 490 U.S. 858 (1989)). 5. Jury Supervision In most courts, a deputy clerk is responsible for jury supervision. However, sometimes law clerks have this responsibility. If so, you should be present early enough in the morning to accommodate those members of the jury who arrive before the normal court time. The jury room should be open and available for use by the jurors as they arrive. If the judge permits the jury to take notes, either you or the deputy clerk should provide pads of paper and pencils for distribution to the jurors before the trial begins. Extra pads and pencils should also be placed in the jury room for use during deliberations. If you are responsible for jury supervision, ensure that there is no communication—in the courtroom, jury room, or hallways adjacent to the courtroom and chambers—between jurors and litigants, lawyers, witnesses, or others attending court. 70 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.E Jurors are usually free to go where they wish during recesses, and they may go home at night. Occasionally, however, when there is unusual publicity about the trial or there is reason to believe that someone will attempt to exert improper influence on jurors, the judge may direct that the jury be sequestered. When this occurs, deputy marshals keep the jurors together at all times and supervise them when court is not in session. Jurors in criminal and civil cases are sometimes sequestered from the time they begin deliberating until they reach a verdict. Judges sometimes have law clerks steward the jury during deliberations. Some judges require the law clerk to take a special oath with respect to this duty just before the jury retires. Once the oath is taken, the law clerk assumes primary responsibility for guarding the jury until relieved of this duty by the judge. Remain outside the jury-room door during the entire deliberation process and take every reasonable precaution to ensure that the jurors do not come into contact with other people, especially the litigants, their attorneys, or witnesses. You must never comment on the evidence, the litigants, the attorneys, or the witnesses to any juror (or, for that matter, to anyone else). If a juror has any questions about the trial, at any stage, you should simply state that such questions should be addressed to the judge in writing. Do not answer the question, however simple it may appear. E. Distributing Opinions Federal Rule of Civil Procedure 52(a) requires the judge to make findings of fact and conclusions of law in all actions tried without a jury or with only an advisory jury. The rule permits the judge to do this orally on the record or in writing in an opinion or memorandum. The judge may also write a formal opinion to explain rulings on particular motions. The judicial assistant sends the original of the findings or the opinion and the original of any order for judgment to the docket clerk for filing in the official record. Then the judicial assistant or clerk of court sends a copy of each set of findings or the opinion to each counsel of record, making and distributing other copies in accordance with the judge’s instructions. In most district courts, the clerk of court handles the distribution of opinions, but in a few district courts, this responsibility falls to the law clerk or judicial assistant. The judge decides whether the opinion or findings are to be published. If you are responsible for distributing opinions, check with the judge to determine whether the judge wishes the opinion to be published and make such distribution as the judge directs. In each case, the opinion should be accompanied by a cover letter from the judge; the judge may have a form letter for this purpose. 71 Law Clerk Handbook Federal Judicial Center § 4.4 § 4.4 Special Duties of Law Clerks to Bankruptcy Judges The duties of law clerks to bankruptcy judges are generally similar to the duties of those working for district judges. The volume of cases and proceedings in bankruptcy court is generally greater than in other trial courts, and the chambers must be organized to handle this volume effectively. Bankruptcy judges hold more, and faster, hearings than do district judges. For the chambers staff, that means more scheduling problems, more substantial prehearing preparation of memoranda, and shorter time limits. It also means more pressure from attorneys telephoning to ask for expedited schedules and to ask about procedures, the disposition of motions, and various other matters. Like district judges, bankruptcy judges differ in their attitudes about direct contact between law clerks and attorneys. Some bankruptcy judges hold court in more than one place. Law clerks and judicial assistants to those judges usually have substantial duties in preparing for travel, including assembly of materials (such as appropriate portions of case records necessary for the trip). The judge’s staff will usually have extra duties in the additional places of holding court because the other staff available may not be as complete as in the home court. § 4.5 U.S. Magistrate Judges The authority of magistrate judges derives primarily from the Federal Magistrates Act of 1968 and as amended numerous times since. 28 U.S.C. §§ 631–639. Significant Supreme Court cases interpreting the Act include Mathews v. Weber, 423 U.S. 261 (1976) (upholding magistrate judge authority to hear Social Security appeals on a report and recommendation basis); United States v. Raddatz, 447 U.S. 667 (1980) (upholding magistrate judge authority to conduct hearings on motions to suppress evidence in felony cases on a report and recommendation basis); Peretz v. United States, 501 U.S. 923 (1991) (upholding magistrate judge authority to conduct felony voir dire proceedings with the parties’ consent); and Roell v. Withrow, 538 U.S. 580 (2003) (holding that parties’ consent to disposition of a civil case by a magistrate judge under 28 U.S.C. § 636(c) could be inferred from the parties’ conduct during the case). A general outline of the duties performed by magistrate judges is described below. 72 Chambers and Case Management fjc.dcn • fjc.gov § 4.5.B A. Initial Proceedings in Criminal Cases Under 28 U.S.C. § 636(a), a magistrate judge may perform various duties and conduct proceedings in criminal cases, including the following: • accept criminal complaints • issue arrest warrants and summonses • issue search warrants • conduct initial appearance proceedings and detention for criminal defendants, informing them of the charges against them and of their rights • set bail or other conditions of release or detention under the Bail Reform Act, 18 U.S.C. §§ 3141–3145 • appoint attorneys for defendants who are unable to afford or obtain counsel • hold preliminary examinations, or “probable cause” hearings • administer oaths and take bail, acknowledgments, affidavits, and depositions • conduct extradition proceedings	G. U.S. Trustees and Private Trustees The U.S. Trustee Program is part of the federal government’s Department of Justice, not a part of the courts. It was established to handle the administrative functions of bankruptcy cases and to ensure the integrity of the bankruptcy system across the nation. The program operates with twenty-one regional offices and ninety-four field offices, which are headed by U.S. trustees and assistant U.S. trustees, respectively. See 28 U.S.C. §§ 581–589b. In the six judicial districts in Alabama and North Carolina, the Bankruptcy Administrator Program, rather than the U.S. Trustee Program, handles the administrative functions. See § 302(d) (3)(1) of the Bankruptcy Judges, United States Trustees, and Family Farmer Act of 1986, P.L. 99-554, 100 Stat. 3119, 3123, and § 317(b) of the Federal Courts Study Committee Implementation Act of 1990. The functions of the U.S. trustees are enumerated in 28 U.S.C. § 581(a), and primarily include (1) appointing and supervising the private trustees who collect and disburse funds to creditors in Chapter 7, 12, and 13 cases; (2) ensuring compliance with the Bankruptcy Code with respect to information provided in schedules, disclosure statements, reorganization plans, and other filings; (3) reviewing fee applications of professionals, such as attorneys and accountants, who serve in Chapter 11 reorganization cases; and (4) monitoring bankruptcy cases for fraud and referring criminal matters to the U.S. attorney for prosecution. Trustees do not have independent enforcement powers; rather, they must request the court to rule on matters of administration for which there is no voluntary compliance. The U.S. trustee is responsible for establishing a panel of private trustees to serve in Chapter 7 cases. When a bankruptcy petition is filed under Chapter 7, the U.S. trustee appoints a disinterested person from this panel to serve as interim trustee. At the first meeting of creditors, the creditors may elect another person as trustee, although such elections are rare. The U.S. trustee is also responsible 44 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.A for appointing one or more “standing” trustees to administer all Chapter 12 and 13 cases filed in a geographic region. In Chapter 11 cases, no trustee is appointed unless the court orders the appointment after notice and a hearing. If the court orders an appointment, the U.S. trustee designates the person who will serve, unless a party-in-interest timely requests that the trustee be elected by the creditors. In Chapter 7, 12, and 13 cases, the U.S. trustee may act as trustee if a private trustee is unavailable, although this is rarely done. The code does not provide for the appointment of a trustee in Chapter 9 cases. 28 U.S.C. § 586, 11 U.S.C. §§ 701–704, 1202, 1104–1106, 1302. § 3.4 Appeals A. Processing Appeals The steps in an appeal are as follows: 1. Filing a notice of appeal 2. Preparing the record on appeal 3. Docketing the appeal 4. Filing the appellant’s brief 5. Filing the appellee’s brief 6. Filing the appellant’s reply brief 7. Deciding if the court dispenses with oral argument, or scheduling of oral argument 8. Hearing oral argument 9. Deliberating by the court 10. Filing the opinion 11. Filing a petition for rehearing 12. Issuing the mandate (the final stage in the appellate process unless the party applies to the Supreme Court for a writ of certiorari) The Federal Rules of Appellate Procedure establish certain procedural uniformity among the thirteen courts of appeals. However, there are still some differences in the procedures in the various circuits. Each court has local rules and internal operating procedures that describe the precise procedure to be followed 45 Law Clerk Handbook Federal Judicial Center § 3.4.B when there is any variation from the rules and, in some instances, that elaborate on or amplify the rules. See section 4.2. B. Notice of Appeal The timely filing of a notice of appeal is a jurisdictional requirement for any appeal. Appeals may be filed to challenge decisions of the district court, an administrative agency, or a bankruptcy appellate panel. Appeals of agency decisions may be classified as original proceedings in the court of appeals. The notice of appeal is filed in the district court. The purpose of the notice is to inform opposing counsel and the court that an appeal is being taken. The clerk of that court is required by Federal Rule of Appellate Procedure 3(d) to forward a copy of the notice to the clerk of the court of appeals. The time for filing commences when the judgment or order is entered in the district court from which the appeal is taken. The running of that time is tolled by the filing of certain posttrial motions in the district court, and the filing of such motions after a notice of appeal has been filed may vitiate the notice, requiring a new notice of appeal to be filed after the motion is decided. Fed. R. App. P. 4(a). Rule 4 provides the following time periods for filing notices of appeal: • private civil cases: 30 days • civil cases in which the United States is a party: 60 days • criminal cases: 10 days • criminal cases in which appeal by the government is authorized by statute (such as appeals from sentences under the 1984 Sentencing Reform Act): 30 days Upon receipt of the notice of appeal, courts of appeals take steps to ensure that all procedural requirements have been met. The clerk’s office may send counsel a case-opening letter to establish schedules for record preparation and briefing. Circuit mediators may conduct initial mediation/settlement conferences to discuss the issues in the case, with a view to eliminating the briefing of frivolous issues and to discuss the possibility of settlement. See Mediation & Conference Programs in the Federal Courts of Appeals: A Sourcebook for Judges and Lawyers (Federal Judicial Center, 2d ed. 2006). 46 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.D C. Record Preparation For an appellate court to review the proceedings in a trial court, appellate judges must have a record available of what occurred in the trial court. Local court rules prescribe the requirements for counsel to provide the district court with the record or excerpts of the record (sometimes referred to as a short record), which may include original papers and exhibits filed in the trial court plus a reporter’s transcript of any relevant proceedings. The Sentencing Reform Act requires that the record in a criminal case must also include “(1) that portion of the record . . . that is designated as pertinent by either of the parties; (2) the presentence report; and (3) the information submitted during the sentencing proceeding.” 18 U.S.C. § 3742(d). This information will often be under seal, because it is confidential. The Federal Rules prescribe time limits (deadlines) for providing the record on appeal to the court of appeals. During this time, the appellant must order a transcript of proceedings if one is needed and make arrangements to pay the court reporter for services or, in courts using electronic sound recording for the official record, the clerk of court. The district court clerk assembles the other papers or electronic files that constitute the record on appeal. The district court has the power to extend for an additional fifty days the time for preparing and sending the record on appeal, after which the court of appeals itself may grant extensions. Additional time may be needed if the court reporter has not finished transcribing the proceedings or if counsel has failed to order the transcript in a timely manner. To prevent undue delay, the appellate courts have the discretion to refuse to grant time extensions and may impose sanctions on the appellant or the reporter for unreasonable delays in preparing the record on appeal. D. Docketing the Appeal When the record is completed, or earlier if desired, the appellant must docket the appeal. This is primarily a clerical process and is performed in the office of the clerk of the court of appeals. Unless the appellant is exempt from payment, a docket fee is charged. The clerk of court opens an appropriate file and record and sends a notice to the parties. Frequently, docketing takes place when the record on appeal is filed. The filing of the record provides the base date for most subsequent proceedings in the case. 47 Law Clerk Handbook Federal Judicial Center § 3.4.E E. Briefs and Joint Appendices Because the appellant has the burden of establishing that the trial court erred, it files the opening brief. The appellee then files a brief in response; if the appellant wishes, the appellant may file a reply brief responding to new matters raised in the appellee’s brief. The Federal Rules of Appellate Procedure establish standards for format, color of brief covers, content, methods of reproduction, number of copies, and times for filing of briefs. The local rules for a circuit may impose further requirements. The schedule for filing briefs is as follows: • appellant’s brief: 40 days after filing the record • appellee’s brief: 30 days after service of appellant’s brief • reply brief: 14 days after service of appellee’s brief Some courts of appeals have modified the requirements and standards of the federal rules in certain cases or classes of cases. One of the more common modifications permits parties appealing in forma pauperis to file fewer copies of their briefs. While the briefs are being prepared, the parties are required to determine which portions of the record on appeal are relevant to the issues raised; the appellant is required to reproduce these portions as an appendix to the briefs. There may be only one appendix containing the portions relied on by both the appellant and the appellee, which would be referred to as a joint appendix. If any relevant material is omitted from the appendix, the court is free to refer to the original record. Multiple copies of the appendix may be filed so that each judge and, if needed, each law clerk may have one. Some courts of appeals have eliminated the requirement of an appendix and permit the substitution of photocopies of relatively few parts of the record, usually called record excerpts. The local rules of those courts describe the substitute requirements. Local rules also address procedures for electronic filing. You should become familiar with the rules and procedures in your court. F. Oral Argument If the court does not decide a case exclusively on the basis of the briefs and written record (see section 4.6.B on screening cases to select those appeals to be decided without oral argument), the parties are given an opportunity to present their arguments to the court orally. Federal Rule of Appellate Procedure 34 permits the court to fix the time allowed for oral argument. Courts may allow counsel to file a request in advance for additional time, and the courts have the discretion whether to grant these requests. Generally, not more than two attorneys are 48 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.G permitted to argue for each side. Some court rules encourage argument by only one attorney for each party. Many appellate judges require their law clerks to prepare a memorandum on each case (called a bench memo) for the judge to review before hearing oral arguments. In some circuits, the law clerk for one judge may prepare a memorandum to be circulated among the three judges on the panel prior to oral argument. The judges will study the briefs before oral argument. The appellant begins the argument. Because the judges have read the briefs and are therefore familiar with the issues, they sometimes begin questioning the attorney shortly after the argument begins. After the appellant’s argument is completed, the appellee responds, followed by any reply by the appellant (if the appellant reserved time for rebuttal). Although the arguments are recorded, so that the judges and their law clerks may later review them, some circuit judges may request one of their law clerks to attend oral argument and take notes of important matters, citations of new authorities, and concessions made during the argument. Most cases are heard by a panel of three judges, but a case may be heard en banc in cases involving a question of exceptional importance or in order to secure or maintain uniformity of decisions. A case heard en banc is heard by all of the active judges on the court and any senior judge of the circuit who sat on the panel that originally heard the case (or, in the Ninth Circuit, by a limited en banc, consisting of the chief judge and ten additional judges selected by lot). En banc hearings are held only when ordered by a majority of the active judges on the court. Some courts hold hearings in only one location, but most hold court in a number of locations within the circuit. G. Deliberation After a case has been argued and submitted to the court, the panel of judges who heard the argument meets to arrive at a decision. In most courts, these meetings are held immediately after the completion of each day’s arguments. Appellate courts perform three distinct functions. First, they decide the controversies before them. Second, they supervise the courts within their jurisdiction. Third, they determine the growth and development of the common law and the interpretation of federal statutory and constitutional law within their jurisdiction. Each of these functions can become important during the decisional phase of an appeal because the court must not only reach the correct result but also explain in its opinion the rationale for its decision. 49 Law Clerk Handbook Federal Judicial Center § 3.4.H In most cases, the court arrives at a tentative decision at the first meeting. At that time, the presiding judge (the senior active circuit judge sitting on the panel) assigns the case to one member of the panel, who later writes an opinion to be submitted to the others for approval. When the judges do not reach agreement so readily, panel members may exchange memoranda about the case and schedule additional meetings or telephone conferences for further discussion. Law clerks for appellate judges should know and follow the court’s internal rules and its customs concerning communications between chambers. H. Opinion and Judgment The final product of the court in most appeals is a written opinion setting forth the decision and the reasoning behind it. The increased number of cases and the burden of writing formal opinions in every case has caused appellate courts to use alternatives to formal opinions (such as memorandum, order, or summary opinions) in many cases, such as those involving only the application of settled principles to a specific fact situation. Local rules or policies may guide the members of the court in deciding which cases deserve full opinions and which opinions should be published. When a panel has agreed on an opinion, the authoring judge electronically transmits it to the clerk of court for public docketing and release. All courts post opinions on the court’s public website. In some courts, before opinions are released, they are circulated to all active judges on the court with a time limit for making suggestions. Sometimes when a judge or a group of judges disagrees with the majority decision reached by their colleagues and they feel strongly enough about it, the judge or judges will write a dissenting opinion explaining what aspects of the decision they disagree with and why. Even though they express opinions that did not prevail, dissents can contribute to the legal debate over the issues at hand and provide judges in similar cases with different perspectives. I. Rehearing The party who loses an appeal may file a petition for rehearing within fourteen days after judgment is entered. That petition attempts to persuade the panel that the decision was erroneous and should be withdrawn or revised. The prevailing party may not file a response to the petition unless one is requested by the court. Most petitions for rehearing are denied. The losing party may also move for a rehearing en banc. That motion is circulated to all members of the original panel and all active judges who did not sit 50 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.K on the panel. Only the active circuit judges and any senior judge who was a member of the original panel may request a vote on the suggestion to rehear the appeal en banc, and only the active circuit judges may vote on whether the appeal should be reheard en banc; if a rehearing en banc is granted, only active circuit judges and senior circuit judges from the circuit who were members of the original panel may sit on the rehearing. By local rule, a circuit may impose time limitations within which a member of the court may request an answer to a petition for rehearing or rehearing en banc or a vote on such a petition. J. Mandate The mandate is the document by which the court of appeals formally notifies the district court of its decision and by which jurisdiction for any necessary additional proceedings is conferred upon the district court. The mandate is issued by the clerk of court seven calendar days after the time to file a petition for rehearing expires, or seven calendar days after entry of an order denying a timely petition for panel rehearing, petition for rehearing en banc, or motion for stay of mandate, whichever is later. These times may be shortened or lengthened by court order. Fed. R. App. P. 41(b). The losing party may request by motion that the issuance of the mandate be stayed in order to maintain the status quo during the pendency of an application for a writ of certiorari to the Supreme Court. The court of appeals may require that a bond be posted as a condition to staying the issuance of the mandate. K. Motions During the course of an appeal, the parties may file a variety of motions. Most of these are procedural and, to the extent permitted by the Federal Rules of Appellate Procedure, some courts have authorized their clerks of court or other court unit executives to act on motions, for example, motions • for extensions of time to perform any of the acts required by local rules or the Federal Rules of Appellate Procedure • for relief from specific requirements of the local rules or the Federal Rules of Appellate Procedure • for permission to alter the form or content of the record on appeal; • for leave to file amicus curiae briefs • for delay in the issuance of the mandate • for voluntary dismissal of the appeal 51 Law Clerk Handbook Federal Judicial Center § 3.4.L Motions requiring action by a judge or panel of judges are those • on issues relating to criminal cases or suits for postconviction relief such as motions for appointment of counsel, leave to appeal in forma pauperis, certificates of probable cause, and bail pending appeal • for stays or injunctions pending appeal • for leave to file interlocutory appeals • for issues relating to stays granted in the district court • for permission to file a brief containing more pages than the number fixed by the rules • for issues relating to the time allowed for oral argument • to dismiss an appeal filed by the appellee In most courts, the staff attorney’s office is responsible for reviewing motions and referring them to judges for appropriate disposition. L. Emergency Proceedings Both district courts and courts of appeals are frequently asked to make decisions on an emergency basis. In the appellate courts, these occasions usually arise when a litigant or a lower court is about to take some action that may cause irreparable injury. The potentially aggrieved party seeks redress by motion for stay or injunction pending appeal or by petition for writ of mandamus or prohibition. In the district courts, these matters usually arise through a request for a temporary restraining order. Each court has developed internal procedures for handling these matters efficiently, but the procedures vary among courts. Courts have also established special procedures for handling emergency appeals of capital (death penalty) cases. Law clerks should become familiar with the procedures established by the local rules and the judge’s own practices. § 3.5 Courts of Specialized Jurisdiction You may also encounter litigation from one of the various special courts established by Congress. The term special courts derives from their specialized jurisdiction. 52 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.5.D A. Court of Appeals for the Federal Circuit The Court of Appeals for the Federal Circuit, based in Washington, D.C., has jurisdiction over appeals from the following: district courts in cases involving patents and certain claims against the United States; the U.S. Court of Federal Claims; the Court of International Trade; the Court of Veterans Appeals; the Merit Systems Protection Board; the Patent and Trademark Office; the boards that decide government contract issues; and a few other Article I agencies. B. Court of International Trade The Court of International Trade, based in New York City, hears cases concerning the value or classification of imports. Its judges may sit by designation on other Article III courts. C. U.S. Judicial Panel on Multidistrict Litigation This panel was created to consider transferring civil actions involving one or more common questions of fact pending in different districts to a single district for coordinated or consolidated pretrial proceedings. The panel consists of seven district and circuit judges who are appointed by the Chief Justice and sit on the panel in addition to their regular judicial assignments. The panel maintains a roster of transferee judges to whom it assigns the cases it certifies for transfer. For discussion of multidistrict litigation problems, see section 3.1.F. D. Foreign Intelligence Surveillance Court The Foreign Intelligence Surveillance Court (FISC), or the FISA court, as it is popularly called (after the Act that created it), is composed of eleven federal judges, selected by the Chief Justice to a nonrenewable seven-year term. The court’s job is to review applications for governmental surveillance of persons within the United States whom the government suspects of having connections to foreign governments and/or terrorist organizations. A Foreign Intelligence Court of Review was also established to review applications denied by the FISA court. 53 Law Clerk Handbook Federal Judicial Center § 3.6 § 3.6 Article I Courts Congress has created many tribunals to assist it in meeting its legislative responsibilities under Article I of the Constitution. These courts do not exercise judicial power conferred by Article III, and the judges are appointed for fixed terms rather than given life tenure. They include the many administrative law judges serving in the executive agencies who hear disputes over claims and benefits, subject to review by agency officials. A. U.S. Tax Court The U.S. Tax Court has jurisdiction over controversies involving deficiencies determined by the commissioner of internal revenue in income, estate, and gift taxes, as well as other tax-related disputes between taxpayers and the Internal Revenue Service. The principal office of the court is located in Washington, D.C., and it conducts trial sessions in other cities throughout the United States. B. U.S. Court of Federal Claims The U.S. Court of Federal Claims was originally called the U.S. Claims Court. The court has jurisdiction over claims brought against the U.S. government. The court is located in Washington, D.C.; however, its jurisdiction is nationwide, enabling it to conduct trials in locations convenient to the parties involved in the case. C. U.S. Court of Appeals for the Armed Forces Congress established the U.S. Court of Appeals for the Armed Forces as an appellate criminal court, hearing all cases involving military courts-martial. It is located in Washington, D.C. D. U.S. Court of Appeals for Veterans Claims The U.S. Court of Appeals for Veterans Claims has exclusive jurisdiction to review the decisions of the Board of Veterans Appeals. The court’s principal location is in Washington, D.C., but it may hold court anywhere in the United States. 54 fjc.dcn • fjc.gov 4 Chambers and Case Management § 4.1 Chambers Administration This chapter gives you a broad overview of some of your responsibilities as a law clerk in maintaining a well-run chambers. These responsibilities include helping to ensure chambers security; answering telephones and mail; maintaining the judge’s motion, hearing, and trial calendars; and other miscellaneous matters. Discussing all such duties would, of course, be impossible, and some judges have chambers manuals detailing how they expect their chambers to operate. Understanding and accommodating your judge’s preferences is key to maintaining an efficient chambers, and regardless of the general guidance offered in this chapter, you should always follow the particular policies and practices of your judge. Effective management is essential to the efficient administration of justice. While judicial assistants often have principal responsibility for managing various aspects of chambers administration, as a law clerk you should be familiar with the standard operating procedures in your chambers and be available to pitch in when needed. A. Security The safety and security of federal buildings and the people who work in and visit them are major concerns for the U.S. Marshals Service (USMS). Attorneys and other members of the public must pass through magnetometers and have their briefcases and other items screened by an X-ray machine to enter most courthouses and other federal buildings. In addition, all judges’ chambers are equipped 55 Law Clerk Handbook Federal Judicial Center § 4.1.A with an entry control system that consists of a security camera and monitor and a door release strike. Courthouse employees may be issued keycards enabling them to enter the courthouse without passing through metal detectors and to access secured, nonpublic sectors of the building, including judges’ chambers, depending on the individual court’s access-control security plans. Employees may also have after-hours and weekend access to the building through use of these keycards, which should be kept in a secure place and reported immediately if lost. All courthouse employees should carefully follow security procedures and report potential problems to the USMS. The U.S. Marshals Service is principally responsible for security of the court and its personnel, though most courthouse security functions are performed by court security officers (CSOs), who are funded by the judiciary’s Court Security Program and by the Federal Protective Service on a limited basis. Become familiar with the court’s Occupant Emergency Plan and other related USMS security plans in your courthouse, and help to maintain a secure chambers. Do not let unauthorized strangers into secure areas of the courthouse, and report suspicious mail or threatening phone calls. During security-sensitive proceedings, a judge may request that a deputy from the U.S. Marshals Service or a CSO be present in the courtroom. Because federal judges are occasionally the targets of terrorists or disgruntled litigants, be careful when opening mail. Mail received in the courthouse is routinely screened by the USMS before distribution to chambers and offices. Still, it pays to be alert to suspicious-looking items. Common recognition points for letter and package bombs include the following: • foreign mail, air mail, and special delivery • restrictive markings (e.g., confidential, personal) • excessive postage • handwritten or poorly typed addresses • incorrect titles • titles, but no names • misspelled common words • oily stains or discolorations • no return addresses • rigid envelopes • lopsided or uneven envelopes 56 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.C • protruding wires or tinfoil • excessive securing material such as masking tape or string • drawings, diagrams, or illustrations If a letter or package arouses attention, do not attempt to open it. Instead, immediately notify the marshals’ office or a CSO. B. Telephone Practices for dealing with incoming calls (e.g., how to answer the telephone, how to take messages, and when and if to transfer a call to the judge) will vary from chambers to chambers. In general, however, answer calls promptly, identify the office (e.g., “Judge Smith’s chambers”), and treat all callers courteously. And, of course, hold personal calls to a minimum, both in length and in number. See section 2.2.A.1 on communication with the media. C. Correspondence, Email, and Other Mail In addition to correspondence by U.S. postal and messenger service, many chambers now correspond by email with a wide variety of people, including counsel. While email has in some ways made communicating easier and more efficient, it has also made it even more important to stay on top of organizing and processing the mail. Email also presents serious potential problems relating to the accidental forwarding of messages, either to unintended parties or containing information not intended for the recipient. And bear in mind how easily emails can be broadly disseminated through forwarding and posting on websites and social media. Take special care to avoid sending and forwarding email messages that may result in embarrassment, a breach of confidence, or worse, and review and carefully proofread any outgoing messages (and fight the temptation not to proofread email as carefully as paper correspondence). Most chambers have practices and procedures for handling incoming and outgoing mail, including email (whether and when to delete email messages, how to store important messages for future reference, and other matters of email retention and organization). Quickly become familiar with these practices to help mitigate complications arising from the enormous number of emails that many chambers receive. Depending on office procedure, either a judicial assistant or a law clerk will open and review correspondence and make an initial decision concerning how 57 Law Clerk Handbook Federal Judicial Center § 4.1.C it should be handled. Many judges receive their own emails directly, though some may ask staff to review messages first. Incoming mail and emails should be reviewed as soon as they are received because they may relate to matters scheduled for that day. When correspondence referring to a pending suit is forwarded to any counsel of record over the signature of the judge, law clerk, or judicial assistant, copies should be sent to all other counsel of record to avoid inappropriate ex parte contact. Appellate judges seldom correspond directly with counsel on case-related matters, because appellate judges work on cases as part of a panel or court rather than individually. Instead, appellate judges will send instructions to the clerk of court on how to respond to counsel. Correspondence from the general public that is not related to a case is still important because citizens have a right to courteous treatment. Also, the public’s opinions about the fairness, responsiveness, and effectiveness of the judiciary are influenced by the promptness and appropriateness of the court’s answers. In the district court, some of the correspondence from the public involves requests to be excused from jury service. That subject is dealt with in section 4.3.D.2. Some correspondence contains character references on behalf of an offender who is scheduled for sentencing. Judges differ in their handling of such correspondence. Many simply acknowledge receipt of the letter and refer the letter to the probation office. Other correspondence from the public may express reactions to a judge’s ruling. Whether positive or negative, expressions of opinion by members of the public generally call only for courteous acknowledgment, not for an explanation or justification of the judge’s action. If a letter requests information about a ruling, many judges simply acknowledge receipt of the letter and send a copy of the opinion, if there is one. If more information is requested, many judges refer the writer to the record in the clerk of court’s office. Some judges may wish to respond to a letter that indicates a misunderstanding concerning a significant fact, proceeding, or legal conclusion. Judges who adopt this policy may ask law clerks to prepare a draft of a response for the judge to review. The response should not be argumentative or defensive; it should merely state the relevant facts or legal conclusion as necessary to alleviate the misunderstanding. Prisoners and persons who have been convicted and are awaiting sentence frequently write district and appellate judges. Handle the correspondence of a prisoner represented by counsel the same way as that of any other litigant. Ask your judge how to handle correspondence from prisoners who are proceeding pro se. In some instances, this correspondence may be handled by district court pro se law clerks or, in the appellate courts, either the clerk’s office or staff attor58 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.D ney’s office. In other instances, your judge may have a form letter explaining, for example, that federal law prohibits judges from giving legal advice and suggesting that the prisoner communicate with a lawyer, or a form letter for responding to requests for transfers to another penal institution (which only the Bureau of Prisons can grant). You should never write anything in a letter that would give a prisoner false hope or could compromise the position of the court. D. Internet and Electronic Research New law clerks will receive a Westlaw and/or a LexisNexis password, which may come with additional electronic research training and certain usage guidelines. All computer-assisted legal research (CALR) use via judiciary contracts is to be limited to official judiciary-related research purposes. In addition to these research services, the Internet also offers more informal avenues of research, including access to nearly every newspaper and magazine in the country, as well as to government and law school websites, Internet search engines, and myriad other sources. Contact the circuit library CALR coordinator for assistance with CALR access or training. The CALR coordinators and reference librarians are also available to assist with your research questions. Become familiar with fjc.dcn (http://fjc.dcn), the Federal Judicial Center’s site on the judiciary’s intranet. It provides access to manuals, monographs, desk references, and other publications, as well as to web-based training and orientation programs, streaming media programs, discussion forums, and other resources. JNet (http://jnet.ao.dcn), the intranet site maintained by the Administrative Office of the U.S. Courts, offers information and forms on a range of topics relevant to judicial employees, including benefits, court security, emergency preparedness, human resources, information technology, legal and general research, and travel. The Internet has also posed some serious security and usage challenges for employees and information technology departments in courthouses across the country. The judiciary provides you with a computer and Internet access to help you do your work. Depending on the policy in your court or chambers, you may use it on a limited basis for personal needs if doing so does not interfere with your work and does not cause congestion, delay, or disruption of service to any government system. You should not do anything on your office computer that would embarrass you or the court if it were made public. 59 Law Clerk Handbook Federal Judicial Center § 4.1.E E. Electronic Filing The federal judiciary’s Case Management/Electronic Case Filing (CM/ECF) system allows courts to maintain case documents in electronic form and provides enhanced and updated docket management services. It also gives each court the option to permit case documents—pleadings, motions, petitions—to be filed electronically with the court. CM/ECF uses an Internet connection and a browser and accepts documents in Portable Document Format (PDF). It is easy to use. Filers prepare documents using conventional word-processing software and save them as PDF files. After logging on to the court’s website with a court-issued password, the filer enters basic information about the case and document being filed, attaches the document, and submits it to the court. CM/ECF automatically generates a notice verifying that the court received the filing, and it also sends an email to other parties in the case notifying them of the filing. There are no added fees for filing documents using CM/ECF, but existing document filing fees do apply. Litigants receive one free copy of documents filed electronically in their cases, which they can save or print for their files. Public electronic access to court data is available through the Public Access to Court Electronic Records (PACER) program. Additional copies are available for a small fee to attorneys and the general public for viewing or downloading. The process for receiving and reviewing daily filings in the cases filed before the judge may vary among courts and chambers; you should quickly learn the process in your chambers and your role in implementing and maintaining it. Although familiarity with the workings of the system is helpful, you should refer counsel’s questions to docketing clerks or others in the clerk’s office who deal with the system on a daily basis. F. Judge’s Chambers Calendar The judicial assistant is usually in charge of maintaining the chambers calendar covering the judge’s scheduled court proceedings and other activities. If the calendar is maintained online, other staff on the chambers network may also have limited access to the judge’s schedule. In appellate courts, the clerk of court advises the judge of panel assignments and hearing dates. The judicial assistant, in consultation with the judge, will then schedule all other engagements and commitments around the hearings. In trial courts, the judicial assistant usually confers with the judge and then typically advises the courtroom deputy in charge of scheduling the court calendar of the dates on which trials and hearings are to 60 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.H be set. The judicial assistant then schedules the judge’s remaining commitments around the trials and hearings. Some judges choose not to have a judicial assistant, which allows them to have an additional law clerk. In these instances, a law clerk may maintain the chambers calendar. G. Opening Court In district courts, a law clerk or courtroom deputy usually opens court. One common method is for the clerk or deputy to rap on the door before the judge enters, open the door, then call out, “All rise.” The judge then enters and walks to the bench. The law clerk or deputy walks to the front of the bench and says: “The United States District Court for the ____ District of ____ is now in session. The Honorable ______ presiding.” The judge usually stands during this call, then says, “Please be seated,” and sits. H. Maintaining the Library; Office Supplies, Equipment, and Furniture Many chambers maintain their own libraries, though electronic databases and Internet research reduce the need for access to hard-copy sources and have enabled chambers in the same courthouse to share libraries. In any event, the employee who maintains the library, either a law clerk or a judicial assistant, should regularly file any advance sheets, pocket parts, slip opinions, replacement volumes, and inserts for loose-leaf services that arrive in the mail. File materials daily so that library maintenance does not become burdensome and the materials are current. Procurement and ordering of all law books is done by the circuit library; contact the librarian if you have questions. Promptly rubber-stamp every incoming library book to identify it as U.S. property. Keep track of books borrowed by attorneys for courtroom use and make sure that books are not taken outside the chambers and courtroom. Promptly reshelve books used during the course of research. They will then be easier to find, and the library will be neater. Also be sure that legal pads, book markers, pencils, and pens are always available in the library. Requests for supplies, equipment, and furniture ordinarily are handled in the clerk of court’s office. 61 Law Clerk Handbook Federal Judicial Center § 4.1.I I. Maintaining Office Records and Files You may have to maintain some of the records in your judge’s office, including the following: • case files • trial schedules or calendars • “tickler” records to remind the judge about future case activities • indices to the judge’s prior decisions • indices to slip opinions • work papers relating to cases in progress Such materials may be stored in hard copy, electronically, or both. Some chambers may also maintain office form books, either in hard copy or electronically. The form books may contain office procedure checklists and frequently used forms, such as samples of letters, orders, opinions, jury charges, minute entries, and office or file memoranda written by prior law clerks. The books describe the format and method for written documents issued by the judge or presented to the judge by chambers staff. The form books provide continuity and consistency in office administration and can help educate new law clerks. If case records are being used in the judge’s chambers, make sure that the records are not misplaced and are returned to the office of the clerk of court as soon as the judge or staff member has finished with them. J. Statistical Reporting The JS-10 form, “Monthly Report of Trials and Other Court Activity,” is a report of the trials and nontrial proceedings that a district judge conducted during the month. The clerk of the district court submits a JS-10 form to the Administrative Office for each active or senior district judge, plus any visiting district judges or appellate judges, who conducted trials or proceedings in the district during the month. The form reports both the number and type of trials and proceedings and the amount of time the judge spent conducting them. Some judges fill out the forms themselves, but usually a member of the chambers staff or the courtroom deputy fills out the form for the judge. The CM/ECF systems in some courts can automatically generate the JS-10 reports based on additional information about the trials and proceedings entered during the normal docketing process. Data on magistrate judge workloads and activities are collected through the MJSTAR 62 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.L function in district CM/ECF systems, which stores that data in the NewStats database. This includes not only the number of tasks completed by magistrate judges, but the time burden of many of these duties, including time spent with attorneys and parties. Bankruptcy courts report trials and other court activity on a monthly basis using the B-102 form. Courts of appeals use the JS-30 form to report the number of appellate cases, interlocutory appeals, and petitions for rehearing each month. K. Out-of-Town Trips Some judges must travel to other cities to attend court sessions and may require a chambers staff member to travel with them if the court to which they are traveling does not provide staffing. Judges may also travel on court-related business. Judicial assistants usually arrange travel (although when the judge has chosen to have an additional law clerk in lieu of a judicial assistant, a law clerk may have to make travel arrangements). If your judge is traveling to hold court in another location, prepare for the judge to take along necessary case files and materials; any personal notes or memoranda relating to the cases to be heard; the judge’s robe; paper, pencils, stationery, and other needed supplies (if the site for the out-of-town session is one frequently used by the court, there may be a permanent stock of stationery and supplies); necessary equipment such as a gavel, recording or dictating equipment, and a laptop or tablet computer; the briefs and any other case materials; and mailing labels and envelopes for returning material that the judge does not wish to carry back. Judges and chambers staff who travel on court business will be reimbursed for transportation, food, lodging, and related expenses according to the detailed rules set forth in the Guide to Judiciary Policy. These rules generally reimburse either a flat dollar amount per day, regardless of actual expenses, or itemized actual expenses not in excess of a fixed dollar amount. The judicial assistant should have forms for travel reimbursement—these forms can also be found on JNet. Judges must also report travel not related to cases under regulations found in Volume 19, section 270, of the Guide to Judiciary Policy. L. Assisting with Judges’ Extrajudicial Activities Many judges engage in teaching, writing, lecturing, and other extrajudicial activities. While law clerks may be called on to assist judges in these activities, the Code of Conduct for United States Judges says that judges should not use staff “to any 63 Law Clerk Handbook Federal Judicial Center § 4.1.M substantial degree” to engage in extrajudicial activities to improve the law, the legal system, and the administration of justice; and judges should not use staff to engage in other extrajudicial activities, “except for uses that are de minimis.” M. Preserving Chambers Papers for Historical Purposes The chambers papers of a district or appellate court judge have historical significance as an essential supplement to the official court record. Many papers in judges’ chambers are widely considered valuable, such as correspondence and background material concerning a case, including memoranda between judges and law clerks and judges on an appeals panel; drafts of orders and opinions (particularly draft opinions that have handwritten comments on them, or that have been circulated to other judges and returned with their comments); and correspondence/memoranda concerning court administration, legal activities in the community, and issues of governance, politics, and law. Chambers papers are the personal property of the judge. Each judge has the prerogative to make final decisions about the preservation of chambers papers and the terms of access. Judges can preserve their personal papers and make them available for eventual study by donating them to a manuscript repository. An FJC publication, A Guide to the Preservation of Federal Judges’ Papers (3d ed. 2018), reviews the organization and preservation of historically significant records created by federal judges. The Federal Judicial History Office at the FJC will also provide assistance on issues concerning judges’ papers. N. Rules Regarding the Media in Court Guidelines for allowing cameras and electronic reproduction equipment in the courtroom are published in Volume 10 of the Guide to Judiciary Policy. The guidelines allow the photographing, recording, or broadcasting of appellate arguments. In trial courts, a presiding judge may authorize broadcasting, televising, recording, or taking photographs in the courtroom during ceremonial proceedings. For nonceremonial proceedings, such activities may be allowed for presenting evidence, perpetuating a record of the proceedings, and for security or judicial administration purposes. Federal Rule of Criminal Procedure 53 prohibits photographing and radio broadcasting of criminal proceedings. Some circuit judicial councils have adopted specific instructions for the use of cameras in the courtroom. Although local rules restrict the means by which news may be reported (e.g., no cameras or broadcasting from the trial courtroom 64 Chambers and Case Management fjc.dcn • fjc.gov § 4.2 or environs), “there is nothing that proscribes the press from reporting events that transpire in the courtroom.” § 4.2Local Court Rules and Administrative Policies Section 2071 of Title 28 of the U.S. Code authorizes federal courts to adopt their own rules, which must be consistent with the national rules and available to the public; it also authorizes the circuit judicial council to abrogate district and bankruptcy courts’ local rules, and authorizes the Judicial Conference to abrogate rules of courts of appeals. Federal Rules of Appellate Procedure 47, Bankruptcy Procedure 9029, Civil Procedure 83, and Criminal Procedure 57 provide additional requirements for local rule adoption and characteristics. The local rules of almost all courts follow the same numbering sequence as the corresponding national rules. These local rules include the procedures for setting cases for trial, scheduling pretrial conferences, setting motions for oral argument, serving memoranda of law, and other details relating to trial. They may also state the procedure for admission of attorneys to practice in the specific district or circuit, the term of the court, the functions of the clerk of court, the rules for filing motions, and more specific data, such as the number of copies required to be filed, limitations on the length of memoranda, the time within which memoranda must be filed, and restrictions on page length, typeface, and margin size. Each court of appeals has local rules concerning procedures for ordering transcripts; filing and docketing the appeal; calendaring; motions; summary disposition of appeals; setting cases for oral argument; time limits on oral argument; petitions for rehearing; petitions for en banc consideration; and stay of mandate. The local rules and internal operating procedures of the courts of appeals are printed in the United States Code Annotated following Title 28 of the Judicial Code, and are available on the courts’ websites. A court’s local rules and any internal operating procedures it adopts establish specific procedures for the court and litigants to follow. You should get these rules and procedures from the court’s website or the clerk’s office and become familiar with them. Keep them available for reference and be on the lookout for any modifications the court may adopt. 65 Law Clerk Handbook Federal Judicial Center § 4.3 § 4.3 Case Management: The Trial Court Many judges believe that the responsibility for moving a case through the trial court is not solely that of the attorneys, and the function of the court is not simply to be available if and when counsel want a hearing. The disposition of all cases as speedily and economically as is consistent with justice is paramount. The Federal Rules of Civil Procedure are to be “construed to secure the just, speedy, and inexpensive determination of every action.” Fed. R. Civ. P. 1. The courts are also required to report semiannually (on April 30 and September 30) for each judge the motions that have been pending and the bench trials that have been submitted for more than six months, and cases that have not been terminated within three years of filing, for publication by the Administrative Office. 28 U.S.C. § 476. Effective docket control means that, early in a case, the judge assumes responsibility for guiding the case to a conclusion. This may include establishing deadlines for filing motions, a time limit for discovery, a date for counsel to take the next step in its prosecution, and a trial date. For specific techniques of case management, consult the Civil Litigation Management Manual. See also Schwarzer & Hirsch, The Elements of Case Management (Federal Judicial Center, 3d ed. 2017). Note that many of the same considerations apply in criminal cases, with the additional complication of computations required by the Speedy Trial Act. 18 U.S.C. §§ 3161–3174. Law clerks should be familiar with the requirements of the Act, since failure to bring a case to trial within the Act’s time limits can have serious repercussions. A. Office Status Sheets Some judges maintain an office status sheet and post it where it is accessible to chambers staff. Its purpose is to keep the judge, the law clerks, and judicial assistants apprised of legal matters under advisement and awaiting disposition. When a matter has been taken under advisement, the assistant or law clerk assigned to the case should indicate it on the status sheet. Keep a personal status list, which can be revised each week, listing all matters for which you are responsible. It will help you make effective use of your time and remember all pending assignments. Some judges require their law clerks to submit personal status lists weekly. Some judges require their judicial assistants to keep a list of all pending matters, the initials or name of the law clerk assigned to work on the matter, and 66 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.C any other pertinent information. If so, keep the assistant advised of all matters assigned, matters completed, and other relevant status information. CM/ECF helps judges use computer technology for docket control and to maintain case inventories and case-status records. Other systems may also be employed. Regardless of which system is used, it is important that it be regularly maintained and continually monitored. B. Calendaring Systems Multijudge trial courts need a system for determining which judge is responsible for each case. In an individual calendar system, each case is randomly assigned to a particular judge at the time it is filed, or soon thereafter, and that judge has complete responsibility for the case until it is terminated. There are also standard procedures for reassigning cases from which the original judge is disqualified, for ensuring that related cases are all assigned to the same judge, and for special assignment of unusual and protracted cases. Local rules usually describe these procedures. C. Trial Scheduling A single trial may be set for a specific date, or the court may set multiple cases for trial on the same day. Some courts use the trailing calendar or trailing docket, in which the court schedules a number of cases for trial beginning on a stated date. The cases are tried in the order reflected by the schedule. Counsel must obtain information from the court and from the attorneys whose cases precede them on the calendar about the progress of those cases, so that they can go to trial whenever the court reaches their case. Most civil cases do not go to trial but are disposed of in some other manner, including dispositive motions and settlement. Judges differ in their approach to encouraging settlement, but the decision whether to settle or proceed to trial is the parties’ alone. If settlement is to be reached, negotiations should be completed in a timely manner. Last-minute settlements may disrupt the court’s schedule, leaving the judges, and sometimes jurors, with unscheduled time. The trailing calendar and other multiple-case-setting devices alleviate some problems caused by last-minute settlement by providing substitute cases to replace those that do not go to trial. Although this resolves the court’s problems, it does not resolve the problems that eve-of-trial settlements cause litigants and counsel. 67 Law Clerk Handbook Federal Judicial Center § 4.3.D Criminal cases take priority on the court’s calendar because they must be tried within the time limits set forth in the Speedy Trial Act. While criminal cases do not settle, the vast majority of them are disposed of by way of plea bargaining and guilty pleas, which again make multiple-case-setting an important calendaring device for the court. D. Jury Management 1. Random Juror Selection The selection of grand and petit jurors in both criminal and civil cases is governed by 28 U.S.C. §§ 1861–1878, under which each district must have a jury selection plan that has been approved by a panel comprising the circuit judicial council and the chief district judge or the chief judge’s designee. The statutory goal of the selection process is to ensure “grand and petit juries selected at random from a fair cross section of the community in the district or division wherein the court convenes” (28 U.S.C. § 1861), and to avoid excluding any citizen “from service as a grand or petit juror . . . on account of race, color, religion, sex, national origin, or economic status” (28 U.S.C. § 1862). The clerk of court usually manages the process of selecting prospective jurors, under the supervision and control of the court. Although the jury selection process may differ slightly in each district, it is generally as follows: 1. The clerk’s office performs a random selection of prospective jurors’ names by computer or manually, using voter registration lists or other sources specified by the court’s plan, and places the names selected in a master jury wheel, which is usually a computer file. The minimum number of names in the master jury wheel must be one-half of 1% of the number on the source lists, or 1,000, whichever is less. 2. As needed by the court, the clerk’s office draws names publicly at random from the master jury wheel and sends jury-qualification questionnaires to those persons whose names are drawn. 3. From the responses to the questionnaires, a determination is made as to which persons are qualified for jury service and which persons are disqualified, exempt, or excused. 4. The names of those determined to be qualified are placed in a second jury wheel consisting of qualified jurors. 5. As needed, the clerk’s office selects names from the qualified jury wheel and prepares lists of the names selected. 68 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.D.2 6. The clerk’s office issues summonses to the necessary number of persons needed for the jury venire several weeks in advance of each trial calendar advising those summoned of the time and place to report for jury service. Some district courts qualify and summons jurors in one step and do not establish a qualified jury wheel. 2. Exemptions, Disqualifications, and Excuses A person is qualified for jury service unless the person • is not a citizen of the United States • is unable to read, write, and understand English with a degree of proficiency sufficient to complete the juror-qualification form satisfactorily • is incapable of rendering satisfactory service because of mental or physical infirmity • is charged with or has been convicted in a state or federal court of record of a crime punishable by imprisonment for more than one year without subsequent restoration of civil rights 28 U.S.C. § 1865. Some district courts have adopted other grounds for exemptions, which are specified in the court’s jury selection plan. Section 1863 of Title 18 requires the plan to provide for the exemption of members of the armed forces in active service; members of state or local fire or police departments; and public officers of the federal, state, and local governments who are actively engaged in the performance of official duties. Jury service is a citizen’s duty as well as a privilege, and courts do not readily grant excuses. A person may, however, be excused from jury service temporarily if the plan states that such service would result in undue hardship or extreme inconvenience. In such a case, the name of an excused juror is placed back in the qualified jury wheel. If a prospective juror approaches you about an excuse, do not express any opinion regarding the request, but simply refer the requester to the clerk’s office or jury administrator for action. Treat persons called for jury service with courtesy; they are providing an important service to the court and the public. Judges in multijudge courthouses often begin jury trials at different hours to obtain maximum use of people summoned for jury service, sending persons examined and not selected to another courtroom so they can be examined for 69 Law Clerk Handbook Federal Judicial Center § 4.3.D.3 selection on another jury, and sometimes using jurors who have served in one trial in a succeeding trial. When prospective jury panels report for possible selection in a case, they should be segregated from other people in the courtroom. Law clerks may be responsible for clearing a portion of the spectator section for the jury panel’s exclusive use. 3. Juror Orientation Most courts conduct a juror orientation program to inform jurors of their responsibilities and to explain the trial process. Orientation videos, including the Federal Judicial Center’s Called to Serve, are available in most courts. 4. Voir Dire In most courts, the judge personally conducts voir dire examination. Federal Rule of Civil Procedure 47 and Federal Rule of Criminal Procedure 24, however, authorize the judge to permit the lawyers to conduct voir dire. If the judge conducts voir dire, the rules authorize counsel to submit specific questions or areas of inquiry that they want the judge to probe. In some courts, magistrate judges conduct voir dire. The law in most circuits permits this in civil cases, though some require consent of the parties. The Supreme Court has held that a magistrate judge may conduct voir dire in a criminal case if the defendant consents (Peretz v. United States, 501 U.S. 923 (1991)), but not if the defendant objects (Gomez v. United States, 490 U.S. 858 (1989)). 5. Jury Supervision In most courts, a deputy clerk is responsible for jury supervision. However, sometimes law clerks have this responsibility. If so, you should be present early enough in the morning to accommodate those members of the jury who arrive before the normal court time. The jury room should be open and available for use by the jurors as they arrive. If the judge permits the jury to take notes, either you or the deputy clerk should provide pads of paper and pencils for distribution to the jurors before the trial begins. Extra pads and pencils should also be placed in the jury room for use during deliberations. If you are responsible for jury supervision, ensure that there is no communication—in the courtroom, jury room, or hallways adjacent to the courtroom and chambers—between jurors and litigants, lawyers, witnesses, or others attending court. 70 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.E Jurors are usually free to go where they wish during recesses, and they may go home at night. Occasionally, however, when there is unusual publicity about the trial or there is reason to believe that someone will attempt to exert improper influence on jurors, the judge may direct that the jury be sequestered. When this occurs, deputy marshals keep the jurors together at all times and supervise them when court is not in session. Jurors in criminal and civil cases are sometimes sequestered from the time they begin deliberating until they reach a verdict. Judges sometimes have law clerks steward the jury during deliberations. Some judges require the law clerk to take a special oath with respect to this duty just before the jury retires. Once the oath is taken, the law clerk assumes primary responsibility for guarding the jury until relieved of this duty by the judge. Remain outside the jury-room door during the entire deliberation process and take every reasonable precaution to ensure that the jurors do not come into contact with other people, especially the litigants, their attorneys, or witnesses. You must never comment on the evidence, the litigants, the attorneys, or the witnesses to any juror (or, for that matter, to anyone else). If a juror has any questions about the trial, at any stage, you should simply state that such questions should be addressed to the judge in writing. Do not answer the question, however simple it may appear. E. Distributing Opinions Federal Rule of Civil Procedure 52(a) requires the judge to make findings of fact and conclusions of law in all actions tried without a jury or with only an advisory jury. The rule permits the judge to do this orally on the record or in writing in an opinion or memorandum. The judge may also write a formal opinion to explain rulings on particular motions. The judicial assistant sends the original of the findings or the opinion and the original of any order for judgment to the docket clerk for filing in the official record. Then the judicial assistant or clerk of court sends a copy of each set of findings or the opinion to each counsel of record, making and distributing other copies in accordance with the judge’s instructions. In most district courts, the clerk of court handles the distribution of opinions, but in a few district courts, this responsibility falls to the law clerk or judicial assistant. The judge decides whether the opinion or findings are to be published. If you are responsible for distributing opinions, check with the judge to determine whether the judge wishes the opinion to be published and make such distribution as the judge directs. In each case, the opinion should be accompanied by a cover letter from the judge; the judge may have a form letter for this purpose. 71 Law Clerk Handbook Federal Judicial Center § 4.4 § 4.4 Special Duties of Law Clerks to Bankruptcy Judges The duties of law clerks to bankruptcy judges are generally similar to the duties of those working for district judges. The volume of cases and proceedings in bankruptcy court is generally greater than in other trial courts, and the chambers must be organized to handle this volume effectively. Bankruptcy judges hold more, and faster, hearings than do district judges. For the chambers staff, that means more scheduling problems, more substantial prehearing preparation of memoranda, and shorter time limits. It also means more pressure from attorneys telephoning to ask for expedited schedules and to ask about procedures, the disposition of motions, and various other matters. Like district judges, bankruptcy judges differ in their attitudes about direct contact between law clerks and attorneys. Some bankruptcy judges hold court in more than one place. Law clerks and judicial assistants to those judges usually have substantial duties in preparing for travel, including assembly of materials (such as appropriate portions of case records necessary for the trip). The judge’s staff will usually have extra duties in the additional places of holding court because the other staff available may not be as complete as in the home court. § 4.5 U.S. Magistrate Judges The authority of magistrate judges derives primarily from the Federal Magistrates Act of 1968 and as amended numerous times since. 28 U.S.C. §§ 631–639. Significant Supreme Court cases interpreting the Act include Mathews v. Weber, 423 U.S. 261 (1976) (upholding magistrate judge authority to hear Social Security appeals on a report and recommendation basis); United States v. Raddatz, 447 U.S. 667 (1980) (upholding magistrate judge authority to conduct hearings on motions to suppress evidence in felony cases on a report and recommendation basis); Peretz v. United States, 501 U.S. 923 (1991) (upholding magistrate judge authority to conduct felony voir dire proceedings with the parties’ consent); and Roell v. Withrow, 538 U.S. 580 (2003) (holding that parties’ consent to disposition of a civil case by a magistrate judge under 28 U.S.C. § 636(c) could be inferred from the parties’ conduct during the case). A general outline of the duties performed by magistrate judges is described below. 72 Chambers and Case Management fjc.dcn • fjc.gov § 4.5.B A. Initial Proceedings in Criminal Cases Under 28 U.S.C. § 636(a), a magistrate judge may perform various duties and conduct proceedings in criminal cases, including the following: • accept criminal complaints • issue arrest warrants and summonses • issue search warrants • conduct initial appearance proceedings and detention for criminal defendants, informing them of the charges against them and of their rights • set bail or other conditions of release or detention under the Bail Reform Act, 18 U.S.C. §§ 3141–3145 • appoint attorneys for defendants who are unable to afford or obtain counsel • hold preliminary examinations, or “probable cause” hearings • administer oaths and take bail, acknowledgments, affidavits, and depositions • conduct extradition proceedings List five similarities and three differences. Use only the Context block contained in the prompt to respond. What are the differences between law clerk duties for a district judge and a bankruptcy judge?	List five similarities and three differences. Use only the Context block contained in the prompt to respond. EVIDENCE: G. U.S. Trustees and Private Trustees The U.S. Trustee Program is part of the federal government’s Department of Justice, not a part of the courts. It was established to handle the administrative functions of bankruptcy cases and to ensure the integrity of the bankruptcy system across the nation. The program operates with twenty-one regional offices and ninety-four field offices, which are headed by U.S. trustees and assistant U.S. trustees, respectively. See 28 U.S.C. §§ 581–589b. In the six judicial districts in Alabama and North Carolina, the Bankruptcy Administrator Program, rather than the U.S. Trustee Program, handles the administrative functions. See § 302(d) (3)(1) of the Bankruptcy Judges, United States Trustees, and Family Farmer Act of 1986, P.L. 99-554, 100 Stat. 3119, 3123, and § 317(b) of the Federal Courts Study Committee Implementation Act of 1990. The functions of the U.S. trustees are enumerated in 28 U.S.C. § 581(a), and primarily include (1) appointing and supervising the private trustees who collect and disburse funds to creditors in Chapter 7, 12, and 13 cases; (2) ensuring compliance with the Bankruptcy Code with respect to information provided in schedules, disclosure statements, reorganization plans, and other filings; (3) reviewing fee applications of professionals, such as attorneys and accountants, who serve in Chapter 11 reorganization cases; and (4) monitoring bankruptcy cases for fraud and referring criminal matters to the U.S. attorney for prosecution. Trustees do not have independent enforcement powers; rather, they must request the court to rule on matters of administration for which there is no voluntary compliance. The U.S. trustee is responsible for establishing a panel of private trustees to serve in Chapter 7 cases. When a bankruptcy petition is filed under Chapter 7, the U.S. trustee appoints a disinterested person from this panel to serve as interim trustee. At the first meeting of creditors, the creditors may elect another person as trustee, although such elections are rare. The U.S. trustee is also responsible 44 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.A for appointing one or more “standing” trustees to administer all Chapter 12 and 13 cases filed in a geographic region. In Chapter 11 cases, no trustee is appointed unless the court orders the appointment after notice and a hearing. If the court orders an appointment, the U.S. trustee designates the person who will serve, unless a party-in-interest timely requests that the trustee be elected by the creditors. In Chapter 7, 12, and 13 cases, the U.S. trustee may act as trustee if a private trustee is unavailable, although this is rarely done. The code does not provide for the appointment of a trustee in Chapter 9 cases. 28 U.S.C. § 586, 11 U.S.C. §§ 701–704, 1202, 1104–1106, 1302. § 3.4 Appeals A. Processing Appeals The steps in an appeal are as follows: 1. Filing a notice of appeal 2. Preparing the record on appeal 3. Docketing the appeal 4. Filing the appellant’s brief 5. Filing the appellee’s brief 6. Filing the appellant’s reply brief 7. Deciding if the court dispenses with oral argument, or scheduling of oral argument 8. Hearing oral argument 9. Deliberating by the court 10. Filing the opinion 11. Filing a petition for rehearing 12. Issuing the mandate (the final stage in the appellate process unless the party applies to the Supreme Court for a writ of certiorari) The Federal Rules of Appellate Procedure establish certain procedural uniformity among the thirteen courts of appeals. However, there are still some differences in the procedures in the various circuits. Each court has local rules and internal operating procedures that describe the precise procedure to be followed 45 Law Clerk Handbook Federal Judicial Center § 3.4.B when there is any variation from the rules and, in some instances, that elaborate on or amplify the rules. See section 4.2. B. Notice of Appeal The timely filing of a notice of appeal is a jurisdictional requirement for any appeal. Appeals may be filed to challenge decisions of the district court, an administrative agency, or a bankruptcy appellate panel. Appeals of agency decisions may be classified as original proceedings in the court of appeals. The notice of appeal is filed in the district court. The purpose of the notice is to inform opposing counsel and the court that an appeal is being taken. The clerk of that court is required by Federal Rule of Appellate Procedure 3(d) to forward a copy of the notice to the clerk of the court of appeals. The time for filing commences when the judgment or order is entered in the district court from which the appeal is taken. The running of that time is tolled by the filing of certain posttrial motions in the district court, and the filing of such motions after a notice of appeal has been filed may vitiate the notice, requiring a new notice of appeal to be filed after the motion is decided. Fed. R. App. P. 4(a). Rule 4 provides the following time periods for filing notices of appeal: • private civil cases: 30 days • civil cases in which the United States is a party: 60 days • criminal cases: 10 days • criminal cases in which appeal by the government is authorized by statute (such as appeals from sentences under the 1984 Sentencing Reform Act): 30 days Upon receipt of the notice of appeal, courts of appeals take steps to ensure that all procedural requirements have been met. The clerk’s office may send counsel a case-opening letter to establish schedules for record preparation and briefing. Circuit mediators may conduct initial mediation/settlement conferences to discuss the issues in the case, with a view to eliminating the briefing of frivolous issues and to discuss the possibility of settlement. See Mediation & Conference Programs in the Federal Courts of Appeals: A Sourcebook for Judges and Lawyers (Federal Judicial Center, 2d ed. 2006). 46 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.D C. Record Preparation For an appellate court to review the proceedings in a trial court, appellate judges must have a record available of what occurred in the trial court. Local court rules prescribe the requirements for counsel to provide the district court with the record or excerpts of the record (sometimes referred to as a short record), which may include original papers and exhibits filed in the trial court plus a reporter’s transcript of any relevant proceedings. The Sentencing Reform Act requires that the record in a criminal case must also include “(1) that portion of the record . . . that is designated as pertinent by either of the parties; (2) the presentence report; and (3) the information submitted during the sentencing proceeding.” 18 U.S.C. § 3742(d). This information will often be under seal, because it is confidential. The Federal Rules prescribe time limits (deadlines) for providing the record on appeal to the court of appeals. During this time, the appellant must order a transcript of proceedings if one is needed and make arrangements to pay the court reporter for services or, in courts using electronic sound recording for the official record, the clerk of court. The district court clerk assembles the other papers or electronic files that constitute the record on appeal. The district court has the power to extend for an additional fifty days the time for preparing and sending the record on appeal, after which the court of appeals itself may grant extensions. Additional time may be needed if the court reporter has not finished transcribing the proceedings or if counsel has failed to order the transcript in a timely manner. To prevent undue delay, the appellate courts have the discretion to refuse to grant time extensions and may impose sanctions on the appellant or the reporter for unreasonable delays in preparing the record on appeal. D. Docketing the Appeal When the record is completed, or earlier if desired, the appellant must docket the appeal. This is primarily a clerical process and is performed in the office of the clerk of the court of appeals. Unless the appellant is exempt from payment, a docket fee is charged. The clerk of court opens an appropriate file and record and sends a notice to the parties. Frequently, docketing takes place when the record on appeal is filed. The filing of the record provides the base date for most subsequent proceedings in the case. 47 Law Clerk Handbook Federal Judicial Center § 3.4.E E. Briefs and Joint Appendices Because the appellant has the burden of establishing that the trial court erred, it files the opening brief. The appellee then files a brief in response; if the appellant wishes, the appellant may file a reply brief responding to new matters raised in the appellee’s brief. The Federal Rules of Appellate Procedure establish standards for format, color of brief covers, content, methods of reproduction, number of copies, and times for filing of briefs. The local rules for a circuit may impose further requirements. The schedule for filing briefs is as follows: • appellant’s brief: 40 days after filing the record • appellee’s brief: 30 days after service of appellant’s brief • reply brief: 14 days after service of appellee’s brief Some courts of appeals have modified the requirements and standards of the federal rules in certain cases or classes of cases. One of the more common modifications permits parties appealing in forma pauperis to file fewer copies of their briefs. While the briefs are being prepared, the parties are required to determine which portions of the record on appeal are relevant to the issues raised; the appellant is required to reproduce these portions as an appendix to the briefs. There may be only one appendix containing the portions relied on by both the appellant and the appellee, which would be referred to as a joint appendix. If any relevant material is omitted from the appendix, the court is free to refer to the original record. Multiple copies of the appendix may be filed so that each judge and, if needed, each law clerk may have one. Some courts of appeals have eliminated the requirement of an appendix and permit the substitution of photocopies of relatively few parts of the record, usually called record excerpts. The local rules of those courts describe the substitute requirements. Local rules also address procedures for electronic filing. You should become familiar with the rules and procedures in your court. F. Oral Argument If the court does not decide a case exclusively on the basis of the briefs and written record (see section 4.6.B on screening cases to select those appeals to be decided without oral argument), the parties are given an opportunity to present their arguments to the court orally. Federal Rule of Appellate Procedure 34 permits the court to fix the time allowed for oral argument. Courts may allow counsel to file a request in advance for additional time, and the courts have the discretion whether to grant these requests. Generally, not more than two attorneys are 48 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.G permitted to argue for each side. Some court rules encourage argument by only one attorney for each party. Many appellate judges require their law clerks to prepare a memorandum on each case (called a bench memo) for the judge to review before hearing oral arguments. In some circuits, the law clerk for one judge may prepare a memorandum to be circulated among the three judges on the panel prior to oral argument. The judges will study the briefs before oral argument. The appellant begins the argument. Because the judges have read the briefs and are therefore familiar with the issues, they sometimes begin questioning the attorney shortly after the argument begins. After the appellant’s argument is completed, the appellee responds, followed by any reply by the appellant (if the appellant reserved time for rebuttal). Although the arguments are recorded, so that the judges and their law clerks may later review them, some circuit judges may request one of their law clerks to attend oral argument and take notes of important matters, citations of new authorities, and concessions made during the argument. Most cases are heard by a panel of three judges, but a case may be heard en banc in cases involving a question of exceptional importance or in order to secure or maintain uniformity of decisions. A case heard en banc is heard by all of the active judges on the court and any senior judge of the circuit who sat on the panel that originally heard the case (or, in the Ninth Circuit, by a limited en banc, consisting of the chief judge and ten additional judges selected by lot). En banc hearings are held only when ordered by a majority of the active judges on the court. Some courts hold hearings in only one location, but most hold court in a number of locations within the circuit. G. Deliberation After a case has been argued and submitted to the court, the panel of judges who heard the argument meets to arrive at a decision. In most courts, these meetings are held immediately after the completion of each day’s arguments. Appellate courts perform three distinct functions. First, they decide the controversies before them. Second, they supervise the courts within their jurisdiction. Third, they determine the growth and development of the common law and the interpretation of federal statutory and constitutional law within their jurisdiction. Each of these functions can become important during the decisional phase of an appeal because the court must not only reach the correct result but also explain in its opinion the rationale for its decision. 49 Law Clerk Handbook Federal Judicial Center § 3.4.H In most cases, the court arrives at a tentative decision at the first meeting. At that time, the presiding judge (the senior active circuit judge sitting on the panel) assigns the case to one member of the panel, who later writes an opinion to be submitted to the others for approval. When the judges do not reach agreement so readily, panel members may exchange memoranda about the case and schedule additional meetings or telephone conferences for further discussion. Law clerks for appellate judges should know and follow the court’s internal rules and its customs concerning communications between chambers. H. Opinion and Judgment The final product of the court in most appeals is a written opinion setting forth the decision and the reasoning behind it. The increased number of cases and the burden of writing formal opinions in every case has caused appellate courts to use alternatives to formal opinions (such as memorandum, order, or summary opinions) in many cases, such as those involving only the application of settled principles to a specific fact situation. Local rules or policies may guide the members of the court in deciding which cases deserve full opinions and which opinions should be published. When a panel has agreed on an opinion, the authoring judge electronically transmits it to the clerk of court for public docketing and release. All courts post opinions on the court’s public website. In some courts, before opinions are released, they are circulated to all active judges on the court with a time limit for making suggestions. Sometimes when a judge or a group of judges disagrees with the majority decision reached by their colleagues and they feel strongly enough about it, the judge or judges will write a dissenting opinion explaining what aspects of the decision they disagree with and why. Even though they express opinions that did not prevail, dissents can contribute to the legal debate over the issues at hand and provide judges in similar cases with different perspectives. I. Rehearing The party who loses an appeal may file a petition for rehearing within fourteen days after judgment is entered. That petition attempts to persuade the panel that the decision was erroneous and should be withdrawn or revised. The prevailing party may not file a response to the petition unless one is requested by the court. Most petitions for rehearing are denied. The losing party may also move for a rehearing en banc. That motion is circulated to all members of the original panel and all active judges who did not sit 50 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.K on the panel. Only the active circuit judges and any senior judge who was a member of the original panel may request a vote on the suggestion to rehear the appeal en banc, and only the active circuit judges may vote on whether the appeal should be reheard en banc; if a rehearing en banc is granted, only active circuit judges and senior circuit judges from the circuit who were members of the original panel may sit on the rehearing. By local rule, a circuit may impose time limitations within which a member of the court may request an answer to a petition for rehearing or rehearing en banc or a vote on such a petition. J. Mandate The mandate is the document by which the court of appeals formally notifies the district court of its decision and by which jurisdiction for any necessary additional proceedings is conferred upon the district court. The mandate is issued by the clerk of court seven calendar days after the time to file a petition for rehearing expires, or seven calendar days after entry of an order denying a timely petition for panel rehearing, petition for rehearing en banc, or motion for stay of mandate, whichever is later. These times may be shortened or lengthened by court order. Fed. R. App. P. 41(b). The losing party may request by motion that the issuance of the mandate be stayed in order to maintain the status quo during the pendency of an application for a writ of certiorari to the Supreme Court. The court of appeals may require that a bond be posted as a condition to staying the issuance of the mandate. K. Motions During the course of an appeal, the parties may file a variety of motions. Most of these are procedural and, to the extent permitted by the Federal Rules of Appellate Procedure, some courts have authorized their clerks of court or other court unit executives to act on motions, for example, motions • for extensions of time to perform any of the acts required by local rules or the Federal Rules of Appellate Procedure • for relief from specific requirements of the local rules or the Federal Rules of Appellate Procedure • for permission to alter the form or content of the record on appeal; • for leave to file amicus curiae briefs • for delay in the issuance of the mandate • for voluntary dismissal of the appeal 51 Law Clerk Handbook Federal Judicial Center § 3.4.L Motions requiring action by a judge or panel of judges are those • on issues relating to criminal cases or suits for postconviction relief such as motions for appointment of counsel, leave to appeal in forma pauperis, certificates of probable cause, and bail pending appeal • for stays or injunctions pending appeal • for leave to file interlocutory appeals • for issues relating to stays granted in the district court • for permission to file a brief containing more pages than the number fixed by the rules • for issues relating to the time allowed for oral argument • to dismiss an appeal filed by the appellee In most courts, the staff attorney’s office is responsible for reviewing motions and referring them to judges for appropriate disposition. L. Emergency Proceedings Both district courts and courts of appeals are frequently asked to make decisions on an emergency basis. In the appellate courts, these occasions usually arise when a litigant or a lower court is about to take some action that may cause irreparable injury. The potentially aggrieved party seeks redress by motion for stay or injunction pending appeal or by petition for writ of mandamus or prohibition. In the district courts, these matters usually arise through a request for a temporary restraining order. Each court has developed internal procedures for handling these matters efficiently, but the procedures vary among courts. Courts have also established special procedures for handling emergency appeals of capital (death penalty) cases. Law clerks should become familiar with the procedures established by the local rules and the judge’s own practices. § 3.5 Courts of Specialized Jurisdiction You may also encounter litigation from one of the various special courts established by Congress. The term special courts derives from their specialized jurisdiction. 52 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.5.D A. Court of Appeals for the Federal Circuit The Court of Appeals for the Federal Circuit, based in Washington, D.C., has jurisdiction over appeals from the following: district courts in cases involving patents and certain claims against the United States; the U.S. Court of Federal Claims; the Court of International Trade; the Court of Veterans Appeals; the Merit Systems Protection Board; the Patent and Trademark Office; the boards that decide government contract issues; and a few other Article I agencies. B. Court of International Trade The Court of International Trade, based in New York City, hears cases concerning the value or classification of imports. Its judges may sit by designation on other Article III courts. C. U.S. Judicial Panel on Multidistrict Litigation This panel was created to consider transferring civil actions involving one or more common questions of fact pending in different districts to a single district for coordinated or consolidated pretrial proceedings. The panel consists of seven district and circuit judges who are appointed by the Chief Justice and sit on the panel in addition to their regular judicial assignments. The panel maintains a roster of transferee judges to whom it assigns the cases it certifies for transfer. For discussion of multidistrict litigation problems, see section 3.1.F. D. Foreign Intelligence Surveillance Court The Foreign Intelligence Surveillance Court (FISC), or the FISA court, as it is popularly called (after the Act that created it), is composed of eleven federal judges, selected by the Chief Justice to a nonrenewable seven-year term. The court’s job is to review applications for governmental surveillance of persons within the United States whom the government suspects of having connections to foreign governments and/or terrorist organizations. A Foreign Intelligence Court of Review was also established to review applications denied by the FISA court. 53 Law Clerk Handbook Federal Judicial Center § 3.6 § 3.6 Article I Courts Congress has created many tribunals to assist it in meeting its legislative responsibilities under Article I of the Constitution. These courts do not exercise judicial power conferred by Article III, and the judges are appointed for fixed terms rather than given life tenure. They include the many administrative law judges serving in the executive agencies who hear disputes over claims and benefits, subject to review by agency officials. A. U.S. Tax Court The U.S. Tax Court has jurisdiction over controversies involving deficiencies determined by the commissioner of internal revenue in income, estate, and gift taxes, as well as other tax-related disputes between taxpayers and the Internal Revenue Service. The principal office of the court is located in Washington, D.C., and it conducts trial sessions in other cities throughout the United States. B. U.S. Court of Federal Claims The U.S. Court of Federal Claims was originally called the U.S. Claims Court. The court has jurisdiction over claims brought against the U.S. government. The court is located in Washington, D.C.; however, its jurisdiction is nationwide, enabling it to conduct trials in locations convenient to the parties involved in the case. C. U.S. Court of Appeals for the Armed Forces Congress established the U.S. Court of Appeals for the Armed Forces as an appellate criminal court, hearing all cases involving military courts-martial. It is located in Washington, D.C. D. U.S. Court of Appeals for Veterans Claims The U.S. Court of Appeals for Veterans Claims has exclusive jurisdiction to review the decisions of the Board of Veterans Appeals. The court’s principal location is in Washington, D.C., but it may hold court anywhere in the United States. 54 fjc.dcn • fjc.gov 4 Chambers and Case Management § 4.1 Chambers Administration This chapter gives you a broad overview of some of your responsibilities as a law clerk in maintaining a well-run chambers. These responsibilities include helping to ensure chambers security; answering telephones and mail; maintaining the judge’s motion, hearing, and trial calendars; and other miscellaneous matters. Discussing all such duties would, of course, be impossible, and some judges have chambers manuals detailing how they expect their chambers to operate. Understanding and accommodating your judge’s preferences is key to maintaining an efficient chambers, and regardless of the general guidance offered in this chapter, you should always follow the particular policies and practices of your judge. Effective management is essential to the efficient administration of justice. While judicial assistants often have principal responsibility for managing various aspects of chambers administration, as a law clerk you should be familiar with the standard operating procedures in your chambers and be available to pitch in when needed. A. Security The safety and security of federal buildings and the people who work in and visit them are major concerns for the U.S. Marshals Service (USMS). Attorneys and other members of the public must pass through magnetometers and have their briefcases and other items screened by an X-ray machine to enter most courthouses and other federal buildings. In addition, all judges’ chambers are equipped 55 Law Clerk Handbook Federal Judicial Center § 4.1.A with an entry control system that consists of a security camera and monitor and a door release strike. Courthouse employees may be issued keycards enabling them to enter the courthouse without passing through metal detectors and to access secured, nonpublic sectors of the building, including judges’ chambers, depending on the individual court’s access-control security plans. Employees may also have after-hours and weekend access to the building through use of these keycards, which should be kept in a secure place and reported immediately if lost. All courthouse employees should carefully follow security procedures and report potential problems to the USMS. The U.S. Marshals Service is principally responsible for security of the court and its personnel, though most courthouse security functions are performed by court security officers (CSOs), who are funded by the judiciary’s Court Security Program and by the Federal Protective Service on a limited basis. Become familiar with the court’s Occupant Emergency Plan and other related USMS security plans in your courthouse, and help to maintain a secure chambers. Do not let unauthorized strangers into secure areas of the courthouse, and report suspicious mail or threatening phone calls. During security-sensitive proceedings, a judge may request that a deputy from the U.S. Marshals Service or a CSO be present in the courtroom. Because federal judges are occasionally the targets of terrorists or disgruntled litigants, be careful when opening mail. Mail received in the courthouse is routinely screened by the USMS before distribution to chambers and offices. Still, it pays to be alert to suspicious-looking items. Common recognition points for letter and package bombs include the following: • foreign mail, air mail, and special delivery • restrictive markings (e.g., confidential, personal) • excessive postage • handwritten or poorly typed addresses • incorrect titles • titles, but no names • misspelled common words • oily stains or discolorations • no return addresses • rigid envelopes • lopsided or uneven envelopes 56 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.C • protruding wires or tinfoil • excessive securing material such as masking tape or string • drawings, diagrams, or illustrations If a letter or package arouses attention, do not attempt to open it. Instead, immediately notify the marshals’ office or a CSO. B. Telephone Practices for dealing with incoming calls (e.g., how to answer the telephone, how to take messages, and when and if to transfer a call to the judge) will vary from chambers to chambers. In general, however, answer calls promptly, identify the office (e.g., “Judge Smith’s chambers”), and treat all callers courteously. And, of course, hold personal calls to a minimum, both in length and in number. See section 2.2.A.1 on communication with the media. C. Correspondence, Email, and Other Mail In addition to correspondence by U.S. postal and messenger service, many chambers now correspond by email with a wide variety of people, including counsel. While email has in some ways made communicating easier and more efficient, it has also made it even more important to stay on top of organizing and processing the mail. Email also presents serious potential problems relating to the accidental forwarding of messages, either to unintended parties or containing information not intended for the recipient. And bear in mind how easily emails can be broadly disseminated through forwarding and posting on websites and social media. Take special care to avoid sending and forwarding email messages that may result in embarrassment, a breach of confidence, or worse, and review and carefully proofread any outgoing messages (and fight the temptation not to proofread email as carefully as paper correspondence). Most chambers have practices and procedures for handling incoming and outgoing mail, including email (whether and when to delete email messages, how to store important messages for future reference, and other matters of email retention and organization). Quickly become familiar with these practices to help mitigate complications arising from the enormous number of emails that many chambers receive. Depending on office procedure, either a judicial assistant or a law clerk will open and review correspondence and make an initial decision concerning how 57 Law Clerk Handbook Federal Judicial Center § 4.1.C it should be handled. Many judges receive their own emails directly, though some may ask staff to review messages first. Incoming mail and emails should be reviewed as soon as they are received because they may relate to matters scheduled for that day. When correspondence referring to a pending suit is forwarded to any counsel of record over the signature of the judge, law clerk, or judicial assistant, copies should be sent to all other counsel of record to avoid inappropriate ex parte contact. Appellate judges seldom correspond directly with counsel on case-related matters, because appellate judges work on cases as part of a panel or court rather than individually. Instead, appellate judges will send instructions to the clerk of court on how to respond to counsel. Correspondence from the general public that is not related to a case is still important because citizens have a right to courteous treatment. Also, the public’s opinions about the fairness, responsiveness, and effectiveness of the judiciary are influenced by the promptness and appropriateness of the court’s answers. In the district court, some of the correspondence from the public involves requests to be excused from jury service. That subject is dealt with in section 4.3.D.2. Some correspondence contains character references on behalf of an offender who is scheduled for sentencing. Judges differ in their handling of such correspondence. Many simply acknowledge receipt of the letter and refer the letter to the probation office. Other correspondence from the public may express reactions to a judge’s ruling. Whether positive or negative, expressions of opinion by members of the public generally call only for courteous acknowledgment, not for an explanation or justification of the judge’s action. If a letter requests information about a ruling, many judges simply acknowledge receipt of the letter and send a copy of the opinion, if there is one. If more information is requested, many judges refer the writer to the record in the clerk of court’s office. Some judges may wish to respond to a letter that indicates a misunderstanding concerning a significant fact, proceeding, or legal conclusion. Judges who adopt this policy may ask law clerks to prepare a draft of a response for the judge to review. The response should not be argumentative or defensive; it should merely state the relevant facts or legal conclusion as necessary to alleviate the misunderstanding. Prisoners and persons who have been convicted and are awaiting sentence frequently write district and appellate judges. Handle the correspondence of a prisoner represented by counsel the same way as that of any other litigant. Ask your judge how to handle correspondence from prisoners who are proceeding pro se. In some instances, this correspondence may be handled by district court pro se law clerks or, in the appellate courts, either the clerk’s office or staff attor58 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.D ney’s office. In other instances, your judge may have a form letter explaining, for example, that federal law prohibits judges from giving legal advice and suggesting that the prisoner communicate with a lawyer, or a form letter for responding to requests for transfers to another penal institution (which only the Bureau of Prisons can grant). You should never write anything in a letter that would give a prisoner false hope or could compromise the position of the court. D. Internet and Electronic Research New law clerks will receive a Westlaw and/or a LexisNexis password, which may come with additional electronic research training and certain usage guidelines. All computer-assisted legal research (CALR) use via judiciary contracts is to be limited to official judiciary-related research purposes. In addition to these research services, the Internet also offers more informal avenues of research, including access to nearly every newspaper and magazine in the country, as well as to government and law school websites, Internet search engines, and myriad other sources. Contact the circuit library CALR coordinator for assistance with CALR access or training. The CALR coordinators and reference librarians are also available to assist with your research questions. Become familiar with fjc.dcn (http://fjc.dcn), the Federal Judicial Center’s site on the judiciary’s intranet. It provides access to manuals, monographs, desk references, and other publications, as well as to web-based training and orientation programs, streaming media programs, discussion forums, and other resources. JNet (http://jnet.ao.dcn), the intranet site maintained by the Administrative Office of the U.S. Courts, offers information and forms on a range of topics relevant to judicial employees, including benefits, court security, emergency preparedness, human resources, information technology, legal and general research, and travel. The Internet has also posed some serious security and usage challenges for employees and information technology departments in courthouses across the country. The judiciary provides you with a computer and Internet access to help you do your work. Depending on the policy in your court or chambers, you may use it on a limited basis for personal needs if doing so does not interfere with your work and does not cause congestion, delay, or disruption of service to any government system. You should not do anything on your office computer that would embarrass you or the court if it were made public. 59 Law Clerk Handbook Federal Judicial Center § 4.1.E E. Electronic Filing The federal judiciary’s Case Management/Electronic Case Filing (CM/ECF) system allows courts to maintain case documents in electronic form and provides enhanced and updated docket management services. It also gives each court the option to permit case documents—pleadings, motions, petitions—to be filed electronically with the court. CM/ECF uses an Internet connection and a browser and accepts documents in Portable Document Format (PDF). It is easy to use. Filers prepare documents using conventional word-processing software and save them as PDF files. After logging on to the court’s website with a court-issued password, the filer enters basic information about the case and document being filed, attaches the document, and submits it to the court. CM/ECF automatically generates a notice verifying that the court received the filing, and it also sends an email to other parties in the case notifying them of the filing. There are no added fees for filing documents using CM/ECF, but existing document filing fees do apply. Litigants receive one free copy of documents filed electronically in their cases, which they can save or print for their files. Public electronic access to court data is available through the Public Access to Court Electronic Records (PACER) program. Additional copies are available for a small fee to attorneys and the general public for viewing or downloading. The process for receiving and reviewing daily filings in the cases filed before the judge may vary among courts and chambers; you should quickly learn the process in your chambers and your role in implementing and maintaining it. Although familiarity with the workings of the system is helpful, you should refer counsel’s questions to docketing clerks or others in the clerk’s office who deal with the system on a daily basis. F. Judge’s Chambers Calendar The judicial assistant is usually in charge of maintaining the chambers calendar covering the judge’s scheduled court proceedings and other activities. If the calendar is maintained online, other staff on the chambers network may also have limited access to the judge’s schedule. In appellate courts, the clerk of court advises the judge of panel assignments and hearing dates. The judicial assistant, in consultation with the judge, will then schedule all other engagements and commitments around the hearings. In trial courts, the judicial assistant usually confers with the judge and then typically advises the courtroom deputy in charge of scheduling the court calendar of the dates on which trials and hearings are to 60 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.H be set. The judicial assistant then schedules the judge’s remaining commitments around the trials and hearings. Some judges choose not to have a judicial assistant, which allows them to have an additional law clerk. In these instances, a law clerk may maintain the chambers calendar. G. Opening Court In district courts, a law clerk or courtroom deputy usually opens court. One common method is for the clerk or deputy to rap on the door before the judge enters, open the door, then call out, “All rise.” The judge then enters and walks to the bench. The law clerk or deputy walks to the front of the bench and says: “The United States District Court for the ____ District of ____ is now in session. The Honorable ______ presiding.” The judge usually stands during this call, then says, “Please be seated,” and sits. H. Maintaining the Library; Office Supplies, Equipment, and Furniture Many chambers maintain their own libraries, though electronic databases and Internet research reduce the need for access to hard-copy sources and have enabled chambers in the same courthouse to share libraries. In any event, the employee who maintains the library, either a law clerk or a judicial assistant, should regularly file any advance sheets, pocket parts, slip opinions, replacement volumes, and inserts for loose-leaf services that arrive in the mail. File materials daily so that library maintenance does not become burdensome and the materials are current. Procurement and ordering of all law books is done by the circuit library; contact the librarian if you have questions. Promptly rubber-stamp every incoming library book to identify it as U.S. property. Keep track of books borrowed by attorneys for courtroom use and make sure that books are not taken outside the chambers and courtroom. Promptly reshelve books used during the course of research. They will then be easier to find, and the library will be neater. Also be sure that legal pads, book markers, pencils, and pens are always available in the library. Requests for supplies, equipment, and furniture ordinarily are handled in the clerk of court’s office. 61 Law Clerk Handbook Federal Judicial Center § 4.1.I I. Maintaining Office Records and Files You may have to maintain some of the records in your judge’s office, including the following: • case files • trial schedules or calendars • “tickler” records to remind the judge about future case activities • indices to the judge’s prior decisions • indices to slip opinions • work papers relating to cases in progress Such materials may be stored in hard copy, electronically, or both. Some chambers may also maintain office form books, either in hard copy or electronically. The form books may contain office procedure checklists and frequently used forms, such as samples of letters, orders, opinions, jury charges, minute entries, and office or file memoranda written by prior law clerks. The books describe the format and method for written documents issued by the judge or presented to the judge by chambers staff. The form books provide continuity and consistency in office administration and can help educate new law clerks. If case records are being used in the judge’s chambers, make sure that the records are not misplaced and are returned to the office of the clerk of court as soon as the judge or staff member has finished with them. J. Statistical Reporting The JS-10 form, “Monthly Report of Trials and Other Court Activity,” is a report of the trials and nontrial proceedings that a district judge conducted during the month. The clerk of the district court submits a JS-10 form to the Administrative Office for each active or senior district judge, plus any visiting district judges or appellate judges, who conducted trials or proceedings in the district during the month. The form reports both the number and type of trials and proceedings and the amount of time the judge spent conducting them. Some judges fill out the forms themselves, but usually a member of the chambers staff or the courtroom deputy fills out the form for the judge. The CM/ECF systems in some courts can automatically generate the JS-10 reports based on additional information about the trials and proceedings entered during the normal docketing process. Data on magistrate judge workloads and activities are collected through the MJSTAR 62 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.L function in district CM/ECF systems, which stores that data in the NewStats database. This includes not only the number of tasks completed by magistrate judges, but the time burden of many of these duties, including time spent with attorneys and parties. Bankruptcy courts report trials and other court activity on a monthly basis using the B-102 form. Courts of appeals use the JS-30 form to report the number of appellate cases, interlocutory appeals, and petitions for rehearing each month. K. Out-of-Town Trips Some judges must travel to other cities to attend court sessions and may require a chambers staff member to travel with them if the court to which they are traveling does not provide staffing. Judges may also travel on court-related business. Judicial assistants usually arrange travel (although when the judge has chosen to have an additional law clerk in lieu of a judicial assistant, a law clerk may have to make travel arrangements). If your judge is traveling to hold court in another location, prepare for the judge to take along necessary case files and materials; any personal notes or memoranda relating to the cases to be heard; the judge’s robe; paper, pencils, stationery, and other needed supplies (if the site for the out-of-town session is one frequently used by the court, there may be a permanent stock of stationery and supplies); necessary equipment such as a gavel, recording or dictating equipment, and a laptop or tablet computer; the briefs and any other case materials; and mailing labels and envelopes for returning material that the judge does not wish to carry back. Judges and chambers staff who travel on court business will be reimbursed for transportation, food, lodging, and related expenses according to the detailed rules set forth in the Guide to Judiciary Policy. These rules generally reimburse either a flat dollar amount per day, regardless of actual expenses, or itemized actual expenses not in excess of a fixed dollar amount. The judicial assistant should have forms for travel reimbursement—these forms can also be found on JNet. Judges must also report travel not related to cases under regulations found in Volume 19, section 270, of the Guide to Judiciary Policy. L. Assisting with Judges’ Extrajudicial Activities Many judges engage in teaching, writing, lecturing, and other extrajudicial activities. While law clerks may be called on to assist judges in these activities, the Code of Conduct for United States Judges says that judges should not use staff “to any 63 Law Clerk Handbook Federal Judicial Center § 4.1.M substantial degree” to engage in extrajudicial activities to improve the law, the legal system, and the administration of justice; and judges should not use staff to engage in other extrajudicial activities, “except for uses that are de minimis.” M. Preserving Chambers Papers for Historical Purposes The chambers papers of a district or appellate court judge have historical significance as an essential supplement to the official court record. Many papers in judges’ chambers are widely considered valuable, such as correspondence and background material concerning a case, including memoranda between judges and law clerks and judges on an appeals panel; drafts of orders and opinions (particularly draft opinions that have handwritten comments on them, or that have been circulated to other judges and returned with their comments); and correspondence/memoranda concerning court administration, legal activities in the community, and issues of governance, politics, and law. Chambers papers are the personal property of the judge. Each judge has the prerogative to make final decisions about the preservation of chambers papers and the terms of access. Judges can preserve their personal papers and make them available for eventual study by donating them to a manuscript repository. An FJC publication, A Guide to the Preservation of Federal Judges’ Papers (3d ed. 2018), reviews the organization and preservation of historically significant records created by federal judges. The Federal Judicial History Office at the FJC will also provide assistance on issues concerning judges’ papers. N. Rules Regarding the Media in Court Guidelines for allowing cameras and electronic reproduction equipment in the courtroom are published in Volume 10 of the Guide to Judiciary Policy. The guidelines allow the photographing, recording, or broadcasting of appellate arguments. In trial courts, a presiding judge may authorize broadcasting, televising, recording, or taking photographs in the courtroom during ceremonial proceedings. For nonceremonial proceedings, such activities may be allowed for presenting evidence, perpetuating a record of the proceedings, and for security or judicial administration purposes. Federal Rule of Criminal Procedure 53 prohibits photographing and radio broadcasting of criminal proceedings. Some circuit judicial councils have adopted specific instructions for the use of cameras in the courtroom. Although local rules restrict the means by which news may be reported (e.g., no cameras or broadcasting from the trial courtroom 64 Chambers and Case Management fjc.dcn • fjc.gov § 4.2 or environs), “there is nothing that proscribes the press from reporting events that transpire in the courtroom.” § 4.2Local Court Rules and Administrative Policies Section 2071 of Title 28 of the U.S. Code authorizes federal courts to adopt their own rules, which must be consistent with the national rules and available to the public; it also authorizes the circuit judicial council to abrogate district and bankruptcy courts’ local rules, and authorizes the Judicial Conference to abrogate rules of courts of appeals. Federal Rules of Appellate Procedure 47, Bankruptcy Procedure 9029, Civil Procedure 83, and Criminal Procedure 57 provide additional requirements for local rule adoption and characteristics. The local rules of almost all courts follow the same numbering sequence as the corresponding national rules. These local rules include the procedures for setting cases for trial, scheduling pretrial conferences, setting motions for oral argument, serving memoranda of law, and other details relating to trial. They may also state the procedure for admission of attorneys to practice in the specific district or circuit, the term of the court, the functions of the clerk of court, the rules for filing motions, and more specific data, such as the number of copies required to be filed, limitations on the length of memoranda, the time within which memoranda must be filed, and restrictions on page length, typeface, and margin size. Each court of appeals has local rules concerning procedures for ordering transcripts; filing and docketing the appeal; calendaring; motions; summary disposition of appeals; setting cases for oral argument; time limits on oral argument; petitions for rehearing; petitions for en banc consideration; and stay of mandate. The local rules and internal operating procedures of the courts of appeals are printed in the United States Code Annotated following Title 28 of the Judicial Code, and are available on the courts’ websites. A court’s local rules and any internal operating procedures it adopts establish specific procedures for the court and litigants to follow. You should get these rules and procedures from the court’s website or the clerk’s office and become familiar with them. Keep them available for reference and be on the lookout for any modifications the court may adopt. 65 Law Clerk Handbook Federal Judicial Center § 4.3 § 4.3 Case Management: The Trial Court Many judges believe that the responsibility for moving a case through the trial court is not solely that of the attorneys, and the function of the court is not simply to be available if and when counsel want a hearing. The disposition of all cases as speedily and economically as is consistent with justice is paramount. The Federal Rules of Civil Procedure are to be “construed to secure the just, speedy, and inexpensive determination of every action.” Fed. R. Civ. P. 1. The courts are also required to report semiannually (on April 30 and September 30) for each judge the motions that have been pending and the bench trials that have been submitted for more than six months, and cases that have not been terminated within three years of filing, for publication by the Administrative Office. 28 U.S.C. § 476. Effective docket control means that, early in a case, the judge assumes responsibility for guiding the case to a conclusion. This may include establishing deadlines for filing motions, a time limit for discovery, a date for counsel to take the next step in its prosecution, and a trial date. For specific techniques of case management, consult the Civil Litigation Management Manual. See also Schwarzer & Hirsch, The Elements of Case Management (Federal Judicial Center, 3d ed. 2017). Note that many of the same considerations apply in criminal cases, with the additional complication of computations required by the Speedy Trial Act. 18 U.S.C. §§ 3161–3174. Law clerks should be familiar with the requirements of the Act, since failure to bring a case to trial within the Act’s time limits can have serious repercussions. A. Office Status Sheets Some judges maintain an office status sheet and post it where it is accessible to chambers staff. Its purpose is to keep the judge, the law clerks, and judicial assistants apprised of legal matters under advisement and awaiting disposition. When a matter has been taken under advisement, the assistant or law clerk assigned to the case should indicate it on the status sheet. Keep a personal status list, which can be revised each week, listing all matters for which you are responsible. It will help you make effective use of your time and remember all pending assignments. Some judges require their law clerks to submit personal status lists weekly. Some judges require their judicial assistants to keep a list of all pending matters, the initials or name of the law clerk assigned to work on the matter, and 66 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.C any other pertinent information. If so, keep the assistant advised of all matters assigned, matters completed, and other relevant status information. CM/ECF helps judges use computer technology for docket control and to maintain case inventories and case-status records. Other systems may also be employed. Regardless of which system is used, it is important that it be regularly maintained and continually monitored. B. Calendaring Systems Multijudge trial courts need a system for determining which judge is responsible for each case. In an individual calendar system, each case is randomly assigned to a particular judge at the time it is filed, or soon thereafter, and that judge has complete responsibility for the case until it is terminated. There are also standard procedures for reassigning cases from which the original judge is disqualified, for ensuring that related cases are all assigned to the same judge, and for special assignment of unusual and protracted cases. Local rules usually describe these procedures. C. Trial Scheduling A single trial may be set for a specific date, or the court may set multiple cases for trial on the same day. Some courts use the trailing calendar or trailing docket, in which the court schedules a number of cases for trial beginning on a stated date. The cases are tried in the order reflected by the schedule. Counsel must obtain information from the court and from the attorneys whose cases precede them on the calendar about the progress of those cases, so that they can go to trial whenever the court reaches their case. Most civil cases do not go to trial but are disposed of in some other manner, including dispositive motions and settlement. Judges differ in their approach to encouraging settlement, but the decision whether to settle or proceed to trial is the parties’ alone. If settlement is to be reached, negotiations should be completed in a timely manner. Last-minute settlements may disrupt the court’s schedule, leaving the judges, and sometimes jurors, with unscheduled time. The trailing calendar and other multiple-case-setting devices alleviate some problems caused by last-minute settlement by providing substitute cases to replace those that do not go to trial. Although this resolves the court’s problems, it does not resolve the problems that eve-of-trial settlements cause litigants and counsel. 67 Law Clerk Handbook Federal Judicial Center § 4.3.D Criminal cases take priority on the court’s calendar because they must be tried within the time limits set forth in the Speedy Trial Act. While criminal cases do not settle, the vast majority of them are disposed of by way of plea bargaining and guilty pleas, which again make multiple-case-setting an important calendaring device for the court. D. Jury Management 1. Random Juror Selection The selection of grand and petit jurors in both criminal and civil cases is governed by 28 U.S.C. §§ 1861–1878, under which each district must have a jury selection plan that has been approved by a panel comprising the circuit judicial council and the chief district judge or the chief judge’s designee. The statutory goal of the selection process is to ensure “grand and petit juries selected at random from a fair cross section of the community in the district or division wherein the court convenes” (28 U.S.C. § 1861), and to avoid excluding any citizen “from service as a grand or petit juror . . . on account of race, color, religion, sex, national origin, or economic status” (28 U.S.C. § 1862). The clerk of court usually manages the process of selecting prospective jurors, under the supervision and control of the court. Although the jury selection process may differ slightly in each district, it is generally as follows: 1. The clerk’s office performs a random selection of prospective jurors’ names by computer or manually, using voter registration lists or other sources specified by the court’s plan, and places the names selected in a master jury wheel, which is usually a computer file. The minimum number of names in the master jury wheel must be one-half of 1% of the number on the source lists, or 1,000, whichever is less. 2. As needed by the court, the clerk’s office draws names publicly at random from the master jury wheel and sends jury-qualification questionnaires to those persons whose names are drawn. 3. From the responses to the questionnaires, a determination is made as to which persons are qualified for jury service and which persons are disqualified, exempt, or excused. 4. The names of those determined to be qualified are placed in a second jury wheel consisting of qualified jurors. 5. As needed, the clerk’s office selects names from the qualified jury wheel and prepares lists of the names selected. 68 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.D.2 6. The clerk’s office issues summonses to the necessary number of persons needed for the jury venire several weeks in advance of each trial calendar advising those summoned of the time and place to report for jury service. Some district courts qualify and summons jurors in one step and do not establish a qualified jury wheel. 2. Exemptions, Disqualifications, and Excuses A person is qualified for jury service unless the person • is not a citizen of the United States • is unable to read, write, and understand English with a degree of proficiency sufficient to complete the juror-qualification form satisfactorily • is incapable of rendering satisfactory service because of mental or physical infirmity • is charged with or has been convicted in a state or federal court of record of a crime punishable by imprisonment for more than one year without subsequent restoration of civil rights 28 U.S.C. § 1865. Some district courts have adopted other grounds for exemptions, which are specified in the court’s jury selection plan. Section 1863 of Title 18 requires the plan to provide for the exemption of members of the armed forces in active service; members of state or local fire or police departments; and public officers of the federal, state, and local governments who are actively engaged in the performance of official duties. Jury service is a citizen’s duty as well as a privilege, and courts do not readily grant excuses. A person may, however, be excused from jury service temporarily if the plan states that such service would result in undue hardship or extreme inconvenience. In such a case, the name of an excused juror is placed back in the qualified jury wheel. If a prospective juror approaches you about an excuse, do not express any opinion regarding the request, but simply refer the requester to the clerk’s office or jury administrator for action. Treat persons called for jury service with courtesy; they are providing an important service to the court and the public. Judges in multijudge courthouses often begin jury trials at different hours to obtain maximum use of people summoned for jury service, sending persons examined and not selected to another courtroom so they can be examined for 69 Law Clerk Handbook Federal Judicial Center § 4.3.D.3 selection on another jury, and sometimes using jurors who have served in one trial in a succeeding trial. When prospective jury panels report for possible selection in a case, they should be segregated from other people in the courtroom. Law clerks may be responsible for clearing a portion of the spectator section for the jury panel’s exclusive use. 3. Juror Orientation Most courts conduct a juror orientation program to inform jurors of their responsibilities and to explain the trial process. Orientation videos, including the Federal Judicial Center’s Called to Serve, are available in most courts. 4. Voir Dire In most courts, the judge personally conducts voir dire examination. Federal Rule of Civil Procedure 47 and Federal Rule of Criminal Procedure 24, however, authorize the judge to permit the lawyers to conduct voir dire. If the judge conducts voir dire, the rules authorize counsel to submit specific questions or areas of inquiry that they want the judge to probe. In some courts, magistrate judges conduct voir dire. The law in most circuits permits this in civil cases, though some require consent of the parties. The Supreme Court has held that a magistrate judge may conduct voir dire in a criminal case if the defendant consents (Peretz v. United States, 501 U.S. 923 (1991)), but not if the defendant objects (Gomez v. United States, 490 U.S. 858 (1989)). 5. Jury Supervision In most courts, a deputy clerk is responsible for jury supervision. However, sometimes law clerks have this responsibility. If so, you should be present early enough in the morning to accommodate those members of the jury who arrive before the normal court time. The jury room should be open and available for use by the jurors as they arrive. If the judge permits the jury to take notes, either you or the deputy clerk should provide pads of paper and pencils for distribution to the jurors before the trial begins. Extra pads and pencils should also be placed in the jury room for use during deliberations. If you are responsible for jury supervision, ensure that there is no communication—in the courtroom, jury room, or hallways adjacent to the courtroom and chambers—between jurors and litigants, lawyers, witnesses, or others attending court. 70 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.E Jurors are usually free to go where they wish during recesses, and they may go home at night. Occasionally, however, when there is unusual publicity about the trial or there is reason to believe that someone will attempt to exert improper influence on jurors, the judge may direct that the jury be sequestered. When this occurs, deputy marshals keep the jurors together at all times and supervise them when court is not in session. Jurors in criminal and civil cases are sometimes sequestered from the time they begin deliberating until they reach a verdict. Judges sometimes have law clerks steward the jury during deliberations. Some judges require the law clerk to take a special oath with respect to this duty just before the jury retires. Once the oath is taken, the law clerk assumes primary responsibility for guarding the jury until relieved of this duty by the judge. Remain outside the jury-room door during the entire deliberation process and take every reasonable precaution to ensure that the jurors do not come into contact with other people, especially the litigants, their attorneys, or witnesses. You must never comment on the evidence, the litigants, the attorneys, or the witnesses to any juror (or, for that matter, to anyone else). If a juror has any questions about the trial, at any stage, you should simply state that such questions should be addressed to the judge in writing. Do not answer the question, however simple it may appear. E. Distributing Opinions Federal Rule of Civil Procedure 52(a) requires the judge to make findings of fact and conclusions of law in all actions tried without a jury or with only an advisory jury. The rule permits the judge to do this orally on the record or in writing in an opinion or memorandum. The judge may also write a formal opinion to explain rulings on particular motions. The judicial assistant sends the original of the findings or the opinion and the original of any order for judgment to the docket clerk for filing in the official record. Then the judicial assistant or clerk of court sends a copy of each set of findings or the opinion to each counsel of record, making and distributing other copies in accordance with the judge’s instructions. In most district courts, the clerk of court handles the distribution of opinions, but in a few district courts, this responsibility falls to the law clerk or judicial assistant. The judge decides whether the opinion or findings are to be published. If you are responsible for distributing opinions, check with the judge to determine whether the judge wishes the opinion to be published and make such distribution as the judge directs. In each case, the opinion should be accompanied by a cover letter from the judge; the judge may have a form letter for this purpose. 71 Law Clerk Handbook Federal Judicial Center § 4.4 § 4.4 Special Duties of Law Clerks to Bankruptcy Judges The duties of law clerks to bankruptcy judges are generally similar to the duties of those working for district judges. The volume of cases and proceedings in bankruptcy court is generally greater than in other trial courts, and the chambers must be organized to handle this volume effectively. Bankruptcy judges hold more, and faster, hearings than do district judges. For the chambers staff, that means more scheduling problems, more substantial prehearing preparation of memoranda, and shorter time limits. It also means more pressure from attorneys telephoning to ask for expedited schedules and to ask about procedures, the disposition of motions, and various other matters. Like district judges, bankruptcy judges differ in their attitudes about direct contact between law clerks and attorneys. Some bankruptcy judges hold court in more than one place. Law clerks and judicial assistants to those judges usually have substantial duties in preparing for travel, including assembly of materials (such as appropriate portions of case records necessary for the trip). The judge’s staff will usually have extra duties in the additional places of holding court because the other staff available may not be as complete as in the home court. § 4.5 U.S. Magistrate Judges The authority of magistrate judges derives primarily from the Federal Magistrates Act of 1968 and as amended numerous times since. 28 U.S.C. §§ 631–639. Significant Supreme Court cases interpreting the Act include Mathews v. Weber, 423 U.S. 261 (1976) (upholding magistrate judge authority to hear Social Security appeals on a report and recommendation basis); United States v. Raddatz, 447 U.S. 667 (1980) (upholding magistrate judge authority to conduct hearings on motions to suppress evidence in felony cases on a report and recommendation basis); Peretz v. United States, 501 U.S. 923 (1991) (upholding magistrate judge authority to conduct felony voir dire proceedings with the parties’ consent); and Roell v. Withrow, 538 U.S. 580 (2003) (holding that parties’ consent to disposition of a civil case by a magistrate judge under 28 U.S.C. § 636(c) could be inferred from the parties’ conduct during the case). A general outline of the duties performed by magistrate judges is described below. 72 Chambers and Case Management fjc.dcn • fjc.gov § 4.5.B A. Initial Proceedings in Criminal Cases Under 28 U.S.C. § 636(a), a magistrate judge may perform various duties and conduct proceedings in criminal cases, including the following: • accept criminal complaints • issue arrest warrants and summonses • issue search warrants • conduct initial appearance proceedings and detention for criminal defendants, informing them of the charges against them and of their rights • set bail or other conditions of release or detention under the Bail Reform Act, 18 U.S.C. §§ 3141–3145 • appoint attorneys for defendants who are unable to afford or obtain counsel • hold preliminary examinations, or “probable cause” hearings • administer oaths and take bail, acknowledgments, affidavits, and depositions • conduct extradition proceedings USER: What are the differences between law clerk duties for a district judge and a bankruptcy judge? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	true	17	16	11,056	null	161
Answer the question using only information found in the context block. Do no rely on any external information, Do not rely on any previous knowledge you may have.	what are the pros and cons of the DMCA as it pertains to online service providers? answer in bullet points	As highlighted by commentators, the DMCA was adopted to both encourage copyright holders to disseminate or allow digital access to their works through online service providers while also protecting intermediaries from liability under specific conditions that would protect the interests of copyright holders.141 Specifically, the DMCA adopted section 512, which excludes the liability of online service providers, which engage in one or more of the following activities: (a) [s]erving as a conduit for the automatic online transmission of material as directed by third parties; (b) catching (i.e., temporarily storing) material that is being transmitted automatically over the internet from one third party to another; (c) storing (i.e., hosting) material at the direction of a user on a service provider’s system or network; or (d) referring or linking users to online sites using information location tools (e.g., a search engine).142 According to section 512, online providers are protected so long as they “(1) adopt and reasonably implement a policy of terminating in appropriate circumstances the accounts of subscribers who are repeat infringers; and (2) accommodate and not interfere with ‘standard technical measures’. . . which are measures copyright owners use to identify or protect copyrighted works.”143 In other words, intermediaries are not liable if they are not aware of the infringing content and the content is promptly removed after being informed of the infringement by the copyright holders—a system known as notice and take down procedure. Nevertheless, also under this system, service providers may be subject to limited injunctive relief for infringing activities conducted on or through their systems or networks.144 Despite the pressure of copyright holders, however, the DMCA does not impose a general monitoring obligation, or content filtering, for service providers.145 Instead, the DMCA leaves it to copyright holders to monitor the infringement of their works and notify service providers of instances of presumed infringement. As noted by commentators, “[i]mposing a general monitoring obligation would be excessive, unpractical and unfeasible to discern illegal contents in the internet universe.”146 Besides the costs of a mandatory filtering system, multiple concerns were expressed in this respect about the consequences of such system on freedom of expression and Internet access. Still, service providers are required to monitor and filter the content shared on their platform when they are aware or know about instances of infringement.147 The absence of a specific mandate does not prevent, however, service providers and copyright holder agreeing that service providers use filtering systems on a voluntary basis.148 Several platforms do adopt voluntary filtering systems and increasingly more often implement automation to monitor the content shared on their sites. With today’s advancement in technology, automatic systems are both less costly and faster than reviews done by humans. For example, beside responding to copyright holders’ independent takedown notices, YouTube uses an internal identification service to filter possible infringements.149 Should any content be flagged through these filters, YouTube takes down the content and later notifies the users, who can appeal the decision.150 For YouTube, this approach is more cost effective, as the number of appeals is lower and thus the platform must review a lower number of cases. Moreover, even in case of successful appeals due to erroneous takedowns, the damages to the user and potential revenue loss for YouTube are lower than the risk of a DMCA f ine for copyright infringement.151 As mentioned, the DMCA safe harbor provisions also do not exclude possible injunctive relief against service providers that do not promptly remove potentially infringing content. In this respect, courts should consider whether the injunction would significantly burden the provider’s system or network, the extension of the harm to the copyright owner, the technical feasibility, effectiveness, and proportionality of the injunction.152 In particular, the DMCA provides for three specific types of injunctions to use against service providers: identification of infringers, website blocking, and internet access suspension. Courts may also consider non-specified injunctions if they consider these necessary to prevent or restrain a copyright infringement.153 With respect to the identification of infringers, the DMCA provides that copyright holders can obtain from any U.S. district court a subpoena to an intermediary to expeditiously identify an alleged infringer to bring a civil lawsuit against him.154 On the other hand, courts need to follow the following steps to grant website blocking injunctions: (i) compare the impact of the injunction on the platform’s business and the harm to the copyright holders;155 (ii) consider the technical feasibility and effectiveness in preventing infringement; (iii) ensure that the injunction will not prevent access to non-infringing material to avoid a claim for violation of the First Amendment.156 In practice, however, courts rarely grant these injunctions.157 Finally, Internet access suspension is regulated by a Memorandum of Understanding (MOU), which entered into force in 2013 and provides for a graduated response based on “six-strikes.”158 Notably, following a copyright holder’s allegation of infringement, the service provider needs to identify the infringer to whom it will send five notices that inform her of the allegation, notify her of the legal alternatives to seek a copyright license, and warn her that a continued infringement may result into sanctions. Following these five strikes, the sixth and last strike is a mitigation measure that can include slower upload and download speeds, account downgrading, or a “temporary restriction” from Internet access.159 The accused infringer can also request an independent review of the case via the American Arbitration Association or the courts.160 Perhaps not surprisingly, the DMCA notice-and-take down procedure has been widely criticized.161 Service providers have often underscored that the system is bias toward copyright holders and allows a considerable number of abuses. For example, sending high volumes of often inaccurate notices is a common occurrence, which is magnified by the fact that copyright owners often automate these notices without effectively vetting their merit.162 Moreover, even though copyright holders are supposed to issue takedown notices in good faith, good faith remains a subjective standard, which is easy to evade and can lead to abuses of the system.163 An additional negative result of this procedure is that risk aversion and fear of a DMCA fines almost systematically lead service providers to ignore the possibility that the uploaded content may constitute fair use of unlicensed content. As a result, fair use is assessed only in case of appeals, which again represent a fraction of the take down cases.164 On the other hand, copyright holders have defined the DMCA as a “very reactive type of protocol” because it requires copyright holders to monitor the Internet for possible infringements and send takedown notices to service providers.165 They also found it to be ineffective against repeated infringers and advocated for a DMCA’s amendment, which would also include a “stay down system” in which copyright holders would notify of a specific infringement once and then the service providers would become responsible for monitoring their sites for repeated incidence of the same infringement.166 In the past years, several initiatives have been undertaken to amend and improve the current notice and takedown system, and overall, the DMCA. In 2020, the Copyright Office released a study on the possible revision of section 512 of the DMCA which found that, overall, “the operation of the section 512 safe harbor system today is unbalanced” in particular with respect to “eligibility qualifications for the service provider safe harbors, repeat infringer policies, knowledge requirement standards, specificity within takedown notices, non-standard notice requirements, subpoenas, and injunctions.”167 Legislators have also considered “modernizing” the current law. In late 2020, Senator Tillis of the Senate Judiciary Committee Subcommittee on Intellectual Property released a draft of the DMCA Modernization Act for stakeholders’ comments,168 which includes a system based on “notice-and-stay-down” procedure as advocated by part of the industry and copyright holders.169 However, the draft was immediately criticized as being against the First Amendment.170 At this time, the bill has not been further discussed and, even if it is clear that the DMCA and section 512 need to be reformed and modernized, these reforms may be lengthy and will certainly lead to heated debates.	Answer the question using only information found in the context block. Do no rely on any external information, Do not rely on any previous knowledge you may have. what are the pros and cons of the DMCA as it pertains to online service providers? answer in bullet points. As highlighted by commentators, the DMCA was adopted to both encourage copyright holders to disseminate or allow digital access to their works through online service providers while also protecting intermediaries from liability under specific conditions that would protect the interests of copyright holders.141 Specifically, the DMCA adopted section 512, which excludes the liability of online service providers, which engage in one or more of the following activities: (a) [s]erving as a conduit for the automatic online transmission of material as directed by third parties; (b) catching (i.e., temporarily storing) material that is being transmitted automatically over the internet from one third party to another; (c) storing (i.e., hosting) material at the direction of a user on a service provider’s system or network; or (d) referring or linking users to online sites using information location tools (e.g., a search engine).142 According to section 512, online providers are protected so long as they “(1) adopt and reasonably implement a policy of terminating in appropriate circumstances the accounts of subscribers who are repeat infringers; and (2) accommodate and not interfere with ‘standard technical measures’. . . which are measures copyright owners use to identify or protect copyrighted works.”143 In other words, intermediaries are not liable if they are not aware of the infringing content and the content is promptly removed after being informed of the infringement by the copyright holders—a system known as notice and take down procedure. Nevertheless, also under this system, service providers may be subject to limited injunctive relief for infringing activities conducted on or through their systems or networks.144 Despite the pressure of copyright holders, however, the DMCA does not impose a general monitoring obligation, or content filtering, for service providers.145 Instead, the DMCA leaves it to copyright holders to monitor the infringement of their works and notify service providers of instances of presumed infringement. As noted by commentators, “[i]mposing a general monitoring obligation would be excessive, unpractical and unfeasible to discern illegal contents in the internet universe.”146 Besides the costs of a mandatory filtering system, multiple concerns were expressed in this respect about the consequences of such system on freedom of expression and Internet access. Still, service providers are required to monitor and filter the content shared on their platform when they are aware or know about instances of infringement.147 The absence of a specific mandate does not prevent, however, service providers and copyright holder agreeing that service providers use filtering systems on a voluntary basis.148 Several platforms do adopt voluntary filtering systems and increasingly more often implement automation to monitor the content shared on their sites. With today’s advancement in technology, automatic systems are both less costly and faster than reviews done by humans. For example, beside responding to copyright holders’ independent takedown notices, YouTube uses an internal identification service to filter possible infringements.149 Should any content be flagged through these filters, YouTube takes down the content and later notifies the users, who can appeal the decision.150 For YouTube, this approach is more cost effective, as the number of appeals is lower and thus the platform must review a lower number of cases. Moreover, even in case of successful appeals due to erroneous takedowns, the damages to the user and potential revenue loss for YouTube are lower than the risk of a DMCA f ine for copyright infringement.151 As mentioned, the DMCA safe harbor provisions also do not exclude possible injunctive relief against service providers that do not promptly remove potentially infringing content. In this respect, courts should consider whether the injunction would significantly burden the provider’s system or network, the extension of the harm to the copyright owner, the technical feasibility, effectiveness, and proportionality of the injunction.152 In particular, the DMCA provides for three specific types of injunctions to use against service providers: identification of infringers, website blocking, and internet access suspension. Courts may also consider non-specified injunctions if they consider these necessary to prevent or restrain a copyright infringement.153 With respect to the identification of infringers, the DMCA provides that copyright holders can obtain from any U.S. district court a subpoena to an intermediary to expeditiously identify an alleged infringer to bring a civil lawsuit against him.154 On the other hand, courts need to follow the following steps to grant website blocking injunctions: (i) compare the impact of the injunction on the platform’s business and the harm to the copyright holders;155 (ii) consider the technical feasibility and effectiveness in preventing infringement; (iii) ensure that the injunction will not prevent access to non-infringing material to avoid a claim for violation of the First Amendment.156 In practice, however, courts rarely grant these injunctions.157 Finally, Internet access suspension is regulated by a Memorandum of Understanding (MOU), which entered into force in 2013 and provides for a graduated response based on “six-strikes.”158 Notably, following a copyright holder’s allegation of infringement, the service provider needs to identify the infringer to whom it will send five notices that inform her of the allegation, notify her of the legal alternatives to seek a copyright license, and warn her that a continued infringement may result into sanctions. Following these five strikes, the sixth and last strike is a mitigation measure that can include slower upload and download speeds, account downgrading, or a “temporary restriction” from Internet access.159 The accused infringer can also request an independent review of the case via the American Arbitration Association or the courts.160 Perhaps not surprisingly, the DMCA notice-and-take down procedure has been widely criticized.161 Service providers have often underscored that the system is bias toward copyright holders and allows a considerable number of abuses. For example, sending high volumes of often inaccurate notices is a common occurrence, which is magnified by the fact that copyright owners often automate these notices without effectively vetting their merit.162 Moreover, even though copyright holders are supposed to issue takedown notices in good faith, good faith remains a subjective standard, which is easy to evade and can lead to abuses of the system.163 An additional negative result of this procedure is that risk aversion and fear of a DMCA fines almost systematically lead service providers to ignore the possibility that the uploaded content may constitute fair use of unlicensed content. As a result, fair use is assessed only in case of appeals, which again represent a fraction of the take down cases.164 On the other hand, copyright holders have defined the DMCA as a “very reactive type of protocol” because it requires copyright holders to monitor the Internet for possible infringements and send takedown notices to service providers.165 They also found it to be ineffective against repeated infringers and advocated for a DMCA’s amendment, which would also include a “stay down system” in which copyright holders would notify of a specific infringement once and then the service providers would become responsible for monitoring their sites for repeated incidence of the same infringement.166 In the past years, several initiatives have been undertaken to amend and improve the current notice and takedown system, and overall, the DMCA. In 2020, the Copyright Office released a study on the possible revision of section 512 of the DMCA which found that, overall, “the operation of the section 512 safe harbor system today is unbalanced” in particular with respect to “eligibility qualifications for the service provider safe harbors, repeat infringer policies, knowledge requirement standards, specificity within takedown notices, non-standard notice requirements, subpoenas, and injunctions.”167 Legislators have also considered “modernizing” the current law. In late 2020, Senator Tillis of the Senate Judiciary Committee Subcommittee on Intellectual Property released a draft of the DMCA Modernization Act for stakeholders’ comments,168 which includes a system based on “notice-and-stay-down” procedure as advocated by part of the industry and copyright holders.169 However, the draft was immediately criticized as being against the First Amendment.170 At this time, the bill has not been further discussed and, even if it is clear that the DMCA and section 512 need to be reformed and modernized, these reforms may be lengthy and will certainly lead to heated debates.	Answer the question using only information found in the context block. Do no rely on any external information, Do not rely on any previous knowledge you may have. EVIDENCE: As highlighted by commentators, the DMCA was adopted to both encourage copyright holders to disseminate or allow digital access to their works through online service providers while also protecting intermediaries from liability under specific conditions that would protect the interests of copyright holders.141 Specifically, the DMCA adopted section 512, which excludes the liability of online service providers, which engage in one or more of the following activities: (a) [s]erving as a conduit for the automatic online transmission of material as directed by third parties; (b) catching (i.e., temporarily storing) material that is being transmitted automatically over the internet from one third party to another; (c) storing (i.e., hosting) material at the direction of a user on a service provider’s system or network; or (d) referring or linking users to online sites using information location tools (e.g., a search engine).142 According to section 512, online providers are protected so long as they “(1) adopt and reasonably implement a policy of terminating in appropriate circumstances the accounts of subscribers who are repeat infringers; and (2) accommodate and not interfere with ‘standard technical measures’. . . which are measures copyright owners use to identify or protect copyrighted works.”143 In other words, intermediaries are not liable if they are not aware of the infringing content and the content is promptly removed after being informed of the infringement by the copyright holders—a system known as notice and take down procedure. Nevertheless, also under this system, service providers may be subject to limited injunctive relief for infringing activities conducted on or through their systems or networks.144 Despite the pressure of copyright holders, however, the DMCA does not impose a general monitoring obligation, or content filtering, for service providers.145 Instead, the DMCA leaves it to copyright holders to monitor the infringement of their works and notify service providers of instances of presumed infringement. As noted by commentators, “[i]mposing a general monitoring obligation would be excessive, unpractical and unfeasible to discern illegal contents in the internet universe.”146 Besides the costs of a mandatory filtering system, multiple concerns were expressed in this respect about the consequences of such system on freedom of expression and Internet access. Still, service providers are required to monitor and filter the content shared on their platform when they are aware or know about instances of infringement.147 The absence of a specific mandate does not prevent, however, service providers and copyright holder agreeing that service providers use filtering systems on a voluntary basis.148 Several platforms do adopt voluntary filtering systems and increasingly more often implement automation to monitor the content shared on their sites. With today’s advancement in technology, automatic systems are both less costly and faster than reviews done by humans. For example, beside responding to copyright holders’ independent takedown notices, YouTube uses an internal identification service to filter possible infringements.149 Should any content be flagged through these filters, YouTube takes down the content and later notifies the users, who can appeal the decision.150 For YouTube, this approach is more cost effective, as the number of appeals is lower and thus the platform must review a lower number of cases. Moreover, even in case of successful appeals due to erroneous takedowns, the damages to the user and potential revenue loss for YouTube are lower than the risk of a DMCA f ine for copyright infringement.151 As mentioned, the DMCA safe harbor provisions also do not exclude possible injunctive relief against service providers that do not promptly remove potentially infringing content. In this respect, courts should consider whether the injunction would significantly burden the provider’s system or network, the extension of the harm to the copyright owner, the technical feasibility, effectiveness, and proportionality of the injunction.152 In particular, the DMCA provides for three specific types of injunctions to use against service providers: identification of infringers, website blocking, and internet access suspension. Courts may also consider non-specified injunctions if they consider these necessary to prevent or restrain a copyright infringement.153 With respect to the identification of infringers, the DMCA provides that copyright holders can obtain from any U.S. district court a subpoena to an intermediary to expeditiously identify an alleged infringer to bring a civil lawsuit against him.154 On the other hand, courts need to follow the following steps to grant website blocking injunctions: (i) compare the impact of the injunction on the platform’s business and the harm to the copyright holders;155 (ii) consider the technical feasibility and effectiveness in preventing infringement; (iii) ensure that the injunction will not prevent access to non-infringing material to avoid a claim for violation of the First Amendment.156 In practice, however, courts rarely grant these injunctions.157 Finally, Internet access suspension is regulated by a Memorandum of Understanding (MOU), which entered into force in 2013 and provides for a graduated response based on “six-strikes.”158 Notably, following a copyright holder’s allegation of infringement, the service provider needs to identify the infringer to whom it will send five notices that inform her of the allegation, notify her of the legal alternatives to seek a copyright license, and warn her that a continued infringement may result into sanctions. Following these five strikes, the sixth and last strike is a mitigation measure that can include slower upload and download speeds, account downgrading, or a “temporary restriction” from Internet access.159 The accused infringer can also request an independent review of the case via the American Arbitration Association or the courts.160 Perhaps not surprisingly, the DMCA notice-and-take down procedure has been widely criticized.161 Service providers have often underscored that the system is bias toward copyright holders and allows a considerable number of abuses. For example, sending high volumes of often inaccurate notices is a common occurrence, which is magnified by the fact that copyright owners often automate these notices without effectively vetting their merit.162 Moreover, even though copyright holders are supposed to issue takedown notices in good faith, good faith remains a subjective standard, which is easy to evade and can lead to abuses of the system.163 An additional negative result of this procedure is that risk aversion and fear of a DMCA fines almost systematically lead service providers to ignore the possibility that the uploaded content may constitute fair use of unlicensed content. As a result, fair use is assessed only in case of appeals, which again represent a fraction of the take down cases.164 On the other hand, copyright holders have defined the DMCA as a “very reactive type of protocol” because it requires copyright holders to monitor the Internet for possible infringements and send takedown notices to service providers.165 They also found it to be ineffective against repeated infringers and advocated for a DMCA’s amendment, which would also include a “stay down system” in which copyright holders would notify of a specific infringement once and then the service providers would become responsible for monitoring their sites for repeated incidence of the same infringement.166 In the past years, several initiatives have been undertaken to amend and improve the current notice and takedown system, and overall, the DMCA. In 2020, the Copyright Office released a study on the possible revision of section 512 of the DMCA which found that, overall, “the operation of the section 512 safe harbor system today is unbalanced” in particular with respect to “eligibility qualifications for the service provider safe harbors, repeat infringer policies, knowledge requirement standards, specificity within takedown notices, non-standard notice requirements, subpoenas, and injunctions.”167 Legislators have also considered “modernizing” the current law. In late 2020, Senator Tillis of the Senate Judiciary Committee Subcommittee on Intellectual Property released a draft of the DMCA Modernization Act for stakeholders’ comments,168 which includes a system based on “notice-and-stay-down” procedure as advocated by part of the industry and copyright holders.169 However, the draft was immediately criticized as being against the First Amendment.170 At this time, the bill has not been further discussed and, even if it is clear that the DMCA and section 512 need to be reformed and modernized, these reforms may be lengthy and will certainly lead to heated debates. USER: what are the pros and cons of the DMCA as it pertains to online service providers? answer in bullet points Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	28	20	1,328	null	392
[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 thought that understanding how computers work was difficult until I learned that there's something actually harder: Quantum computing. Concepts of qubits (quantum dots, superconducting qubits, photons, etc) and the key principles sound more like they belong to physics. What are these concepts? Explain them in less than 500 words.	Four key principles of quantum mechanics Understanding quantum computing requires understanding these four key principles of quantum mechanics: Superposition: Superposition is the state in which a quantum particle or system can represent not just one possibility, but a combination of multiple possibilities. Entanglement: Entanglement is the process in which multiple quantum particles become correlated more strongly than regular probability allows. Decoherence: Decoherence is the process in which quantum particles and systems can decay, collapse or change, converting into single states measurable by classical physics. Interference: Interference is the phenomenon in which entangled quantum states can interact and produce more and less likely probabilities. Qubits While classical computers rely on binary bits (zeros and ones) to store and process data, quantum computers can encode even more data at once using quantum bits, or qubits, in superposition. A qubit can behave like a bit and store either a zero or a one, but it can also be a weighted combination of zero and one at the same time. When combined, qubits in superposition can scale exponentially. Two qubits can store four bits of information, three can store eight, and four can store twelve. However, each qubit can only output a single bit of information at the end of the computation. Quantum algorithms work by storing and manipulating information in a way inaccessible to classical computers, which can provide speedups for certain problems. As silicon chip and superconductor development has scaled over the years, it is distinctly possible that we might soon reach a material limit on the computing power of classical computers. Quantum computing could provide a path forward for certain important problems. With leading institutions such as IBM, Microsoft, Google and Amazon joining eager startups such as Rigetti and Ionq in investing heavily in this exciting new technology, quantum computing is estimated to become a USD 1.3 trillion industry by 2035.1 Secure your enterprise for the quantum era Quantum computers are scaling rapidly. Soon, they will be powerful enough to solve previously unsolvable problems. This opportunity comes with a global challenge: quantum computers will be able to break some of the most widely-used security protocols in the world. Learn more How do quantum computers work? A primary difference between classical and quantum computers is that quantum computers use qubits instead of bits to store exponentially more information. While quantum computing does use binary code, qubits process information differently from classical computers. But what are qubits and where do they come from? What are qubits? Generally, qubits are created by manipulating and measuring quantum particles (the smallest known building blocks of the physical universe), such as photons, electrons, trapped ions and atoms. Qubits can also engineer systems that behave like a quantum particle, as in superconducting circuits. To manipulate such particles, qubits must be kept extremely cold to minimize noise and prevent them from providing inaccurate results or errors resulting from unintended decoherence. There are many different types of qubits used in quantum computing today, with some better suited for different types of tasks. A few of the more common types of qubits in use are as follows: Superconducting qubits: Made from superconducting materials operating at extremely low temperatures, these qubits are favored for their speed in performing computations and fine-tuned control. Trapped ion qubits: Trapped ion particles can also be used as qubits and are noted for long coherence times and high-fidelity measurements. Quantum dots: Quantum dots are small semiconductors that capture a single electron and use it as a qubit, offering promising potential for scalability and compatibility with existing semiconductor technology. Photons: Photons are individual light particles used to send quantum information across long distances through optical fiber cables and are currently being used in quantum communication and quantum cryptography. Neutral atoms: Commonly occurring neutral atoms charged with lasers are well suited for scaling and performing operations. When processing a complex problem, such as factoring large numbers, classical bits become bound up by holding large quantities of information. Quantum bits behave differently. Because qubits can hold a superposition, a quantum computer that uses qubits can approach the problem in ways different from classical computers. As a helpful analogy for understanding how quantum computers use qubits to solve complicated problems, imagine you are standing in the center of a complicated maze. To escape the maze, a traditional computer would have to “brute force” the problem, trying every possible combination of paths to find the exit. This kind of computer would use bits to explore new paths and remember which ones are dead ends. Comparatively, a quantum computer might derive a bird’s-eye view of the maze, testing multiple paths simultaneously and using quantum interference to reveal the correct solution. However, qubits don't test multiple paths at once; instead, quantum computers measure the probability amplitudes of qubits to determine an outcome. These amplitudes function like waves, overlapping and interfering with each other. When asynchronous waves overlap, it effectively eliminates possible solutions to complex problems, and the realized coherent wave or waves present the solution. Key principles of quantum computing When discussing quantum computers, it is important to understand that quantum mechanics is not like traditional physics. The behaviors of quantum particles often appear to be bizarre, counterintuitive or even impossible. Yet the laws of quantum mechanics dictate the order of the natural world. Describing the behaviors of quantum particles presents a unique challenge. Most common-sense paradigms for the natural world lack the vocabulary to communicate the surprising behaviors of quantum particles. To understand quantum computing, it is important to understand a few key terms: Superposition Entanglement Decoherence Interference. Superposition A qubit itself isn't very useful. But it can place the quantum information it holds into a state of superposition, which represents a combination of all possible configurations of the qubit. Groups of qubits in superposition can create complex, multidimensional computational spaces. Complex problems can be represented in new ways in these spaces. This superposition of qubits gives quantum computers their inherent parallelism, allowing them to process many inputs simultaneously. Entanglement Entanglement is the ability of qubits to correlate their state with other qubits. Entangled systems are so intrinsically linked that when quantum processors measure a single entangled qubit, they can immediately determine information about other qubits in the entangled system. When a quantum system is measured, its state collapses from a superposition of possibilities into a binary state, which can be registered like binary code as either a zero or a one. Decoherence Decoherence is the process in which a system in a quantum state collapses into a nonquantum state. It can be intentionally triggered by measuring a quantum system or by other environmental factors (sometimes these factors trigger it unintentionally). Decoherence allows quantum computers to provide measurements and interact with classical computers. Interference An environment of entangled qubits placed into a state of collective superposition structures information in a way that looks like waves, with amplitudes associated with each outcome. These amplitudes become the probabilities of the outcomes of a measurement of the system. These waves can build on each other when many of them peak at a particular outcome, or cancel each other out when peaks and troughs interact. Amplifying a probability or canceling out others are both forms of interference.	[question] I thought that understanding how computers work was difficult until I learned that there's something actually harder: Quantum computing. Concepts of qubits (quantum dots, superconducting qubits, photons, etc) and the key principles sound more like they belong to physics. What are these concepts? Explain them in less than 500 words. ===================== [text] Four key principles of quantum mechanics Understanding quantum computing requires understanding these four key principles of quantum mechanics: Superposition: Superposition is the state in which a quantum particle or system can represent not just one possibility, but a combination of multiple possibilities. Entanglement: Entanglement is the process in which multiple quantum particles become correlated more strongly than regular probability allows. Decoherence: Decoherence is the process in which quantum particles and systems can decay, collapse or change, converting into single states measurable by classical physics. Interference: Interference is the phenomenon in which entangled quantum states can interact and produce more and less likely probabilities. Qubits While classical computers rely on binary bits (zeros and ones) to store and process data, quantum computers can encode even more data at once using quantum bits, or qubits, in superposition. A qubit can behave like a bit and store either a zero or a one, but it can also be a weighted combination of zero and one at the same time. When combined, qubits in superposition can scale exponentially. Two qubits can store four bits of information, three can store eight, and four can store twelve. However, each qubit can only output a single bit of information at the end of the computation. Quantum algorithms work by storing and manipulating information in a way inaccessible to classical computers, which can provide speedups for certain problems. As silicon chip and superconductor development has scaled over the years, it is distinctly possible that we might soon reach a material limit on the computing power of classical computers. Quantum computing could provide a path forward for certain important problems. With leading institutions such as IBM, Microsoft, Google and Amazon joining eager startups such as Rigetti and Ionq in investing heavily in this exciting new technology, quantum computing is estimated to become a USD 1.3 trillion industry by 2035.1 Secure your enterprise for the quantum era Quantum computers are scaling rapidly. Soon, they will be powerful enough to solve previously unsolvable problems. This opportunity comes with a global challenge: quantum computers will be able to break some of the most widely-used security protocols in the world. Learn more How do quantum computers work? A primary difference between classical and quantum computers is that quantum computers use qubits instead of bits to store exponentially more information. While quantum computing does use binary code, qubits process information differently from classical computers. But what are qubits and where do they come from? What are qubits? Generally, qubits are created by manipulating and measuring quantum particles (the smallest known building blocks of the physical universe), such as photons, electrons, trapped ions and atoms. Qubits can also engineer systems that behave like a quantum particle, as in superconducting circuits. To manipulate such particles, qubits must be kept extremely cold to minimize noise and prevent them from providing inaccurate results or errors resulting from unintended decoherence. There are many different types of qubits used in quantum computing today, with some better suited for different types of tasks. A few of the more common types of qubits in use are as follows: Superconducting qubits: Made from superconducting materials operating at extremely low temperatures, these qubits are favored for their speed in performing computations and fine-tuned control. Trapped ion qubits: Trapped ion particles can also be used as qubits and are noted for long coherence times and high-fidelity measurements. Quantum dots: Quantum dots are small semiconductors that capture a single electron and use it as a qubit, offering promising potential for scalability and compatibility with existing semiconductor technology. Photons: Photons are individual light particles used to send quantum information across long distances through optical fiber cables and are currently being used in quantum communication and quantum cryptography. Neutral atoms: Commonly occurring neutral atoms charged with lasers are well suited for scaling and performing operations. When processing a complex problem, such as factoring large numbers, classical bits become bound up by holding large quantities of information. Quantum bits behave differently. Because qubits can hold a superposition, a quantum computer that uses qubits can approach the problem in ways different from classical computers. As a helpful analogy for understanding how quantum computers use qubits to solve complicated problems, imagine you are standing in the center of a complicated maze. To escape the maze, a traditional computer would have to “brute force” the problem, trying every possible combination of paths to find the exit. This kind of computer would use bits to explore new paths and remember which ones are dead ends. Comparatively, a quantum computer might derive a bird’s-eye view of the maze, testing multiple paths simultaneously and using quantum interference to reveal the correct solution. However, qubits don't test multiple paths at once; instead, quantum computers measure the probability amplitudes of qubits to determine an outcome. These amplitudes function like waves, overlapping and interfering with each other. When asynchronous waves overlap, it effectively eliminates possible solutions to complex problems, and the realized coherent wave or waves present the solution. Key principles of quantum computing When discussing quantum computers, it is important to understand that quantum mechanics is not like traditional physics. The behaviors of quantum particles often appear to be bizarre, counterintuitive or even impossible. Yet the laws of quantum mechanics dictate the order of the natural world. Describing the behaviors of quantum particles presents a unique challenge. Most common-sense paradigms for the natural world lack the vocabulary to communicate the surprising behaviors of quantum particles. To understand quantum computing, it is important to understand a few key terms: Superposition Entanglement Decoherence Interference. Superposition A qubit itself isn't very useful. But it can place the quantum information it holds into a state of superposition, which represents a combination of all possible configurations of the qubit. Groups of qubits in superposition can create complex, multidimensional computational spaces. Complex problems can be represented in new ways in these spaces. This superposition of qubits gives quantum computers their inherent parallelism, allowing them to process many inputs simultaneously. Entanglement Entanglement is the ability of qubits to correlate their state with other qubits. Entangled systems are so intrinsically linked that when quantum processors measure a single entangled qubit, they can immediately determine information about other qubits in the entangled system. When a quantum system is measured, its state collapses from a superposition of possibilities into a binary state, which can be registered like binary code as either a zero or a one. Decoherence Decoherence is the process in which a system in a quantum state collapses into a nonquantum state. It can be intentionally triggered by measuring a quantum system or by other environmental factors (sometimes these factors trigger it unintentionally). Decoherence allows quantum computers to provide measurements and interact with classical computers. Interference An environment of entangled qubits placed into a state of collective superposition structures information in a way that looks like waves, with amplitudes associated with each outcome. These amplitudes become the probabilities of the outcomes of a measurement of the system. These waves can build on each other when many of them peak at a particular outcome, or cancel each other out when peaks and troughs interact. Amplifying a probability or canceling out others are both forms of interference. https://www.ibm.com/topics/quantum-computing#:~:text=Schneider%2C%20Ian%20Smalley-,What%20is%20quantum%20computing%3F,the%20most%20powerful%20classical%20computers. ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.	[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: Four key principles of quantum mechanics Understanding quantum computing requires understanding these four key principles of quantum mechanics: Superposition: Superposition is the state in which a quantum particle or system can represent not just one possibility, but a combination of multiple possibilities. Entanglement: Entanglement is the process in which multiple quantum particles become correlated more strongly than regular probability allows. Decoherence: Decoherence is the process in which quantum particles and systems can decay, collapse or change, converting into single states measurable by classical physics. Interference: Interference is the phenomenon in which entangled quantum states can interact and produce more and less likely probabilities. Qubits While classical computers rely on binary bits (zeros and ones) to store and process data, quantum computers can encode even more data at once using quantum bits, or qubits, in superposition. A qubit can behave like a bit and store either a zero or a one, but it can also be a weighted combination of zero and one at the same time. When combined, qubits in superposition can scale exponentially. Two qubits can store four bits of information, three can store eight, and four can store twelve. However, each qubit can only output a single bit of information at the end of the computation. Quantum algorithms work by storing and manipulating information in a way inaccessible to classical computers, which can provide speedups for certain problems. As silicon chip and superconductor development has scaled over the years, it is distinctly possible that we might soon reach a material limit on the computing power of classical computers. Quantum computing could provide a path forward for certain important problems. With leading institutions such as IBM, Microsoft, Google and Amazon joining eager startups such as Rigetti and Ionq in investing heavily in this exciting new technology, quantum computing is estimated to become a USD 1.3 trillion industry by 2035.1 Secure your enterprise for the quantum era Quantum computers are scaling rapidly. Soon, they will be powerful enough to solve previously unsolvable problems. This opportunity comes with a global challenge: quantum computers will be able to break some of the most widely-used security protocols in the world. Learn more How do quantum computers work? A primary difference between classical and quantum computers is that quantum computers use qubits instead of bits to store exponentially more information. While quantum computing does use binary code, qubits process information differently from classical computers. But what are qubits and where do they come from? What are qubits? Generally, qubits are created by manipulating and measuring quantum particles (the smallest known building blocks of the physical universe), such as photons, electrons, trapped ions and atoms. Qubits can also engineer systems that behave like a quantum particle, as in superconducting circuits. To manipulate such particles, qubits must be kept extremely cold to minimize noise and prevent them from providing inaccurate results or errors resulting from unintended decoherence. There are many different types of qubits used in quantum computing today, with some better suited for different types of tasks. A few of the more common types of qubits in use are as follows: Superconducting qubits: Made from superconducting materials operating at extremely low temperatures, these qubits are favored for their speed in performing computations and fine-tuned control. Trapped ion qubits: Trapped ion particles can also be used as qubits and are noted for long coherence times and high-fidelity measurements. Quantum dots: Quantum dots are small semiconductors that capture a single electron and use it as a qubit, offering promising potential for scalability and compatibility with existing semiconductor technology. Photons: Photons are individual light particles used to send quantum information across long distances through optical fiber cables and are currently being used in quantum communication and quantum cryptography. Neutral atoms: Commonly occurring neutral atoms charged with lasers are well suited for scaling and performing operations. When processing a complex problem, such as factoring large numbers, classical bits become bound up by holding large quantities of information. Quantum bits behave differently. Because qubits can hold a superposition, a quantum computer that uses qubits can approach the problem in ways different from classical computers. As a helpful analogy for understanding how quantum computers use qubits to solve complicated problems, imagine you are standing in the center of a complicated maze. To escape the maze, a traditional computer would have to “brute force” the problem, trying every possible combination of paths to find the exit. This kind of computer would use bits to explore new paths and remember which ones are dead ends. Comparatively, a quantum computer might derive a bird’s-eye view of the maze, testing multiple paths simultaneously and using quantum interference to reveal the correct solution. However, qubits don't test multiple paths at once; instead, quantum computers measure the probability amplitudes of qubits to determine an outcome. These amplitudes function like waves, overlapping and interfering with each other. When asynchronous waves overlap, it effectively eliminates possible solutions to complex problems, and the realized coherent wave or waves present the solution. Key principles of quantum computing When discussing quantum computers, it is important to understand that quantum mechanics is not like traditional physics. The behaviors of quantum particles often appear to be bizarre, counterintuitive or even impossible. Yet the laws of quantum mechanics dictate the order of the natural world. Describing the behaviors of quantum particles presents a unique challenge. Most common-sense paradigms for the natural world lack the vocabulary to communicate the surprising behaviors of quantum particles. To understand quantum computing, it is important to understand a few key terms: Superposition Entanglement Decoherence Interference. Superposition A qubit itself isn't very useful. But it can place the quantum information it holds into a state of superposition, which represents a combination of all possible configurations of the qubit. Groups of qubits in superposition can create complex, multidimensional computational spaces. Complex problems can be represented in new ways in these spaces. This superposition of qubits gives quantum computers their inherent parallelism, allowing them to process many inputs simultaneously. Entanglement Entanglement is the ability of qubits to correlate their state with other qubits. Entangled systems are so intrinsically linked that when quantum processors measure a single entangled qubit, they can immediately determine information about other qubits in the entangled system. When a quantum system is measured, its state collapses from a superposition of possibilities into a binary state, which can be registered like binary code as either a zero or a one. Decoherence Decoherence is the process in which a system in a quantum state collapses into a nonquantum state. It can be intentionally triggered by measuring a quantum system or by other environmental factors (sometimes these factors trigger it unintentionally). Decoherence allows quantum computers to provide measurements and interact with classical computers. Interference An environment of entangled qubits placed into a state of collective superposition structures information in a way that looks like waves, with amplitudes associated with each outcome. These amplitudes become the probabilities of the outcomes of a measurement of the system. These waves can build on each other when many of them peak at a particular outcome, or cancel each other out when peaks and troughs interact. Amplifying a probability or canceling out others are both forms of interference. USER: I thought that understanding how computers work was difficult until I learned that there's something actually harder: Quantum computing. Concepts of qubits (quantum dots, superconducting qubits, photons, etc) and the key principles sound more like they belong to physics. What are these concepts? Explain them in less than 500 words. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	28	50	1,200	null	216
Only use information from the document to answer questions. At the end of each response include a list of all other documents referenced in the input document. If any URL's or contact information is included, make sure that information is listed at the end of the response.	User Input: Write two, roughly 200 word paragraphs listing at least four ways PII can be leaked.	4.3 Protecting Data on Telework Client Devices Telework often involves creating and editing work-related information such as email, word processing documents, and spreadsheets. Because that data is important, it should be treated like other important assets of the organization. Two things an organization can do to protect data on telework devices are to secure it on the telework device and to periodically back it up to a location controlled by the organization. More information on this is provided in Sections 4.3.1 through 4.3.3. Organizations can also choose not to allow the organization’s information to be stored on telework devices, but to instead store it centrally at the organization. Sensitive information, such as certain types of personally identifiable information (PII) (e.g., personnel records, medical records, financial records), that is stored on or sent to or from telework devices should be protected so that malicious parties cannot access or alter it. For example, teleworkers often forget that 32 For more information on application whitelisting, see NIST SP 800-167, Guide to Application Whitelisting (http://dx.doi.org/10.6028/NIST.SP.800-167). NIST SP 800-46 REV. 2 GUIDE TO ENTERPRISE TELEWORK, REMOTE ACCESS, AND BYOD SECURITY 26 This publication is available free of charge from: http://dx.doi.org/10.6028/NIST.SP.800-46r2 storing sensitive information on a CD that is carried with their device, or printing the information on a public printer, can also expose the information in ways that are not significant within a typical enterprise environment. An unauthorized release of sensitive information could damage the public’s trust in an organization, jeopardize the organization’s mission, or harm individuals if their personal information has been released. 4.3.1 Encrypting Data at Rest All telework devices, regardless of their size or location, can be stolen. Some thieves may want to read the contents of the data on the device, and quite possibly use that data for criminal purposes. To prevent this, an organization should have a policy of encrypting all sensitive data when it is at rest on the device and on removable media used by the device. The creation and use of cryptographic keys for encrypting remote data at rest should follow the same policies that an organization has for other keys that protect data at rest.33 There are many methods for protecting data at rest, and they mostly depend on the type of device or removable media that is being protected. Most operating systems have their own data encryption mechanisms, and there are also numerous third-party applications that provide similar capabilities. 34 Generally, when technologies such as full disk encryption are being used to protect data at rest on PCs, teleworkers should shut down their telework devices instead of placing them into sleep mode when the devices will not be used for an extended time or when the teleworker will not be with the device. This helps ensure that the data at rest and the decryption key are protected by the storage encryption technology.	Only use information from the document to answer questions. At the end of each response include a list of all other documents referenced in the input document. If any URL's or contact information is included, make sure that information is listed at the end of the response. Input Document: 4.3 Protecting Data on Telework Client Devices Telework often involves creating and editing work-related information such as email, word processing documents, and spreadsheets. Because that data is important, it should be treated like other important assets of the organization. Two things an organization can do to protect data on telework devices are to secure it on the telework device and to periodically back it up to a location controlled by the organization. More information on this is provided in Sections 4.3.1 through 4.3.3. Organizations can also choose not to allow the organization’s information to be stored on telework devices, but to instead store it centrally at the organization. Sensitive information, such as certain types of personally identifiable information (PII) (e.g., personnel records, medical records, financial records), that is stored on or sent to or from telework devices should be protected so that malicious parties cannot access or alter it. For example, teleworkers often forget that 32 For more information on application whitelisting, see NIST SP 800-167, Guide to Application Whitelisting (http://dx.doi.org/10.6028/NIST.SP.800-167). NIST SP 800-46 REV. 2 GUIDE TO ENTERPRISE TELEWORK, REMOTE ACCESS, AND BYOD SECURITY 26 This publication is available free of charge from: http://dx.doi.org/10.6028/NIST.SP.800-46r2 storing sensitive information on a CD that is carried with their device, or printing the information on a public printer, can also expose the information in ways that are not significant within a typical enterprise environment. An unauthorized release of sensitive information could damage the public’s trust in an organization, jeopardize the organization’s mission, or harm individuals if their personal information has been released. 4.3.1 Encrypting Data at Rest All telework devices, regardless of their size or location, can be stolen. Some thieves may want to read the contents of the data on the device, and quite possibly use that data for criminal purposes. To prevent this, an organization should have a policy of encrypting all sensitive data when it is at rest on the device and on removable media used by the device. The creation and use of cryptographic keys for encrypting remote data at rest should follow the same policies that an organization has for other keys that protect data at rest.33 There are many methods for protecting data at rest, and they mostly depend on the type of device or removable media that is being protected. Most operating systems have their own data encryption mechanisms, and there are also numerous third-party applications that provide similar capabilities. 34 Generally, when technologies such as full disk encryption are being used to protect data at rest on PCs, teleworkers should shut down their telework devices instead of placing them into sleep mode when the devices will not be used for an extended time or when the teleworker will not be with the device. This helps ensure that the data at rest and the decryption key are protected by the storage encryption technology. User Input: Write two, roughly 200 word paragraphs listing at least four ways PII can be leaked.	Only use information from the document to answer questions. At the end of each response include a list of all other documents referenced in the input document. If any URL's or contact information is included, make sure that information is listed at the end of the response. EVIDENCE: 4.3 Protecting Data on Telework Client Devices Telework often involves creating and editing work-related information such as email, word processing documents, and spreadsheets. Because that data is important, it should be treated like other important assets of the organization. Two things an organization can do to protect data on telework devices are to secure it on the telework device and to periodically back it up to a location controlled by the organization. More information on this is provided in Sections 4.3.1 through 4.3.3. Organizations can also choose not to allow the organization’s information to be stored on telework devices, but to instead store it centrally at the organization. Sensitive information, such as certain types of personally identifiable information (PII) (e.g., personnel records, medical records, financial records), that is stored on or sent to or from telework devices should be protected so that malicious parties cannot access or alter it. For example, teleworkers often forget that 32 For more information on application whitelisting, see NIST SP 800-167, Guide to Application Whitelisting (http://dx.doi.org/10.6028/NIST.SP.800-167). NIST SP 800-46 REV. 2 GUIDE TO ENTERPRISE TELEWORK, REMOTE ACCESS, AND BYOD SECURITY 26 This publication is available free of charge from: http://dx.doi.org/10.6028/NIST.SP.800-46r2 storing sensitive information on a CD that is carried with their device, or printing the information on a public printer, can also expose the information in ways that are not significant within a typical enterprise environment. An unauthorized release of sensitive information could damage the public’s trust in an organization, jeopardize the organization’s mission, or harm individuals if their personal information has been released. 4.3.1 Encrypting Data at Rest All telework devices, regardless of their size or location, can be stolen. Some thieves may want to read the contents of the data on the device, and quite possibly use that data for criminal purposes. To prevent this, an organization should have a policy of encrypting all sensitive data when it is at rest on the device and on removable media used by the device. The creation and use of cryptographic keys for encrypting remote data at rest should follow the same policies that an organization has for other keys that protect data at rest.33 There are many methods for protecting data at rest, and they mostly depend on the type of device or removable media that is being protected. Most operating systems have their own data encryption mechanisms, and there are also numerous third-party applications that provide similar capabilities. 34 Generally, when technologies such as full disk encryption are being used to protect data at rest on PCs, teleworkers should shut down their telework devices instead of placing them into sleep mode when the devices will not be used for an extended time or when the teleworker will not be with the device. This helps ensure that the data at rest and the decryption key are protected by the storage encryption technology. USER: User Input: Write two, roughly 200 word paragraphs listing at least four ways PII can be leaked. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	true	47	17	477	null	207
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]	My aunt currently lives in Germany. She said they have so many protesters and they always interfere with regular public activities. I heard there was an issue with the German courts and the protestors. Can you tell me more about the situation? Specifically what happened and how the Germany courts responded? I believe it was something along the lines of they got sued. Give me more than 400 words.	Journalists file complaint with Germany constitutional court over phone wiretappingNewsMartin Kraft, CC BY-SA 3.0, via Wikimedia Commons Journalists file complaint with Germany constitutional court over phone wiretapping Salma Ben Mariem \| Faculty of Law and Political Science of Sousse, TN September 12, 2024 01:42:34 pm Three journalist organizations filed a complaint against German authorities with the country’s Federal Constitutional Court, local media reported on Wednesday. The complaint concerns investigators’ wiretapping of phone calls between journalists and climate activists. This constitutional complaint follows two previous verdicts issued by Munich’s District Court and Munich’s Regional Court. The three associations that filed the complaint are the Bavarian Journalists Association (BJV), Reporters Without Borders (RSF) and the Society for Civil Rights (GFF). They claimed that investigators illegally listened to phone conversations between journalists and members of the group the Last Generation (Letzte Generation). They argued that this measure constituted a violation of press freedom and a threat to democracy. The Last Generation is a group of climate activists who use direct action methods such as traffic blockades and vandalism of buildings, private boats and planes to protest against and raise awareness of climate change. According to a press release published by the GFF, the Munich prosecutor’s office surveilled the phone line provided by the Last Generation to receive journalist inquiries. The surveillance lasted for months and affected 171 journalists who were not informed by authorities of this investigative measure. Consequently, the three journalist’s associations filed a first complaint to Munich’s District Court which ruled that the surveillance measure was lawful. The associations filed a second complaint to Munich’s Regional Court which saw the wiretapping of phone calls as “a profound interference with press freedom.” However, the court considered that the surveillance measure was “proportionate” and rejected the complaint because of an ongoing investigation at the time against seven Last Generation activists over suspicion of supporting a criminal organization. This accusation was denied by the environmental group. The Chairman of the BJV Harald Stocker criticized both rulings and stated in a press release that before approving a wiretapping operation, judges needed to weigh up the interference with press freedom. He explained, “If judges authorize the recording of confidential conversations with journalists, they must first exhaust other options and carefully examine and justify the benefits.” He also added, regarding the Regional Court’s verdict, that it wasn’t sufficient to recognize several months later that the wiretapping operation constituted an interference with press freedom and at the same time uphold the measure as lawful. Furthermore, the BJV Managing Director Dennis Amour described the surveillance of journalists’ phone conversations as a “disproportionate” measure that the courts shouldn’t use to circumvent the protection of reporters bound by professional secrecy. By raising this complaint, the concerned journalists want to ensure that in the future, all courts carefully consider the impact on press freedom and provide a documented assessment of alternatives before approving any surveillance measures. As environmental protests escalated in many European countries, a July Human Rights Watch report revealed that governments have also intensified suppressive measures to quell activists’ dissent.	<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> My aunt currently lives in Germany. She said they have so many protesters and they always interfere with regular public activities. I heard there was an issue with the German courts and the protestors. Can you tell me more about the situation? Specifically what happened and how the Germany courts responded? I believe it was something along the lines of they got sued. Give me more than 400 words. <TEXT> Journalists file complaint with Germany constitutional court over phone wiretappingNewsMartin Kraft, CC BY-SA 3.0, via Wikimedia Commons Journalists file complaint with Germany constitutional court over phone wiretapping Salma Ben Mariem \| Faculty of Law and Political Science of Sousse, TN September 12, 2024 01:42:34 pm Three journalist organizations filed a complaint against German authorities with the country’s Federal Constitutional Court, local media reported on Wednesday. The complaint concerns investigators’ wiretapping of phone calls between journalists and climate activists. This constitutional complaint follows two previous verdicts issued by Munich’s District Court and Munich’s Regional Court. The three associations that filed the complaint are the Bavarian Journalists Association (BJV), Reporters Without Borders (RSF) and the Society for Civil Rights (GFF). They claimed that investigators illegally listened to phone conversations between journalists and members of the group the Last Generation (Letzte Generation). They argued that this measure constituted a violation of press freedom and a threat to democracy. The Last Generation is a group of climate activists who use direct action methods such as traffic blockades and vandalism of buildings, private boats and planes to protest against and raise awareness of climate change. According to a press release published by the GFF, the Munich prosecutor’s office surveilled the phone line provided by the Last Generation to receive journalist inquiries. The surveillance lasted for months and affected 171 journalists who were not informed by authorities of this investigative measure. Consequently, the three journalist’s associations filed a first complaint to Munich’s District Court which ruled that the surveillance measure was lawful. The associations filed a second complaint to Munich’s Regional Court which saw the wiretapping of phone calls as “a profound interference with press freedom.” However, the court considered that the surveillance measure was “proportionate” and rejected the complaint because of an ongoing investigation at the time against seven Last Generation activists over suspicion of supporting a criminal organization. This accusation was denied by the environmental group. The Chairman of the BJV Harald Stocker criticized both rulings and stated in a press release that before approving a wiretapping operation, judges needed to weigh up the interference with press freedom. He explained, “If judges authorize the recording of confidential conversations with journalists, they must first exhaust other options and carefully examine and justify the benefits.” He also added, regarding the Regional Court’s verdict, that it wasn’t sufficient to recognize several months later that the wiretapping operation constituted an interference with press freedom and at the same time uphold the measure as lawful. Furthermore, the BJV Managing Director Dennis Amour described the surveillance of journalists’ phone conversations as a “disproportionate” measure that the courts shouldn’t use to circumvent the protection of reporters bound by professional secrecy. By raising this complaint, the concerned journalists want to ensure that in the future, all courts carefully consider the impact on press freedom and provide a documented assessment of alternatives before approving any surveillance measures. As environmental protests escalated in many European countries, a July Human Rights Watch report revealed that governments have also intensified suppressive measures to quell activists’ dissent. https://www.jurist.org/news/2024/09/journalists-file-complaint-with-germany-constitutional-court-over-phone-wiretapping/	<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document] EVIDENCE: Journalists file complaint with Germany constitutional court over phone wiretappingNewsMartin Kraft, CC BY-SA 3.0, via Wikimedia Commons Journalists file complaint with Germany constitutional court over phone wiretapping Salma Ben Mariem \| Faculty of Law and Political Science of Sousse, TN September 12, 2024 01:42:34 pm Three journalist organizations filed a complaint against German authorities with the country’s Federal Constitutional Court, local media reported on Wednesday. The complaint concerns investigators’ wiretapping of phone calls between journalists and climate activists. This constitutional complaint follows two previous verdicts issued by Munich’s District Court and Munich’s Regional Court. The three associations that filed the complaint are the Bavarian Journalists Association (BJV), Reporters Without Borders (RSF) and the Society for Civil Rights (GFF). They claimed that investigators illegally listened to phone conversations between journalists and members of the group the Last Generation (Letzte Generation). They argued that this measure constituted a violation of press freedom and a threat to democracy. The Last Generation is a group of climate activists who use direct action methods such as traffic blockades and vandalism of buildings, private boats and planes to protest against and raise awareness of climate change. According to a press release published by the GFF, the Munich prosecutor’s office surveilled the phone line provided by the Last Generation to receive journalist inquiries. The surveillance lasted for months and affected 171 journalists who were not informed by authorities of this investigative measure. Consequently, the three journalist’s associations filed a first complaint to Munich’s District Court which ruled that the surveillance measure was lawful. The associations filed a second complaint to Munich’s Regional Court which saw the wiretapping of phone calls as “a profound interference with press freedom.” However, the court considered that the surveillance measure was “proportionate” and rejected the complaint because of an ongoing investigation at the time against seven Last Generation activists over suspicion of supporting a criminal organization. This accusation was denied by the environmental group. The Chairman of the BJV Harald Stocker criticized both rulings and stated in a press release that before approving a wiretapping operation, judges needed to weigh up the interference with press freedom. He explained, “If judges authorize the recording of confidential conversations with journalists, they must first exhaust other options and carefully examine and justify the benefits.” He also added, regarding the Regional Court’s verdict, that it wasn’t sufficient to recognize several months later that the wiretapping operation constituted an interference with press freedom and at the same time uphold the measure as lawful. Furthermore, the BJV Managing Director Dennis Amour described the surveillance of journalists’ phone conversations as a “disproportionate” measure that the courts shouldn’t use to circumvent the protection of reporters bound by professional secrecy. By raising this complaint, the concerned journalists want to ensure that in the future, all courts carefully consider the impact on press freedom and provide a documented assessment of alternatives before approving any surveillance measures. As environmental protests escalated in many European countries, a July Human Rights Watch report revealed that governments have also intensified suppressive measures to quell activists’ dissent. USER: My aunt currently lives in Germany. She said they have so many protesters and they always interfere with regular public activities. I heard there was an issue with the German courts and the protestors. Can you tell me more about the situation? Specifically what happened and how the Germany courts responded? I believe it was something along the lines of they got sued. Give me more than 400 words. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	20	69	510	null	606
Use the source provided only.	Who should not get the vaccine, and what other common products should these people be careful of?	Number 124a October 2023 COVID-19 mRNA vaccines Immunization has saved more lives in Canada in the Getting all of the recommended doses of vaccine is last 50 years than any other health measure. your best protection against COVID-19. It is important to keep a record of all immunizations What are COVID-19 mRNA vaccines? received. The COVID-19 mRNA vaccines (Moderna and Pfizer- BioNTech) protect against infection from the severe What are the benefits of the vaccines? acute respiratory syndrome coronavirus 2 (SARS-CoV- Immunization is the best way to protect you against 2) that causes COVID-19. The vaccines cause your COVID-19, which is a serious and sometimes fatal body to produce antibodies that will help protect you disease. The vaccines provide strong protection from getting sick if exposed to the virus. The vaccines against severe COVID-19 illness, including are approved by Health Canada. hospitalization and death. The COVID-19 mRNA vaccines provide better protection than other COVID- Who should get the vaccines? 19 vaccines. When you get immunized, you help The vaccines are recommended for those 6 months of protect others as well, including those who are unable age and older. The vaccines are especially important to get the vaccine. for those at increased risk of infection or severe disease, including: What are the possible reactions after the  People 65 years of age and older vaccines?  Residents of long-term care facilities Vaccines are very safe. It is much safer to get the  People with underlying medical conditions vaccine than to get COVID-19. The vaccines are not live virus vaccines and cannot give you COVID-19.  Pregnant people Common reactions to the vaccines may include  Healthcare workers soreness, redness, swelling and itchiness where the  First responders (police, firefighters, ambulance vaccine was given. For some people, these reactions attendants) may show up 8 or more days after getting the Indigenous peoples may be at increased risk of vaccine. Other reactions may include tiredness, serious illness from COVID-19 due to health inequities headache, fever, chills, muscle or joint soreness, resulting from colonialism. swollen lymph nodes under the armpit, nausea and vomiting. Babies and young children may be irritable, More information, including how to register for the sleepy and have a decreased appetite. These vaccine, can be found on the Government of British reactions are mild and generally last 1 to 2 days. If Columbia’s website: you have concerns about any symptoms you develop www2.gov.bc.ca/gov/content/covid- after receiving the vaccine, speak with your health 19/vaccine/register. care provider or call 8-1-1 for advice. If you had, or may have had, COVID-19 you should Rare cases of inflammation of the heart (myocarditis still get the vaccine. This is because you may not be and pericarditis) have been reported after getting the immune to the virus and/or variants of the virus that COVID-19 mRNA vaccines. These were most often causes COVID-19 and could get infected and sick seen: again.  After a second dose of the vaccine when the time How are the vaccines given? between doses was less than 8 weeks The vaccines are given by injection. People 5 years of  In males 12-29 years of age age and older should get 1 dose. Children 6 months to 4 years of age and people with weakened immune systems may need more than 1 dose depending on their immunization history.  With a higher dose of the Moderna vaccine vaccine or if you have had anaphylaxis with an unknown cause. Acetaminophen (e.g. Tylenol®) or ibuprofen (e.g. Are there additional considerations to getting Advil®) can be taken for fever or soreness. ASA the vaccine? (e.g. Aspirin®) should not be given to anyone Speak with your health care provider if you: under 18 years of age due to the risk of Reye  Were diagnosed with inflammation of the heart syndrome. (myocarditis or pericarditis) by a physician after a *Ibuprofen should not be given to children under 6 previous dose of COVID-19 vaccine without another months of age without first speaking to your health cause being identified care provider.  Have a history of multisystem inflammatory For information on Reye syndrome, see HealthLinkBC syndrome following COVID-19 File #84 Reye syndrome.  Have symptoms of COVID-19 It is important to stay in the clinic for 15 minutes after If you have a new illness preventing you from your getting any vaccine. There is an extremely rare regular activities, you should wait until you have possibility of a life-threatening allergic reaction called recovered. This will help to distinguish side effects of anaphylaxis. This happens in less than 1 in a million the vaccine from worsening of your illness. people who get the vaccine. Symptoms may include hives, difficulty breathing, or swelling of the throat, What is COVID-19? tongue or lips. If this reaction occurs, your health care COVID-19 is an infection of the airways and lungs provider is prepared to treat it. Emergency treatment caused by the SARS-CoV-2 coronavirus. Symptoms of includes administration of epinephrine (adrenaline) COVID-19 can include cough, shortness of breath, and transfer by ambulance to the nearest emergency fever, chills, tiredness and loss of smell or taste. While department. If symptoms develop after you leave the some people with COVID-19 may have no symptoms clinic, call 9-1-1 or your local emergency number. or only mild symptoms, others can require Always report serious or unexpected reactions to your hospitalization and may die. Serious illness is more health care provider. common in those who are older and those with After getting the COVID-19 mRNA vaccine, you might certain chronic health conditions such as diabetes, be contacted to participate in a study monitoring the heart disease or lung disease. For some people, safety of the vaccine. To learn more about the study symptoms of COVID-19 can last for weeks or longer. please visit https://canvas-network.ca. The long-term effects of COVID-19 on a person’s health are unknown. Who should not get the vaccine? You should not get the vaccine if you have a serious How is COVID-19 spread? allergy (anaphylaxis) to polyethylene glycol (PEG) The virus that causes COVID-19 is spread from person which is in both of the COVID-19 mRNA vaccines. PEG to person by coughing, sneezing, talking and singing. can be found in some cosmetics, skin care products, It can also be spread by touching an object or surface laxatives, cough syrups, and bowel preparation with the virus on it and then touching your eyes, nose products for colonoscopy. PEG can be an additive in or mouth. some processed foods and drinks, but no cases of For more information on COVID-19 vaccines, visit anaphylaxis to PEG in foods and drinks have been BCCDC’s COVID-19 vaccine page reported. www.bccdc.ca/health-info/diseases-conditions/covid- Speak with your health care provider if you had 19/covid-19-vaccine. anaphylaxis after a previous dose of a COVID-19 For more HealthLinkBC File topics, visit www.HealthLinkBC.ca/more/resources/healthlink-bc-files or your local public health unit. For non-emergency health information and advice in B.C. visit www.HealthLinkBC.ca or call 8- 1-1 (toll-free). For the deaf and hard of hearing, call 7-1-1. Translation services are available in more than 130 languages on request.	Use the source provided only. Who should not get the vaccine, and what other common products should these people be careful of? Number 124a October 2023 COVID-19 mRNA vaccines Immunization has saved more lives in Canada in the Getting all of the recommended doses of vaccine is last 50 years than any other health measure. your best protection against COVID-19. It is important to keep a record of all immunizations What are COVID-19 mRNA vaccines? received. The COVID-19 mRNA vaccines (Moderna and Pfizer- BioNTech) protect against infection from the severe What are the benefits of the vaccines? acute respiratory syndrome coronavirus 2 (SARS-CoV- Immunization is the best way to protect you against 2) that causes COVID-19. The vaccines cause your COVID-19, which is a serious and sometimes fatal body to produce antibodies that will help protect you disease. The vaccines provide strong protection from getting sick if exposed to the virus. The vaccines against severe COVID-19 illness, including are approved by Health Canada. hospitalization and death. The COVID-19 mRNA vaccines provide better protection than other COVID- Who should get the vaccines? 19 vaccines. When you get immunized, you help The vaccines are recommended for those 6 months of protect others as well, including those who are unable age and older. The vaccines are especially important to get the vaccine. for those at increased risk of infection or severe disease, including: What are the possible reactions after the  People 65 years of age and older vaccines?  Residents of long-term care facilities Vaccines are very safe. It is much safer to get the  People with underlying medical conditions vaccine than to get COVID-19. The vaccines are not live virus vaccines and cannot give you COVID-19.  Pregnant people Common reactions to the vaccines may include  Healthcare workers soreness, redness, swelling and itchiness where the  First responders (police, firefighters, ambulance vaccine was given. For some people, these reactions attendants) may show up 8 or more days after getting the Indigenous peoples may be at increased risk of vaccine. Other reactions may include tiredness, serious illness from COVID-19 due to health inequities headache, fever, chills, muscle or joint soreness, resulting from colonialism. swollen lymph nodes under the armpit, nausea and vomiting. Babies and young children may be irritable, More information, including how to register for the sleepy and have a decreased appetite. These vaccine, can be found on the Government of British reactions are mild and generally last 1 to 2 days. If Columbia’s website: you have concerns about any symptoms you develop www2.gov.bc.ca/gov/content/covid- after receiving the vaccine, speak with your health 19/vaccine/register. care provider or call 8-1-1 for advice. If you had, or may have had, COVID-19 you should Rare cases of inflammation of the heart (myocarditis still get the vaccine. This is because you may not be and pericarditis) have been reported after getting the immune to the virus and/or variants of the virus that COVID-19 mRNA vaccines. These were most often causes COVID-19 and could get infected and sick seen: again.  After a second dose of the vaccine when the time How are the vaccines given? between doses was less than 8 weeks The vaccines are given by injection. People 5 years of  In males 12-29 years of age age and older should get 1 dose. Children 6 months to 4 years of age and people with weakened immune systems may need more than 1 dose depending on their immunization history.  With a higher dose of the Moderna vaccine vaccine or if you have had anaphylaxis with an unknown cause. Acetaminophen (e.g. Tylenol®) or ibuprofen (e.g. Are there additional considerations to getting Advil®) can be taken for fever or soreness. ASA the vaccine? (e.g. Aspirin®) should not be given to anyone Speak with your health care provider if you: under 18 years of age due to the risk of Reye  Were diagnosed with inflammation of the heart syndrome. (myocarditis or pericarditis) by a physician after a *Ibuprofen should not be given to children under 6 previous dose of COVID-19 vaccine without another months of age without first speaking to your health cause being identified care provider.  Have a history of multisystem inflammatory For information on Reye syndrome, see HealthLinkBC syndrome following COVID-19 File #84 Reye syndrome.  Have symptoms of COVID-19 It is important to stay in the clinic for 15 minutes after If you have a new illness preventing you from your getting any vaccine. There is an extremely rare regular activities, you should wait until you have possibility of a life-threatening allergic reaction called recovered. This will help to distinguish side effects of anaphylaxis. This happens in less than 1 in a million the vaccine from worsening of your illness. people who get the vaccine. Symptoms may include hives, difficulty breathing, or swelling of the throat, What is COVID-19? tongue or lips. If this reaction occurs, your health care COVID-19 is an infection of the airways and lungs provider is prepared to treat it. Emergency treatment caused by the SARS-CoV-2 coronavirus. Symptoms of includes administration of epinephrine (adrenaline) COVID-19 can include cough, shortness of breath, and transfer by ambulance to the nearest emergency fever, chills, tiredness and loss of smell or taste. While department. If symptoms develop after you leave the some people with COVID-19 may have no symptoms clinic, call 9-1-1 or your local emergency number. or only mild symptoms, others can require Always report serious or unexpected reactions to your hospitalization and may die. Serious illness is more health care provider. common in those who are older and those with After getting the COVID-19 mRNA vaccine, you might certain chronic health conditions such as diabetes, be contacted to participate in a study monitoring the heart disease or lung disease. For some people, safety of the vaccine. To learn more about the study symptoms of COVID-19 can last for weeks or longer. please visit https://canvas-network.ca. The long-term effects of COVID-19 on a person’s health are unknown. Who should not get the vaccine? You should not get the vaccine if you have a serious How is COVID-19 spread? allergy (anaphylaxis) to polyethylene glycol (PEG) The virus that causes COVID-19 is spread from person which is in both of the COVID-19 mRNA vaccines. PEG to person by coughing, sneezing, talking and singing. can be found in some cosmetics, skin care products, It can also be spread by touching an object or surface laxatives, cough syrups, and bowel preparation with the virus on it and then touching your eyes, nose products for colonoscopy. PEG can be an additive in or mouth. some processed foods and drinks, but no cases of For more information on COVID-19 vaccines, visit anaphylaxis to PEG in foods and drinks have been BCCDC’s COVID-19 vaccine page reported. www.bccdc.ca/health-info/diseases-conditions/covid- Speak with your health care provider if you had 19/covid-19-vaccine. anaphylaxis after a previous dose of a COVID-19 For more HealthLinkBC File topics, visit www.HealthLinkBC.ca/more/resources/healthlink-bc-files or your local public health unit. For non-emergency health information and advice in B.C. visit www.HealthLinkBC.ca or call 8- 1-1 (toll-free). For the deaf and hard of hearing, call 7-1-1. Translation services are available in more than 130 languages on request.	Use the source provided only. EVIDENCE: Number 124a October 2023 COVID-19 mRNA vaccines Immunization has saved more lives in Canada in the Getting all of the recommended doses of vaccine is last 50 years than any other health measure. your best protection against COVID-19. It is important to keep a record of all immunizations What are COVID-19 mRNA vaccines? received. The COVID-19 mRNA vaccines (Moderna and Pfizer- BioNTech) protect against infection from the severe What are the benefits of the vaccines? acute respiratory syndrome coronavirus 2 (SARS-CoV- Immunization is the best way to protect you against 2) that causes COVID-19. The vaccines cause your COVID-19, which is a serious and sometimes fatal body to produce antibodies that will help protect you disease. The vaccines provide strong protection from getting sick if exposed to the virus. The vaccines against severe COVID-19 illness, including are approved by Health Canada. hospitalization and death. The COVID-19 mRNA vaccines provide better protection than other COVID- Who should get the vaccines? 19 vaccines. When you get immunized, you help The vaccines are recommended for those 6 months of protect others as well, including those who are unable age and older. The vaccines are especially important to get the vaccine. for those at increased risk of infection or severe disease, including: What are the possible reactions after the  People 65 years of age and older vaccines?  Residents of long-term care facilities Vaccines are very safe. It is much safer to get the  People with underlying medical conditions vaccine than to get COVID-19. The vaccines are not live virus vaccines and cannot give you COVID-19.  Pregnant people Common reactions to the vaccines may include  Healthcare workers soreness, redness, swelling and itchiness where the  First responders (police, firefighters, ambulance vaccine was given. For some people, these reactions attendants) may show up 8 or more days after getting the Indigenous peoples may be at increased risk of vaccine. Other reactions may include tiredness, serious illness from COVID-19 due to health inequities headache, fever, chills, muscle or joint soreness, resulting from colonialism. swollen lymph nodes under the armpit, nausea and vomiting. Babies and young children may be irritable, More information, including how to register for the sleepy and have a decreased appetite. These vaccine, can be found on the Government of British reactions are mild and generally last 1 to 2 days. If Columbia’s website: you have concerns about any symptoms you develop www2.gov.bc.ca/gov/content/covid- after receiving the vaccine, speak with your health 19/vaccine/register. care provider or call 8-1-1 for advice. If you had, or may have had, COVID-19 you should Rare cases of inflammation of the heart (myocarditis still get the vaccine. This is because you may not be and pericarditis) have been reported after getting the immune to the virus and/or variants of the virus that COVID-19 mRNA vaccines. These were most often causes COVID-19 and could get infected and sick seen: again.  After a second dose of the vaccine when the time How are the vaccines given? between doses was less than 8 weeks The vaccines are given by injection. People 5 years of  In males 12-29 years of age age and older should get 1 dose. Children 6 months to 4 years of age and people with weakened immune systems may need more than 1 dose depending on their immunization history.  With a higher dose of the Moderna vaccine vaccine or if you have had anaphylaxis with an unknown cause. Acetaminophen (e.g. Tylenol®) or ibuprofen (e.g. Are there additional considerations to getting Advil®) can be taken for fever or soreness. ASA the vaccine? (e.g. Aspirin®) should not be given to anyone Speak with your health care provider if you: under 18 years of age due to the risk of Reye  Were diagnosed with inflammation of the heart syndrome. (myocarditis or pericarditis) by a physician after a Ibuprofen should not be given to children under 6 previous dose of COVID-19 vaccine without another months of age without first speaking to your health cause being identified care provider.  Have a history of multisystem inflammatory For information on Reye syndrome, see HealthLinkBC syndrome following COVID-19 File #84 Reye syndrome.  Have symptoms of COVID-19 It is important to stay in the clinic for 15 minutes after If you have a new illness preventing you from your getting any vaccine. There is an extremely rare regular activities, you should wait until you have possibility of a life-threatening allergic reaction called recovered. This will help to distinguish side effects of anaphylaxis. This happens in less than 1 in a million the vaccine from worsening of your illness. people who get the vaccine. Symptoms may include hives, difficulty breathing, or swelling of the throat, What is COVID-19? tongue or lips. If this reaction occurs, your health care COVID-19 is an infection of the airways and lungs provider is prepared to treat it. Emergency treatment caused by the SARS-CoV-2 coronavirus. Symptoms of includes administration of epinephrine (adrenaline) COVID-19 can include cough, shortness of breath, and transfer by ambulance to the nearest emergency fever, chills, tiredness and loss of smell or taste. While department. If symptoms develop after you leave the some people with COVID-19 may have no symptoms clinic, call 9-1-1 or your local emergency number. or only mild symptoms, others can require Always report serious or unexpected reactions to your hospitalization and may die. Serious illness is more health care provider. common in those who are older and those with After getting the COVID-19 mRNA vaccine, you might certain chronic health conditions such as diabetes, be contacted to participate in a study monitoring the heart disease or lung disease. For some people, safety of the vaccine. To learn more about the study symptoms of COVID-19 can last for weeks or longer. please visit https://canvas-network.ca. The long-term effects of COVID-19 on a person’s health are unknown. Who should not get the vaccine? You should not get the vaccine if you have a serious How is COVID-19 spread? allergy (anaphylaxis) to polyethylene glycol (PEG) The virus that causes COVID-19 is spread from person which is in both of the COVID-19 mRNA vaccines. PEG to person by coughing, sneezing, talking and singing. can be found in some cosmetics, skin care products, It can also be spread by touching an object or surface laxatives, cough syrups, and bowel preparation with the virus on it and then touching your eyes, nose products for colonoscopy. PEG can be an additive in or mouth. some processed foods and drinks, but no cases of For more information on COVID-19 vaccines, visit anaphylaxis to PEG in foods and drinks have been BCCDC’s COVID-19 vaccine page reported. www.bccdc.ca/health-info/diseases-conditions/covid- Speak with your health care provider if you had 19/covid-19-vaccine. anaphylaxis after a previous dose of a COVID-19 For more HealthLinkBC File topics, visit www.HealthLinkBC.ca/more/resources/healthlink-bc-files or your local public health unit. For non-emergency health information and advice in B.C. visit www.HealthLinkBC.ca or call 8- 1-1 (toll-free). For the deaf and hard of hearing, call 7-1-1. Translation services are available in more than 130 languages on request. USER: Who should not get the vaccine, and what other common products should these people be careful of? Assistant: Answer only* using the evidence. If unknown, say you cannot answer. Cite sources.	true	5	17	1,175	null	112
The document should be the only source used to answer the question.	Does chewing gum cause tooth decay?	Oral Effects of Chewing Gum Chewing gum after a meal can increase salivary flow by stimulating both mechanical and taste receptors in the mouth. The average unstimulated salivary flow rate for healthy people is 0.3-0.4 mL/min.6 The physical act of chewing stimulates salivary flow: simply chewing unsweetened, unflavored chewing gum base stimulates the salivary flow rate by 10-12 times that of the unstimulated rate.7 Flavors also act as salivary stimulants.6 The stimulated salivary flow rate is significantly greater while chewing sweetened and flavored gum as opposed to unsweetened, unflavored chewing gum base.7, 8 Increasing saliva volume helps to dilute and neutralize acids produced by the bacteria in plaque on teeth. Over time, these acids can damage tooth enamel, potentially resulting in decay. There are several mechanisms by which stimulated saliva flow may protect against dental caries. Increased saliva flow carries with it calcium and phosphate ions, which can contribute to remineralization of tooth enamel; the presence of fluoride in the saliva can serve to replace enamel components magnesium and carbonate with the stronger, more caries-resistant fluorapatite crystals.9 Saliva can buffer the effects of acids in foods or drinks that could otherwise soften teeth’s enamel surface, and swallowing excess saliva created by stimulation clears acid.8 While unstimulated saliva does not have a strong buffering capacity against acid, stimulated saliva has higher concentrations of protein, sodium, calcium, chloride, and bicarbonate increasing its buffering capacity.6 Additionally, saliva contributes proteins to dental surfaces, creating an acquired enamel pellicle that protects against dental erosion.6, 8 Sugar-containing Chewing Gum Monosaccharides and disaccharides may be used in sugar-containing chewing gum. These fermentable carbohydrates can be metabolized by oral bacteria. The bacteria (particularly S. mutans and Lactobacillus spp.) in turn produce dental biofilm and acid, which can lead to enamel demineralization and caries.10 The potential cariogenicity of sugar-containing gum depends on the physical consistency, oral retention time of the gum, the frequency with which it is chewed, and the sequence of consumption (for instance, chewing sugar-containing gum before eating foods that reduce acid production will be less cariogenic than the reverse).10 Sugar-free Chewing Gum As defined by the Food and Drug Administration (FDA) in the Code of Federal Regulations (CFR) a food or food substance such as chewing gum, can be labeled as “sugar-free” if it contains less than 0.5 g of sugars per serving.11 In place of sugar, these gums use high-intensity sweeteners such as aspartame, acesulfame-K, neotame, saccharin, sucralose or stevia.12 They also may be sweetened with sugar alcohols such as erythritol, isomalt, maltitol, mannitol, sorbitol, or xylitol.12 These high-intensity sweeteners, with the exception of aspartame, are considered non-nutritive and contain fewer calories than sugar, but the FDA categorizes aspartame, as well as the aforementioned sugar alcohols, to be nutritive sweeteners, since they contain more than 2% of the calories in an equivalent amount of sugar.13 Clinical trials have found decreased caries incidence in subjects who chewed sugar-free gum for 20 minutes after meals.14, 15 Unlike sugar, these sweeteners are noncariogenic, since they are metabolized slowly or not at all by cariogenic plaque bacteria.16 A 2021 systematic review and meta-analysis by Nasseripour et al.17 examined the use of sugar-free gum sweetened with xylitol and reported that the use of sugar-free chewing gum resulted in a statistically significant reduction in the S. mutans load. The authors reported an effect size of -0.42 (95% CI: -0.60 to -0.25), which is suggestive of its benefit as an adjunct to recommended home oral hygiene.	{QUERY} ========== Does chewing gum cause tooth decay? {SYSTEM INSTRUCTION} ========== The document should be the only source used to answer the question. {PASSAGE} ========== Oral Effects of Chewing Gum Chewing gum after a meal can increase salivary flow by stimulating both mechanical and taste receptors in the mouth. The average unstimulated salivary flow rate for healthy people is 0.3-0.4 mL/min.6 The physical act of chewing stimulates salivary flow: simply chewing unsweetened, unflavored chewing gum base stimulates the salivary flow rate by 10-12 times that of the unstimulated rate.7 Flavors also act as salivary stimulants.6 The stimulated salivary flow rate is significantly greater while chewing sweetened and flavored gum as opposed to unsweetened, unflavored chewing gum base.7, 8 Increasing saliva volume helps to dilute and neutralize acids produced by the bacteria in plaque on teeth. Over time, these acids can damage tooth enamel, potentially resulting in decay. There are several mechanisms by which stimulated saliva flow may protect against dental caries. Increased saliva flow carries with it calcium and phosphate ions, which can contribute to remineralization of tooth enamel; the presence of fluoride in the saliva can serve to replace enamel components magnesium and carbonate with the stronger, more caries-resistant fluorapatite crystals.9 Saliva can buffer the effects of acids in foods or drinks that could otherwise soften teeth’s enamel surface, and swallowing excess saliva created by stimulation clears acid.8 While unstimulated saliva does not have a strong buffering capacity against acid, stimulated saliva has higher concentrations of protein, sodium, calcium, chloride, and bicarbonate increasing its buffering capacity.6 Additionally, saliva contributes proteins to dental surfaces, creating an acquired enamel pellicle that protects against dental erosion.6, 8 Sugar-containing Chewing Gum Monosaccharides and disaccharides may be used in sugar-containing chewing gum. These fermentable carbohydrates can be metabolized by oral bacteria. The bacteria (particularly S. mutans and Lactobacillus spp.) in turn produce dental biofilm and acid, which can lead to enamel demineralization and caries.10 The potential cariogenicity of sugar-containing gum depends on the physical consistency, oral retention time of the gum, the frequency with which it is chewed, and the sequence of consumption (for instance, chewing sugar-containing gum before eating foods that reduce acid production will be less cariogenic than the reverse).10 Sugar-free Chewing Gum As defined by the Food and Drug Administration (FDA) in the Code of Federal Regulations (CFR) a food or food substance such as chewing gum, can be labeled as “sugar-free” if it contains less than 0.5 g of sugars per serving.11 In place of sugar, these gums use high-intensity sweeteners such as aspartame, acesulfame-K, neotame, saccharin, sucralose or stevia.12 They also may be sweetened with sugar alcohols such as erythritol, isomalt, maltitol, mannitol, sorbitol, or xylitol.12 These high-intensity sweeteners, with the exception of aspartame, are considered non-nutritive and contain fewer calories than sugar, but the FDA categorizes aspartame, as well as the aforementioned sugar alcohols, to be nutritive sweeteners, since they contain more than 2% of the calories in an equivalent amount of sugar.13 Clinical trials have found decreased caries incidence in subjects who chewed sugar-free gum for 20 minutes after meals.14, 15 Unlike sugar, these sweeteners are noncariogenic, since they are metabolized slowly or not at all by cariogenic plaque bacteria.16 A 2021 systematic review and meta-analysis by Nasseripour et al.17 examined the use of sugar-free gum sweetened with xylitol and reported that the use of sugar-free chewing gum resulted in a statistically significant reduction in the S. mutans load. The authors reported an effect size of -0.42 (95% CI: -0.60 to -0.25), which is suggestive of its benefit as an adjunct to recommended home oral hygiene.	The document should be the only source used to answer the question. EVIDENCE: Oral Effects of Chewing Gum Chewing gum after a meal can increase salivary flow by stimulating both mechanical and taste receptors in the mouth. The average unstimulated salivary flow rate for healthy people is 0.3-0.4 mL/min.6 The physical act of chewing stimulates salivary flow: simply chewing unsweetened, unflavored chewing gum base stimulates the salivary flow rate by 10-12 times that of the unstimulated rate.7 Flavors also act as salivary stimulants.6 The stimulated salivary flow rate is significantly greater while chewing sweetened and flavored gum as opposed to unsweetened, unflavored chewing gum base.7, 8 Increasing saliva volume helps to dilute and neutralize acids produced by the bacteria in plaque on teeth. Over time, these acids can damage tooth enamel, potentially resulting in decay. There are several mechanisms by which stimulated saliva flow may protect against dental caries. Increased saliva flow carries with it calcium and phosphate ions, which can contribute to remineralization of tooth enamel; the presence of fluoride in the saliva can serve to replace enamel components magnesium and carbonate with the stronger, more caries-resistant fluorapatite crystals.9 Saliva can buffer the effects of acids in foods or drinks that could otherwise soften teeth’s enamel surface, and swallowing excess saliva created by stimulation clears acid.8 While unstimulated saliva does not have a strong buffering capacity against acid, stimulated saliva has higher concentrations of protein, sodium, calcium, chloride, and bicarbonate increasing its buffering capacity.6 Additionally, saliva contributes proteins to dental surfaces, creating an acquired enamel pellicle that protects against dental erosion.6, 8 Sugar-containing Chewing Gum Monosaccharides and disaccharides may be used in sugar-containing chewing gum. These fermentable carbohydrates can be metabolized by oral bacteria. The bacteria (particularly S. mutans and Lactobacillus spp.) in turn produce dental biofilm and acid, which can lead to enamel demineralization and caries.10 The potential cariogenicity of sugar-containing gum depends on the physical consistency, oral retention time of the gum, the frequency with which it is chewed, and the sequence of consumption (for instance, chewing sugar-containing gum before eating foods that reduce acid production will be less cariogenic than the reverse).10 Sugar-free Chewing Gum As defined by the Food and Drug Administration (FDA) in the Code of Federal Regulations (CFR) a food or food substance such as chewing gum, can be labeled as “sugar-free” if it contains less than 0.5 g of sugars per serving.11 In place of sugar, these gums use high-intensity sweeteners such as aspartame, acesulfame-K, neotame, saccharin, sucralose or stevia.12 They also may be sweetened with sugar alcohols such as erythritol, isomalt, maltitol, mannitol, sorbitol, or xylitol.12 These high-intensity sweeteners, with the exception of aspartame, are considered non-nutritive and contain fewer calories than sugar, but the FDA categorizes aspartame, as well as the aforementioned sugar alcohols, to be nutritive sweeteners, since they contain more than 2% of the calories in an equivalent amount of sugar.13 Clinical trials have found decreased caries incidence in subjects who chewed sugar-free gum for 20 minutes after meals.14, 15 Unlike sugar, these sweeteners are noncariogenic, since they are metabolized slowly or not at all by cariogenic plaque bacteria.16 A 2021 systematic review and meta-analysis by Nasseripour et al.17 examined the use of sugar-free gum sweetened with xylitol and reported that the use of sugar-free chewing gum resulted in a statistically significant reduction in the S. mutans load. The authors reported an effect size of -0.42 (95% CI: -0.60 to -0.25), which is suggestive of its benefit as an adjunct to recommended home oral hygiene. USER: Does chewing gum cause tooth decay? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	12	6	574	null	507
Using only the information contained in the prompt/context block below, (do not use any external resources or prior knowledge), answer the following question.	Compare/contrast two organic fertilizers: seaweed extract and fish emulsion, how are they the same/different from each other?	Plant by-products: Alfalfa Meal or Pellets Alfalfa meal or pellets are often used as animal feed. Primarily they are used to increase organic matter in the soil but do provide nutrients and a high availability of trace minerals. They contain trianconatol, a natural fatty acid growth stimulant. Corn Gluten meal Corn Gluten products have a high percentage of nitrogen. It carries a warning to allow 1 to 4 months of decomposition in the soil prior to seeding. Allelopathic properties will inhibit the germination of seeds. However, there is no danger to established or transplanted plants. This product is also marketed as a pre-emergent weed control for annual grasses in bluegrass lawns. Cottonseed meal In warm soils this fertilizer is readily available with little danger of over-fertilizing. Use for acid-loving plants such as rhododendrons, blueberries and azaleas. Seaweed extract Seaweed is a good source of trace metals, micronutrients, amino acids and vitamins plus growth hormones that stimulate plant cell division. It doesn't smell as much as a fish emulsion but is more expensive. Kelp Meal – a product of the ocean is primarily used as a trace mineral source. It is often combined with fish meal to add N-P-K value Kelp Powder – similar to kelp meal but ground fine enough to put into solution and applied as a foliar spray or injected into an irrigation system. Liquid Kelp – usually cold processed, liquid kelp will have higher levels of growth hormones than extracts. Some may be enzymatically digested, making growth hormones even more available to the plants. Animal by-products: Manures Nutrient concentrations in manures vary widely with the kind of animal they're from. Fresh manure has the highest concentration and can burn tender roots easily. Composted manure is less harsh. Although the concentration of nutrients is lower in manure than in man-made fertilizers, manure improves soil structure and increases its water holding capacity. Blood meal This dried blood from cattle slaughterhouses is a rich source of nitrogen. Do not apply at more than recommended rates because it is concentrated enough to harm plants. Always wear a mask to protect your lungs from dust. Bone Meal Bone meal decomposes slowly and releases phosphorus gradually. Bone meal is good for bulbs that don't sprout for several months after they're planted and for alkaline-loving plants such as clematis, lilac and hydrangea. NOTE: Rarely need phosphorus in the Spokane area. Feather Meal Sourced from poultry slaughter feather meal has high nitrogen (N) levels but is very slow to release the N. Fish emulsion This well-rounded fertilizer consists of partly decomposed ground fish. The smell is strong but will dissipate in a day or two, and can deter pests that don't like the fish smell. It has a high concentration of nitrogen and can burn plants if over-used (especially container plants). Enzymatically digested hydrolyzed liquid fish Enzymatically digested hydrolyzed fish use enzymes to digest the fish wastes instead of using heat and acids (fish emulsion). This retains more of the proteins, enzymes, vitamins and micronutrients than emulsions. Fish meal Fish meal is ground and heat dried fish waste.	Using only the information contained in the prompt/context block below, (do not use any external resources or prior knowledge), answer the following question. Compare/contrast two organic fertilizers: seaweed extract and fish emulsion, how are they the same/different from each other? Plant by-products: Alfalfa Meal or Pellets Alfalfa meal or pellets are often used as animal feed. Primarily they are used to increase organic matter in the soil but do provide nutrients and a high availability of trace minerals. They contain trianconatol, a natural fatty acid growth stimulant. Corn Gluten meal Corn Gluten products have a high percentage of nitrogen. It carries a warning to allow 1 to 4 months of decomposition in the soil prior to seeding. Allelopathic properties will inhibit the germination of seeds. However, there is no danger to established or transplanted plants. This product is also marketed as a pre-emergent weed control for annual grasses in bluegrass lawns. Cottonseed meal In warm soils this fertilizer is readily available with little danger of over-fertilizing. Use for acid-loving plants such as rhododendrons, blueberries and azaleas. Seaweed extract Seaweed is a good source of trace metals, micronutrients, amino acids and vitamins plus growth hormones that stimulate plant cell division. It doesn't smell as much as a fish emulsion but is more expensive. Kelp Meal – a product of the ocean is primarily used as a trace mineral source. It is often combined with fish meal to add N-P-K value Kelp Powder – similar to kelp meal but ground fine enough to put into solution and applied as a foliar spray or injected into an irrigation system. Liquid Kelp – usually cold processed, liquid kelp will have higher levels of growth hormones than extracts. Some may be enzymatically digested, making growth hormones even more available to the plants. Animal by-products: Manures Nutrient concentrations in manures vary widely with the kind of animal they're from. Fresh manure has the highest concentration and can burn tender roots easily. Composted manure is less harsh. Although the concentration of nutrients is lower in manure than in man-made fertilizers, manure improves soil structure and increases its water holding capacity. Blood meal This dried blood from cattle slaughterhouses is a rich source of nitrogen. Do not apply at more than recommended rates because it is concentrated enough to harm plants. Always wear a mask to protect your lungs from dust. Bone Meal Bone meal decomposes slowly and releases phosphorus gradually. Bone meal is good for bulbs that don't sprout for several months after they're planted and for alkaline-loving plants such as clematis, lilac and hydrangea. NOTE: Rarely need phosphorus in the Spokane area. Feather Meal Sourced from poultry slaughter feather meal has high nitrogen (N) levels but is very slow to release the N. Fish emulsion This well-rounded fertilizer consists of partly decomposed ground fish. The smell is strong but will dissipate in a day or two, and can deter pests that don't like the fish smell. It has a high concentration of nitrogen and can burn plants if over-used (especially container plants). Enzymatically digested hydrolyzed liquid fish Enzymatically digested hydrolyzed fish use enzymes to digest the fish wastes instead of using heat and acids (fish emulsion). This retains more of the proteins, enzymes, vitamins and micronutrients than emulsions. Fish meal Fish meal is ground and heat dried fish waste.	Using only the information contained in the prompt/context block below, (do not use any external resources or prior knowledge), answer the following question. EVIDENCE: Plant by-products: Alfalfa Meal or Pellets Alfalfa meal or pellets are often used as animal feed. Primarily they are used to increase organic matter in the soil but do provide nutrients and a high availability of trace minerals. They contain trianconatol, a natural fatty acid growth stimulant. Corn Gluten meal Corn Gluten products have a high percentage of nitrogen. It carries a warning to allow 1 to 4 months of decomposition in the soil prior to seeding. Allelopathic properties will inhibit the germination of seeds. However, there is no danger to established or transplanted plants. This product is also marketed as a pre-emergent weed control for annual grasses in bluegrass lawns. Cottonseed meal In warm soils this fertilizer is readily available with little danger of over-fertilizing. Use for acid-loving plants such as rhododendrons, blueberries and azaleas. Seaweed extract Seaweed is a good source of trace metals, micronutrients, amino acids and vitamins plus growth hormones that stimulate plant cell division. It doesn't smell as much as a fish emulsion but is more expensive. Kelp Meal – a product of the ocean is primarily used as a trace mineral source. It is often combined with fish meal to add N-P-K value Kelp Powder – similar to kelp meal but ground fine enough to put into solution and applied as a foliar spray or injected into an irrigation system. Liquid Kelp – usually cold processed, liquid kelp will have higher levels of growth hormones than extracts. Some may be enzymatically digested, making growth hormones even more available to the plants. Animal by-products: Manures Nutrient concentrations in manures vary widely with the kind of animal they're from. Fresh manure has the highest concentration and can burn tender roots easily. Composted manure is less harsh. Although the concentration of nutrients is lower in manure than in man-made fertilizers, manure improves soil structure and increases its water holding capacity. Blood meal This dried blood from cattle slaughterhouses is a rich source of nitrogen. Do not apply at more than recommended rates because it is concentrated enough to harm plants. Always wear a mask to protect your lungs from dust. Bone Meal Bone meal decomposes slowly and releases phosphorus gradually. Bone meal is good for bulbs that don't sprout for several months after they're planted and for alkaline-loving plants such as clematis, lilac and hydrangea. NOTE: Rarely need phosphorus in the Spokane area. Feather Meal Sourced from poultry slaughter feather meal has high nitrogen (N) levels but is very slow to release the N. Fish emulsion This well-rounded fertilizer consists of partly decomposed ground fish. The smell is strong but will dissipate in a day or two, and can deter pests that don't like the fish smell. It has a high concentration of nitrogen and can burn plants if over-used (especially container plants). Enzymatically digested hydrolyzed liquid fish Enzymatically digested hydrolyzed fish use enzymes to digest the fish wastes instead of using heat and acids (fish emulsion). This retains more of the proteins, enzymes, vitamins and micronutrients than emulsions. Fish meal Fish meal is ground and heat dried fish waste. USER: Compare/contrast two organic fertilizers: seaweed extract and fish emulsion, how are they the same/different from each other? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	23	17	513	null	18
You must generate a response using only this provided document. Do not use any other outside source to support your claims. If you are unable to answer the request using the supporting document only, then you must respond with "please support more relevant documents so that I may answer your request accurately".	What is neurotechnology?	3/9/24, 4:11 PM Neurotechnology \| Technology Networks Neurotechnology Imagine you could control your computer's mouse with your brain instead of your hand1. Imagine helping a patient with spinal cord injury to walk again2 by using a brain implant. It might sound like science fiction, but researchers have figured out how to make both scenarios a reality. It's all thanks to neurotechnology. There are many different types of neurotechnology, each with their role to play. From improving therapeutics for neurological and psychiatric disorders to augmenting current human capability (ever wanted to read someone's mind?) neurotechnology has a wide range of applications that make it a blossoming field worth paying attention to. What is neurotechnology? In its simplest form, neurotechnology is the integration of technical components3 with the nervous system. These components can be computers, electrodes or any other piece of engineering that can be set up to interface with the electric pulses coursing through our bodies. Neurotechnology has two main objectives - either to record signals from the brain and “translate” them into technical control commands (like our braincontrolled computer mouse), or to manipulate brain activity by applying electrical or optical stimuli (to help our paralysis patient). https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 1/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks The applications of neurotechnology are wide-ranging - from furthering the potential of academic research, to therapeutics, to developing brain/machine interfaces and more - and there are a lot of different types of neurotechnologies, some less invasive than others, which we will cover in this article. Electrophysiology In the 1780s, while experimenting with frogs’ legs, Luigi Galvani noticed that applying electric shocks made the legs twitch4 - even though they were disconnected from the frog's brain and body. That breakthrough instigated two centuries of research which would teach us a substantial amount5 about how neurons fire in response to stimuli, and how that firing is carried across different areas of the brain. It was the key that unlocked our understanding of how the brain is organized. In a nutshell6, electrophysiology involves the use of electrodes to understand the electrical properties of neurons. Researchers can record the activity of hundreds of cells at once, or home in on single cells using the patch-clamp technique. An electroencephalogram (EEG) is a type of electrophysiological monitoring method used to record electrical activity of several neurons at once.1 It is typically noninvasive, with the electrodes arranged in a cap and placed over the scalp, which measures voltage fluctuations of the brain regions beneath7. By contrast, an electrocorticogram (ECoG) involves placing electrodes in direct contact with the surface of the brain and measuring the brain waves in those specific brain regions. It is typically used intraoperatively to map epileptic regions of the brain and facilitate their safe removal8. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 2/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Figure 1: Patch-clamp electrophysiology. Credit: Technology Networks In patch-clamp electrophysiology9, a glass micropipette with diameter < 3 microns10 is inserted into the membrane of a single cell. Electrically charged ions passing from the inside to the outside of the cell through the transmembrane channels charge the pipette solution. The electric current generated by this transmembrane movement of ions is detected by a metal electrode, which relays the data to an amplifier. This technique gives researchers incredible precision and certainty in their readings. Researchers can also measure the activity of several neurons at once. There are two main ways of doing this11. Firstly, a microelectrode array can be used. This is a grid of dozens of electrodes which can record the activity of multiple neurons on the surface of the brain. Despite being small in size, it is still too large to be inserted deep in the brain, so this technique is reserved for neurons on the surface of the brain. The second technique involves tetrodes. Tetrodes are microelectrode arrays composed of just four active electrodes - making them small enough to insert https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 3/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks into these deeper regions. Measuring large swathes of neurons like this leads to more uncertainty.5 Some types of neurons have a distinctive waveform, making them easily identifiable. However, these are the exception rather than the rule. Most neurons have ambiguous waveforms, making it difficult to ascertain exactly which neurons have been studied. Deep brain stimulation Deep brain stimulation refers to a technique12 that involves surgically implanting an electrode into specific areas of the brain to modulate the way it operates. These electrodes produce electrical impulses that regulate abnormal neuronal activity in the patient. The stimulation delivered to the brain is regulated by a pacemaker-like device that is implanted under the skin in the upper chest. A wire runs under the skin from this pacemaker to the electrodes. Though highly invasive, this procedure is reversible13 and generally doesn't lead to many side effects. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 4/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Figure 2: A deep brain stimulator includes a pacemaker connected to electrodes in the brain. Credit: Technology Networks. While the exact mechanism of action isn't clear, the therapeutic effects14 of deep brain stimulation can be significant. For example, implanting electrodes into the ventral intermediate nucleus of the thalamus has been shown15 to dramatically decrease tremor, and even halt disease progression in essential tremor patients for more than 6 years after implantation. Additionally, stimulation of either the internal segment of the globus pallidus or the subthalamic nucleus has been shown14 to decrease the symptoms of bradykinesia, rigidity and gait impairment in patients with Parkinson's Disease. Other conditions that benefit from treatment with deep brain stimulation include epilepsy, OCD and dystonia. Transcranial magnetic stimulation https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 5/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Transcranial magnetic stimulation (TMS)16 is a recently developed technique used in the treatment of psychiatric and neurological disorders. It belongs to a growing field of non-invasive brain stimulation (NIBS)17 techniques. TMS exposes the scalp to a magnetic field, which can modulate the electrical signals fired from neurons in the target region. Usually the magnetic field emanates from a "wand-like" device. Though the exact biological mechanism of TMS is not understood, it has been shown to provide relief18 from depressive symptoms and improve mood in some patients. Transcranial direct current stimulation Transcranial direct current stimulation (tDCS) is a method of brain stimulation19 that centers on modulating behavioral and cognitive processes, as well as the neural circuits underlying motor function. Like TMS, tDCS is a painless and non-invasive procedure. Two electrodes are placed on the scalp of the participant - a smaller target electrode on one hemisphere, and a larger reference electrode on the other hemisphere. A weak electrical current passes from the target electrode, through the brain, to the reference electrode - and in doing so, modulates the behavior of the patient. One line of study currently in the spotlight is ADHD therapy. Cognitive control tasks rely on good prefrontal cortex function - the impairment of this region can lead to impulse control issues. Studies have found that adolescents with ADHD exhibit reduced activity in certain prefrontal cortex regions, specifically the left dorsolateral prefrontal cortex (DLPFC). Using tDCS to stimulate the left https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 6/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks DLPFC has been shown to reduce impulsivity in patients with ADHD, by effectively making up for the deficit in activity20. Figure 3: tDCS may be delivered through cap-mounted electrodes. Credit: iStock It is generally accepted21 that a positive anodal, or excitatory, current is associated with upregulation of behaviors regulated by the brain region under the target electrode. On the other hand, negative cathodal, or inhibitory, current is associated with downregulation of said behaviors. tDCS is used to identify22 brain-behavior relationships across cognitive, motor, social and affective domains. Applications of tDCS on healthy populations have been demonstrated23 to temporarily modify behavior, accelerate learning, and boost task performance. Focused ultrasound https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 7/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Breakthrough research24 at Carnegie Mellon University has recently shown that low-intensity ultrasound techniques can be applied to manipulate neurons in a cell-type selective manner. In other words, focused ultrasound (FUS) gives researchers the power to modulate specific neuro-circuits, making FUS a more highly targeted neurotherapy25 than deep brain stimulation, TMS, and tDCS. Figure 4: A diagram showing the mechanisms behind focused ultrasound (FUS). Credit: Technology Networks. FUS neuromodulation works by directing ultrasonic wave energy, through the skull, at highly-targeted brain regions. By tuning the parameters, scientists can either excite or inhibit specific neural circuits. FUS is FDA-approved in the US for treatment of essential tremor26. However, it is still not widely used in hospitals - it is a relatively novel therapy, barely a decade old. It carries several advantages over older therapies for essential tremor, namely being non-invasive, not relying on radiation, and not posing https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 8/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks any risk of infection27. For these reasons, we may see its presence pick up in the coming years. Brain-computer interfaces Simply put, a brain-computer interface (BCI)28 is a computer-based system that receives brain signals, analyzes them and then translates them into commands for devices, which produce a desired output. The main function of BCI in a medical context is therapeutic - restoring normal neuromuscular function to patients with disorders such as amyotrophic lateral sclerosis (ALS), cerebral palsy, stroke or spinal cord injury. Turning brain signals into commands for a computer system means patients will be able to move a cursor, type on a keyboard, manipulate a prosthetic just by using their brain. In 2015, researchers at the University of Houston succeeded in making an amputee control his prosthetic hand using only his mind for the first time - without the need for an invasive brain implant. Instead, the subject wore an 64-channel EEG headset, which monitored brain activity across motor, decision-making and action observation regions of the brain. The neuronal activity in these regions preceded the movement of the prosthetic hand by 50 - 90 milliseconds, proving that the brain was anticipating the movement before it happened29. Beyond this, BCIs also have a role to play in making surgery safer30. For example, BCIs can be used to monitor the surgeon's mental focus while they are performing a procedure, and then use this information to make the procedure safer. This system can train the surgeon to regulate their own mental state while performing surgery-like tasks using a robotic system. The https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 9/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks system presents augmented reality feedback to the surgeon, which helps their effort in maintaining a high level of mental focus during the task. Brain Implants The below video shows a monkey playing Pong with its mind31. As well as being, let’s be honest, pretty strange to watch, it is a beautiful illustration of a brain-computer interface in action. This technology, developed by Elon Musk's company Neuralink, is part of a revival of interest in brain implants. Monkey MindPong Though they might sound like something belonging to the future, the human fascination with brain implants has been around since the early 20th century, with the development of electroencephalography (EEG) by Hans Berger in 1929.32 Brain implants are one of the ways brains and computers interface in the first place. They allow users to communicate to computers and other external devices such as robotic hands. This makes them strong candidates as a therapy for patients who may have nerve damage in their limbs or spinal cord, as the brain implant allows these nerves to be bypassed entirely while still achieving the desired output. The implants record action potentials and local field potentials of neurons with high temporal and spatial resolution and high channel count33. This lets researchers cover lots of neural tissue at once. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 10/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks The implantation is currently delivered manually, by a surgeon, via a craniotomy. While it is certainly invasive, the procedure is reversible34 without any serious side-effects, at least in the pigs that Musk has also experimented on. While Musk's vision for Neuralink is to offer its brain technology as an elective procedure35 for any average person, other brain implant companies are thinking differently. For example, Florian Solzbacher is clear that the development of nonimplantable BCIs32 are also of great interest to his company Blackrock Neurotech. According to the company, just 34 people in the world currently have a device implanted in their brains - this neurotechnology is clearly still in its infancy. That said, Blackrock's MoveAgain BCI implant recently gained Breakthrough Device designation from the FDA, and the company intends to commercialize MoveAgain this year36. It wouldn't be a stretch to imagine we may be standing on the precipice of brain implants taking off as a standard therapy for several debilitating, chronic conditions. Ethics of neurotechnology If reading about all these developments in neurotechnology has made you uncomfortable, you're not alone. Continue reading below... https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 11/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Neurotechnology, while therapeutically very promising, is an ethical minefield. It raises questions around rights to data, privacy, and the risk of side-stepping regulations in the name of easier marketing. Let's think back to our Pong-playing monkey. The researchers monitoring Pager's neuroactivity have that data on their computers. Who owns that data? Is it Pager's, or Neuralink's? Moving a cursor on a screen is one thing, but what if the neural activity encoded is more sensitive than that? What kind of rules around privacy exist to protect the user? These are all questions that need to be considered. The rapid rise in interest in neurotechnology has also meant regulation has been slow to keep up. Because the way products are marketed informs the regulations they need to comply with, there is a fear that companies are sidestepping critical checks37 by marketing their neurotechnologies as "wellness" products rather than medical devices. Conclusion The field of neurotechnology encompasses many techniques and types of technology. From being able to record the activity of a single neuron firing, to https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 12/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks modulating the activity of entire brain regions, there's no doubt neurotechnology is and will continue to change the way we treat neurological and psychiatric conditions. As Florien Solzbacher of Blackrock Neurotech put it, "I do foresee that in 20-30 years, these types of implants will be just as common and acceptable as cardiac pacemakers are today."33 If Solzbacher's predictions come true, it will change the game for sufferers of dementia, mood disorders and neurodegenerative diseases. Neurotechnology has the potential to help us diminish the symptoms of these diseases, but also to augment the human experience. We just have to be open to it. About the author: Julia is a location-independent writer with a passion for communicating scientific ideas to the public. She holds a BSc (Hons) in Medical Science and a MSc in Sustainable Agriculture, and loves writing about neuroscience, behaviour, agriculture, ecology, conservation, and more. In her free time she loves dancing, hiking, and making music. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 13/13	You must generate a response using only this provided document. Do not use any other outside source to support your claims. If you are unable to answer the request using the supporting document only, then you must respond with "please support more relevant documents so that I may answer your request accurately". What is neurotechnology? 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Neurotechnology Imagine you could control your computer's mouse with your brain instead of your hand1. Imagine helping a patient with spinal cord injury to walk again2 by using a brain implant. It might sound like science fiction, but researchers have figured out how to make both scenarios a reality. It's all thanks to neurotechnology. There are many different types of neurotechnology, each with their role to play. From improving therapeutics for neurological and psychiatric disorders to augmenting current human capability (ever wanted to read someone's mind?) neurotechnology has a wide range of applications that make it a blossoming field worth paying attention to. What is neurotechnology? In its simplest form, neurotechnology is the integration of technical components3 with the nervous system. These components can be computers, electrodes or any other piece of engineering that can be set up to interface with the electric pulses coursing through our bodies. Neurotechnology has two main objectives - either to record signals from the brain and “translate” them into technical control commands (like our braincontrolled computer mouse), or to manipulate brain activity by applying electrical or optical stimuli (to help our paralysis patient). https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 1/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks The applications of neurotechnology are wide-ranging - from furthering the potential of academic research, to therapeutics, to developing brain/machine interfaces and more - and there are a lot of different types of neurotechnologies, some less invasive than others, which we will cover in this article. Electrophysiology In the 1780s, while experimenting with frogs’ legs, Luigi Galvani noticed that applying electric shocks made the legs twitch4 - even though they were disconnected from the frog's brain and body. That breakthrough instigated two centuries of research which would teach us a substantial amount5 about how neurons fire in response to stimuli, and how that firing is carried across different areas of the brain. It was the key that unlocked our understanding of how the brain is organized. In a nutshell6, electrophysiology involves the use of electrodes to understand the electrical properties of neurons. Researchers can record the activity of hundreds of cells at once, or home in on single cells using the patch-clamp technique. An electroencephalogram (EEG) is a type of electrophysiological monitoring method used to record electrical activity of several neurons at once.1 It is typically noninvasive, with the electrodes arranged in a cap and placed over the scalp, which measures voltage fluctuations of the brain regions beneath7. By contrast, an electrocorticogram (ECoG) involves placing electrodes in direct contact with the surface of the brain and measuring the brain waves in those specific brain regions. It is typically used intraoperatively to map epileptic regions of the brain and facilitate their safe removal8. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 2/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Figure 1: Patch-clamp electrophysiology. Credit: Technology Networks In patch-clamp electrophysiology9, a glass micropipette with diameter < 3 microns10 is inserted into the membrane of a single cell. Electrically charged ions passing from the inside to the outside of the cell through the transmembrane channels charge the pipette solution. The electric current generated by this transmembrane movement of ions is detected by a metal electrode, which relays the data to an amplifier. This technique gives researchers incredible precision and certainty in their readings. Researchers can also measure the activity of several neurons at once. There are two main ways of doing this11. Firstly, a microelectrode array can be used. This is a grid of dozens of electrodes which can record the activity of multiple neurons on the surface of the brain. Despite being small in size, it is still too large to be inserted deep in the brain, so this technique is reserved for neurons on the surface of the brain. The second technique involves tetrodes. Tetrodes are microelectrode arrays composed of just four active electrodes - making them small enough to insert https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 3/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks into these deeper regions. Measuring large swathes of neurons like this leads to more uncertainty.5 Some types of neurons have a distinctive waveform, making them easily identifiable. However, these are the exception rather than the rule. Most neurons have ambiguous waveforms, making it difficult to ascertain exactly which neurons have been studied. Deep brain stimulation Deep brain stimulation refers to a technique12 that involves surgically implanting an electrode into specific areas of the brain to modulate the way it operates. These electrodes produce electrical impulses that regulate abnormal neuronal activity in the patient. The stimulation delivered to the brain is regulated by a pacemaker-like device that is implanted under the skin in the upper chest. A wire runs under the skin from this pacemaker to the electrodes. Though highly invasive, this procedure is reversible13 and generally doesn't lead to many side effects. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 4/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Figure 2: A deep brain stimulator includes a pacemaker connected to electrodes in the brain. Credit: Technology Networks. While the exact mechanism of action isn't clear, the therapeutic effects14 of deep brain stimulation can be significant. For example, implanting electrodes into the ventral intermediate nucleus of the thalamus has been shown15 to dramatically decrease tremor, and even halt disease progression in essential tremor patients for more than 6 years after implantation. Additionally, stimulation of either the internal segment of the globus pallidus or the subthalamic nucleus has been shown14 to decrease the symptoms of bradykinesia, rigidity and gait impairment in patients with Parkinson's Disease. Other conditions that benefit from treatment with deep brain stimulation include epilepsy, OCD and dystonia. Transcranial magnetic stimulation https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 5/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Transcranial magnetic stimulation (TMS)16 is a recently developed technique used in the treatment of psychiatric and neurological disorders. It belongs to a growing field of non-invasive brain stimulation (NIBS)17 techniques. TMS exposes the scalp to a magnetic field, which can modulate the electrical signals fired from neurons in the target region. Usually the magnetic field emanates from a "wand-like" device. Though the exact biological mechanism of TMS is not understood, it has been shown to provide relief18 from depressive symptoms and improve mood in some patients. Transcranial direct current stimulation Transcranial direct current stimulation (tDCS) is a method of brain stimulation19 that centers on modulating behavioral and cognitive processes, as well as the neural circuits underlying motor function. Like TMS, tDCS is a painless and non-invasive procedure. Two electrodes are placed on the scalp of the participant - a smaller target electrode on one hemisphere, and a larger reference electrode on the other hemisphere. A weak electrical current passes from the target electrode, through the brain, to the reference electrode - and in doing so, modulates the behavior of the patient. One line of study currently in the spotlight is ADHD therapy. Cognitive control tasks rely on good prefrontal cortex function - the impairment of this region can lead to impulse control issues. Studies have found that adolescents with ADHD exhibit reduced activity in certain prefrontal cortex regions, specifically the left dorsolateral prefrontal cortex (DLPFC). Using tDCS to stimulate the left https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 6/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks DLPFC has been shown to reduce impulsivity in patients with ADHD, by effectively making up for the deficit in activity20. Figure 3: tDCS may be delivered through cap-mounted electrodes. Credit: iStock It is generally accepted21 that a positive anodal, or excitatory, current is associated with upregulation of behaviors regulated by the brain region under the target electrode. On the other hand, negative cathodal, or inhibitory, current is associated with downregulation of said behaviors. tDCS is used to identify22 brain-behavior relationships across cognitive, motor, social and affective domains. Applications of tDCS on healthy populations have been demonstrated23 to temporarily modify behavior, accelerate learning, and boost task performance. Focused ultrasound https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 7/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Breakthrough research24 at Carnegie Mellon University has recently shown that low-intensity ultrasound techniques can be applied to manipulate neurons in a cell-type selective manner. In other words, focused ultrasound (FUS) gives researchers the power to modulate specific neuro-circuits, making FUS a more highly targeted neurotherapy25 than deep brain stimulation, TMS, and tDCS. Figure 4: A diagram showing the mechanisms behind focused ultrasound (FUS). Credit: Technology Networks. FUS neuromodulation works by directing ultrasonic wave energy, through the skull, at highly-targeted brain regions. By tuning the parameters, scientists can either excite or inhibit specific neural circuits. FUS is FDA-approved in the US for treatment of essential tremor26. However, it is still not widely used in hospitals - it is a relatively novel therapy, barely a decade old. It carries several advantages over older therapies for essential tremor, namely being non-invasive, not relying on radiation, and not posing https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 8/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks any risk of infection27. For these reasons, we may see its presence pick up in the coming years. Brain-computer interfaces Simply put, a brain-computer interface (BCI)28 is a computer-based system that receives brain signals, analyzes them and then translates them into commands for devices, which produce a desired output. The main function of BCI in a medical context is therapeutic - restoring normal neuromuscular function to patients with disorders such as amyotrophic lateral sclerosis (ALS), cerebral palsy, stroke or spinal cord injury. Turning brain signals into commands for a computer system means patients will be able to move a cursor, type on a keyboard, manipulate a prosthetic just by using their brain. In 2015, researchers at the University of Houston succeeded in making an amputee control his prosthetic hand using only his mind for the first time - without the need for an invasive brain implant. Instead, the subject wore an 64-channel EEG headset, which monitored brain activity across motor, decision-making and action observation regions of the brain. The neuronal activity in these regions preceded the movement of the prosthetic hand by 50 - 90 milliseconds, proving that the brain was anticipating the movement before it happened29. Beyond this, BCIs also have a role to play in making surgery safer30. For example, BCIs can be used to monitor the surgeon's mental focus while they are performing a procedure, and then use this information to make the procedure safer. This system can train the surgeon to regulate their own mental state while performing surgery-like tasks using a robotic system. The https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 9/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks system presents augmented reality feedback to the surgeon, which helps their effort in maintaining a high level of mental focus during the task. Brain Implants The below video shows a monkey playing Pong with its mind31. As well as being, let’s be honest, pretty strange to watch, it is a beautiful illustration of a brain-computer interface in action. This technology, developed by Elon Musk's company Neuralink, is part of a revival of interest in brain implants. Monkey MindPong Though they might sound like something belonging to the future, the human fascination with brain implants has been around since the early 20th century, with the development of electroencephalography (EEG) by Hans Berger in 1929.32 Brain implants are one of the ways brains and computers interface in the first place. They allow users to communicate to computers and other external devices such as robotic hands. This makes them strong candidates as a therapy for patients who may have nerve damage in their limbs or spinal cord, as the brain implant allows these nerves to be bypassed entirely while still achieving the desired output. The implants record action potentials and local field potentials of neurons with high temporal and spatial resolution and high channel count33. This lets researchers cover lots of neural tissue at once. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 10/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks The implantation is currently delivered manually, by a surgeon, via a craniotomy. While it is certainly invasive, the procedure is reversible34 without any serious side-effects, at least in the pigs that Musk has also experimented on. While Musk's vision for Neuralink is to offer its brain technology as an elective procedure35 for any average person, other brain implant companies are thinking differently. For example, Florian Solzbacher is clear that the development of nonimplantable BCIs32 are also of great interest to his company Blackrock Neurotech. According to the company, just 34 people in the world currently have a device implanted in their brains - this neurotechnology is clearly still in its infancy. That said, Blackrock's MoveAgain BCI implant recently gained Breakthrough Device designation from the FDA, and the company intends to commercialize MoveAgain this year36. It wouldn't be a stretch to imagine we may be standing on the precipice of brain implants taking off as a standard therapy for several debilitating, chronic conditions. Ethics of neurotechnology If reading about all these developments in neurotechnology has made you uncomfortable, you're not alone. Continue reading below... https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 11/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Neurotechnology, while therapeutically very promising, is an ethical minefield. It raises questions around rights to data, privacy, and the risk of side-stepping regulations in the name of easier marketing. Let's think back to our Pong-playing monkey. The researchers monitoring Pager's neuroactivity have that data on their computers. Who owns that data? Is it Pager's, or Neuralink's? Moving a cursor on a screen is one thing, but what if the neural activity encoded is more sensitive than that? What kind of rules around privacy exist to protect the user? These are all questions that need to be considered. The rapid rise in interest in neurotechnology has also meant regulation has been slow to keep up. Because the way products are marketed informs the regulations they need to comply with, there is a fear that companies are sidestepping critical checks37 by marketing their neurotechnologies as "wellness" products rather than medical devices. Conclusion The field of neurotechnology encompasses many techniques and types of technology. From being able to record the activity of a single neuron firing, to https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 12/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks modulating the activity of entire brain regions, there's no doubt neurotechnology is and will continue to change the way we treat neurological and psychiatric conditions. As Florien Solzbacher of Blackrock Neurotech put it, "I do foresee that in 20-30 years, these types of implants will be just as common and acceptable as cardiac pacemakers are today."33 If Solzbacher's predictions come true, it will change the game for sufferers of dementia, mood disorders and neurodegenerative diseases. Neurotechnology has the potential to help us diminish the symptoms of these diseases, but also to augment the human experience. We just have to be open to it. About the author: Julia is a location-independent writer with a passion for communicating scientific ideas to the public. She holds a BSc (Hons) in Medical Science and a MSc in Sustainable Agriculture, and loves writing about neuroscience, behaviour, agriculture, ecology, conservation, and more. In her free time she loves dancing, hiking, and making music. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 13/13	You must generate a response using only this provided document. Do not use any other outside source to support your claims. If you are unable to answer the request using the supporting document only, then you must respond with "please support more relevant documents so that I may answer your request accurately". EVIDENCE: 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Neurotechnology Imagine you could control your computer's mouse with your brain instead of your hand1. Imagine helping a patient with spinal cord injury to walk again2 by using a brain implant. It might sound like science fiction, but researchers have figured out how to make both scenarios a reality. It's all thanks to neurotechnology. There are many different types of neurotechnology, each with their role to play. From improving therapeutics for neurological and psychiatric disorders to augmenting current human capability (ever wanted to read someone's mind?) neurotechnology has a wide range of applications that make it a blossoming field worth paying attention to. What is neurotechnology? In its simplest form, neurotechnology is the integration of technical components3 with the nervous system. These components can be computers, electrodes or any other piece of engineering that can be set up to interface with the electric pulses coursing through our bodies. Neurotechnology has two main objectives - either to record signals from the brain and “translate” them into technical control commands (like our braincontrolled computer mouse), or to manipulate brain activity by applying electrical or optical stimuli (to help our paralysis patient). https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 1/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks The applications of neurotechnology are wide-ranging - from furthering the potential of academic research, to therapeutics, to developing brain/machine interfaces and more - and there are a lot of different types of neurotechnologies, some less invasive than others, which we will cover in this article. Electrophysiology In the 1780s, while experimenting with frogs’ legs, Luigi Galvani noticed that applying electric shocks made the legs twitch4 - even though they were disconnected from the frog's brain and body. That breakthrough instigated two centuries of research which would teach us a substantial amount5 about how neurons fire in response to stimuli, and how that firing is carried across different areas of the brain. It was the key that unlocked our understanding of how the brain is organized. In a nutshell6, electrophysiology involves the use of electrodes to understand the electrical properties of neurons. Researchers can record the activity of hundreds of cells at once, or home in on single cells using the patch-clamp technique. An electroencephalogram (EEG) is a type of electrophysiological monitoring method used to record electrical activity of several neurons at once.1 It is typically noninvasive, with the electrodes arranged in a cap and placed over the scalp, which measures voltage fluctuations of the brain regions beneath7. By contrast, an electrocorticogram (ECoG) involves placing electrodes in direct contact with the surface of the brain and measuring the brain waves in those specific brain regions. It is typically used intraoperatively to map epileptic regions of the brain and facilitate their safe removal8. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 2/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Figure 1: Patch-clamp electrophysiology. Credit: Technology Networks In patch-clamp electrophysiology9, a glass micropipette with diameter < 3 microns10 is inserted into the membrane of a single cell. Electrically charged ions passing from the inside to the outside of the cell through the transmembrane channels charge the pipette solution. The electric current generated by this transmembrane movement of ions is detected by a metal electrode, which relays the data to an amplifier. This technique gives researchers incredible precision and certainty in their readings. Researchers can also measure the activity of several neurons at once. There are two main ways of doing this11. Firstly, a microelectrode array can be used. This is a grid of dozens of electrodes which can record the activity of multiple neurons on the surface of the brain. Despite being small in size, it is still too large to be inserted deep in the brain, so this technique is reserved for neurons on the surface of the brain. The second technique involves tetrodes. Tetrodes are microelectrode arrays composed of just four active electrodes - making them small enough to insert https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 3/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks into these deeper regions. Measuring large swathes of neurons like this leads to more uncertainty.5 Some types of neurons have a distinctive waveform, making them easily identifiable. However, these are the exception rather than the rule. Most neurons have ambiguous waveforms, making it difficult to ascertain exactly which neurons have been studied. Deep brain stimulation Deep brain stimulation refers to a technique12 that involves surgically implanting an electrode into specific areas of the brain to modulate the way it operates. These electrodes produce electrical impulses that regulate abnormal neuronal activity in the patient. The stimulation delivered to the brain is regulated by a pacemaker-like device that is implanted under the skin in the upper chest. A wire runs under the skin from this pacemaker to the electrodes. Though highly invasive, this procedure is reversible13 and generally doesn't lead to many side effects. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 4/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Figure 2: A deep brain stimulator includes a pacemaker connected to electrodes in the brain. Credit: Technology Networks. While the exact mechanism of action isn't clear, the therapeutic effects14 of deep brain stimulation can be significant. For example, implanting electrodes into the ventral intermediate nucleus of the thalamus has been shown15 to dramatically decrease tremor, and even halt disease progression in essential tremor patients for more than 6 years after implantation. Additionally, stimulation of either the internal segment of the globus pallidus or the subthalamic nucleus has been shown14 to decrease the symptoms of bradykinesia, rigidity and gait impairment in patients with Parkinson's Disease. Other conditions that benefit from treatment with deep brain stimulation include epilepsy, OCD and dystonia. Transcranial magnetic stimulation https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 5/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Transcranial magnetic stimulation (TMS)16 is a recently developed technique used in the treatment of psychiatric and neurological disorders. It belongs to a growing field of non-invasive brain stimulation (NIBS)17 techniques. TMS exposes the scalp to a magnetic field, which can modulate the electrical signals fired from neurons in the target region. Usually the magnetic field emanates from a "wand-like" device. Though the exact biological mechanism of TMS is not understood, it has been shown to provide relief18 from depressive symptoms and improve mood in some patients. Transcranial direct current stimulation Transcranial direct current stimulation (tDCS) is a method of brain stimulation19 that centers on modulating behavioral and cognitive processes, as well as the neural circuits underlying motor function. Like TMS, tDCS is a painless and non-invasive procedure. Two electrodes are placed on the scalp of the participant - a smaller target electrode on one hemisphere, and a larger reference electrode on the other hemisphere. A weak electrical current passes from the target electrode, through the brain, to the reference electrode - and in doing so, modulates the behavior of the patient. One line of study currently in the spotlight is ADHD therapy. Cognitive control tasks rely on good prefrontal cortex function - the impairment of this region can lead to impulse control issues. Studies have found that adolescents with ADHD exhibit reduced activity in certain prefrontal cortex regions, specifically the left dorsolateral prefrontal cortex (DLPFC). Using tDCS to stimulate the left https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 6/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks DLPFC has been shown to reduce impulsivity in patients with ADHD, by effectively making up for the deficit in activity20. Figure 3: tDCS may be delivered through cap-mounted electrodes. Credit: iStock It is generally accepted21 that a positive anodal, or excitatory, current is associated with upregulation of behaviors regulated by the brain region under the target electrode. On the other hand, negative cathodal, or inhibitory, current is associated with downregulation of said behaviors. tDCS is used to identify22 brain-behavior relationships across cognitive, motor, social and affective domains. Applications of tDCS on healthy populations have been demonstrated23 to temporarily modify behavior, accelerate learning, and boost task performance. Focused ultrasound https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 7/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Breakthrough research24 at Carnegie Mellon University has recently shown that low-intensity ultrasound techniques can be applied to manipulate neurons in a cell-type selective manner. In other words, focused ultrasound (FUS) gives researchers the power to modulate specific neuro-circuits, making FUS a more highly targeted neurotherapy25 than deep brain stimulation, TMS, and tDCS. Figure 4: A diagram showing the mechanisms behind focused ultrasound (FUS). Credit: Technology Networks. FUS neuromodulation works by directing ultrasonic wave energy, through the skull, at highly-targeted brain regions. By tuning the parameters, scientists can either excite or inhibit specific neural circuits. FUS is FDA-approved in the US for treatment of essential tremor26. However, it is still not widely used in hospitals - it is a relatively novel therapy, barely a decade old. It carries several advantages over older therapies for essential tremor, namely being non-invasive, not relying on radiation, and not posing https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 8/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks any risk of infection27. For these reasons, we may see its presence pick up in the coming years. Brain-computer interfaces Simply put, a brain-computer interface (BCI)28 is a computer-based system that receives brain signals, analyzes them and then translates them into commands for devices, which produce a desired output. The main function of BCI in a medical context is therapeutic - restoring normal neuromuscular function to patients with disorders such as amyotrophic lateral sclerosis (ALS), cerebral palsy, stroke or spinal cord injury. Turning brain signals into commands for a computer system means patients will be able to move a cursor, type on a keyboard, manipulate a prosthetic just by using their brain. In 2015, researchers at the University of Houston succeeded in making an amputee control his prosthetic hand using only his mind for the first time - without the need for an invasive brain implant. Instead, the subject wore an 64-channel EEG headset, which monitored brain activity across motor, decision-making and action observation regions of the brain. The neuronal activity in these regions preceded the movement of the prosthetic hand by 50 - 90 milliseconds, proving that the brain was anticipating the movement before it happened29. Beyond this, BCIs also have a role to play in making surgery safer30. For example, BCIs can be used to monitor the surgeon's mental focus while they are performing a procedure, and then use this information to make the procedure safer. This system can train the surgeon to regulate their own mental state while performing surgery-like tasks using a robotic system. The https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 9/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks system presents augmented reality feedback to the surgeon, which helps their effort in maintaining a high level of mental focus during the task. Brain Implants The below video shows a monkey playing Pong with its mind31. As well as being, let’s be honest, pretty strange to watch, it is a beautiful illustration of a brain-computer interface in action. This technology, developed by Elon Musk's company Neuralink, is part of a revival of interest in brain implants. Monkey MindPong Though they might sound like something belonging to the future, the human fascination with brain implants has been around since the early 20th century, with the development of electroencephalography (EEG) by Hans Berger in 1929.32 Brain implants are one of the ways brains and computers interface in the first place. They allow users to communicate to computers and other external devices such as robotic hands. This makes them strong candidates as a therapy for patients who may have nerve damage in their limbs or spinal cord, as the brain implant allows these nerves to be bypassed entirely while still achieving the desired output. The implants record action potentials and local field potentials of neurons with high temporal and spatial resolution and high channel count33. This lets researchers cover lots of neural tissue at once. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 10/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks The implantation is currently delivered manually, by a surgeon, via a craniotomy. While it is certainly invasive, the procedure is reversible34 without any serious side-effects, at least in the pigs that Musk has also experimented on. While Musk's vision for Neuralink is to offer its brain technology as an elective procedure35 for any average person, other brain implant companies are thinking differently. For example, Florian Solzbacher is clear that the development of nonimplantable BCIs32 are also of great interest to his company Blackrock Neurotech. According to the company, just 34 people in the world currently have a device implanted in their brains - this neurotechnology is clearly still in its infancy. That said, Blackrock's MoveAgain BCI implant recently gained Breakthrough Device designation from the FDA, and the company intends to commercialize MoveAgain this year36. It wouldn't be a stretch to imagine we may be standing on the precipice of brain implants taking off as a standard therapy for several debilitating, chronic conditions. Ethics of neurotechnology If reading about all these developments in neurotechnology has made you uncomfortable, you're not alone. Continue reading below... https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 11/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks Neurotechnology, while therapeutically very promising, is an ethical minefield. It raises questions around rights to data, privacy, and the risk of side-stepping regulations in the name of easier marketing. Let's think back to our Pong-playing monkey. The researchers monitoring Pager's neuroactivity have that data on their computers. Who owns that data? Is it Pager's, or Neuralink's? Moving a cursor on a screen is one thing, but what if the neural activity encoded is more sensitive than that? What kind of rules around privacy exist to protect the user? These are all questions that need to be considered. The rapid rise in interest in neurotechnology has also meant regulation has been slow to keep up. Because the way products are marketed informs the regulations they need to comply with, there is a fear that companies are sidestepping critical checks37 by marketing their neurotechnologies as "wellness" products rather than medical devices. Conclusion The field of neurotechnology encompasses many techniques and types of technology. From being able to record the activity of a single neuron firing, to https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 12/13 3/9/24, 4:11 PM Neurotechnology \| Technology Networks modulating the activity of entire brain regions, there's no doubt neurotechnology is and will continue to change the way we treat neurological and psychiatric conditions. As Florien Solzbacher of Blackrock Neurotech put it, "I do foresee that in 20-30 years, these types of implants will be just as common and acceptable as cardiac pacemakers are today."33 If Solzbacher's predictions come true, it will change the game for sufferers of dementia, mood disorders and neurodegenerative diseases. Neurotechnology has the potential to help us diminish the symptoms of these diseases, but also to augment the human experience. We just have to be open to it. About the author: Julia is a location-independent writer with a passion for communicating scientific ideas to the public. She holds a BSc (Hons) in Medical Science and a MSc in Sustainable Agriculture, and loves writing about neuroscience, behaviour, agriculture, ecology, conservation, and more. In her free time she loves dancing, hiking, and making music. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 13/13 USER: What is neurotechnology? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	true	52	3	2,482	null	523
You can only respond to the prompt using information in the context block and no other sources. Your role is to explain complicated tax information to consumers using clear and understandable language.	Explain the rationale behind the global minimum tax on multinational enterprises for Canadian businesses as outlined in the context document.	International Tax Reform Canada is one of 138 members of the Organisation for Economic Co-operation and Development (OECD)/Group of 20 (G20) Inclusive Framework on Base Erosion and Profit Shifting (the Inclusive Framework) that have joined a two-pillar plan for international tax reform agreed to on October 8, 2021. The historic “Statement on a Two-Pillar Solution to Address the Tax Challenges Arising from the Digitalisation of the Economy” (the October 2021 Statement) agreed to on that day has since been endorsed by G20 Finance Ministers and Leaders. Pillar One is intended to reallocate a portion of taxing rights over the profits of the largest and most profitable multinational enterprises (MNEs) to market countries (i.e., where their users and customers are located). Pillar Two is intended to ensure that the profits of large MNEs are subject to an effective tax rate of at least 15 per cent, regardless of where they are earned. The following provides an update on recent developments and upcoming implementation steps in relation to the pillars. Pillar One – Reallocation of Taxing Rights Pillar One is an update to the framework that underlies current tax treaties, which allocates the income of MNEs between countries for tax purposes. The existing framework relies on principles of connection with a country based on physical presence that were designed for traditional bricks-and-mortar businesses; they do not produce appropriate results in today’s digitalized economy. Pillar One instead uses a broader test of connection and a formulary allocation of residual profits to ensure that the largest and most profitable MNEs pay a fair share of tax in the countries where their users and customers are located. The government is working with its international partners in an OECD-led process to develop the model rules and the multilateral convention needed to establish this new multilateral tax framework and bring it into effect. To help ensure that the final rules will be effective and administrable, the OECD has been releasing draft model rules for public comment as each element reaches maturity. The draft rules were consolidated in two major progress reports released in July and October of 2022. Countries are working toward completing multilateral negotiations so that the convention to implement Pillar One can be signed by mid-2023, with a view to it entering into force in 2024. To ensure that Canadians' interests are protected, the government released draft legislative proposals for a Digital Services Tax (DST) in December 2021. The government intends to release a revised draft of the legislative proposals for public comment before introducing a bill in Parliament. Consistent with the October 2021 Statement, the DST could be imposed as of January 1, 2024, but only if the multilateral convention implementing the Pillar One framework has not come into force. In that event, the DST would be payable as of 2024 in respect of revenues earned as of January 1, 2022. It remains the government’s hope and underlying assumption that the timely implementation of the new multilateral framework will make this unnecessary. Pillar Two – Global Minimum Tax Pillar Two is a multilateral framework for a global minimum tax regime that is designed to ensure that MNEs with annual revenues of €750 million or more are subject to a minimum effective tax rate of 15 per cent on their profits in every jurisdiction in which they operate. It is intended to reduce the incentive for MNEs to shift profits into low-tax jurisdictions and, at the same time, end the “race to the bottom” in international corporate taxation by setting a floor on tax competition. The primary charging rule for Pillar Two is known as the Income Inclusion Rule (IIR). In general terms, if the jurisdiction where the ultimate parent entity of an MNE is located has implemented the IIR, it has the primary right to impose a top-up tax on the ultimate parent entity with respect to income from the MNE’s operations in any jurisdiction where it is taxed at an effective tax rate below 15 per cent. Pillar Two also contains a “backstop” rule, known as the Undertaxed Profits Rule (UTPR). If a parent jurisdiction of an MNE has not implemented the IIR, other jurisdictions in which the MNE operates that have implemented the UTPR would impose the top-up tax on the group entities located in their jurisdiction, with the top-up tax being allocated among those jurisdictions on a formulary basis. This ensures that MNEs whose parent entities are located in non-implementing jurisdictions are nonetheless subject to top-up tax in respect of their low-taxed income. The details of the IIR and UTPR are set out in the model rules (the Global Anti-Base Erosion or GloBE Rules), and related commentary and administrative guidance, all agreed by the Inclusive Framework. The Pillar Two framework contemplates that a jurisdiction may enact a domestic minimum top-up tax that would apply a top-up tax on low-taxed income of its domestic entities. If such a tax is designed to achieve the intended outcomes under Pillar Two, it is treated as a “qualified” domestic minimum top-up tax and is creditable dollar-for-dollar against the top-up tax liability that would otherwise arise under Pillar Two. In effect, this allows a jurisdiction to collect the top-up tax applicable to any low-taxed income of its domestic entities, rather than allowing the top-up tax to accrue to the treasuries of other countries under the IIR or UTPR. A more detailed outline of the Pillar Two framework is set out in the Supplementary Information to Budget 2022 (https://www.budget.canada.ca/2022/report-rapport/tm-mf-en.html#a4), which launched a public consultation on the implementation of Pillar Two in Canada, which ended on July 7, 2022.	You can only respond to the prompt using information in the context block and no other sources. Your role is to explain complicated tax information to consumers using clear and understandable language. Explain the rationale behind the global minimum tax on multinational enterprises for Canadian businesses as outlined in the context document. International Tax Reform Canada is one of 138 members of the Organisation for Economic Co-operation and Development (OECD)/Group of 20 (G20) Inclusive Framework on Base Erosion and Profit Shifting (the Inclusive Framework) that have joined a two-pillar plan for international tax reform agreed to on October 8, 2021. The historic “Statement on a Two-Pillar Solution to Address the Tax Challenges Arising from the Digitalisation of the Economy” (the October 2021 Statement) agreed to on that day has since been endorsed by G20 Finance Ministers and Leaders. Pillar One is intended to reallocate a portion of taxing rights over the profits of the largest and most profitable multinational enterprises (MNEs) to market countries (i.e., where their users and customers are located). Pillar Two is intended to ensure that the profits of large MNEs are subject to an effective tax rate of at least 15 per cent, regardless of where they are earned. The following provides an update on recent developments and upcoming implementation steps in relation to the pillars. Pillar One – Reallocation of Taxing Rights Pillar One is an update to the framework that underlies current tax treaties, which allocates the income of MNEs between countries for tax purposes. The existing framework relies on principles of connection with a country based on physical presence that were designed for traditional bricks-and-mortar businesses; they do not produce appropriate results in today’s digitalized economy. Pillar One instead uses a broader test of connection and a formulary allocation of residual profits to ensure that the largest and most profitable MNEs pay a fair share of tax in the countries where their users and customers are located. The government is working with its international partners in an OECD-led process to develop the model rules and the multilateral convention needed to establish this new multilateral tax framework and bring it into effect. To help ensure that the final rules will be effective and administrable, the OECD has been releasing draft model rules for public comment as each element reaches maturity. The draft rules were consolidated in two major progress reports released in July and October of 2022. Countries are working toward completing multilateral negotiations so that the convention to implement Pillar One can be signed by mid-2023, with a view to it entering into force in 2024. To ensure that Canadians' interests are protected, the government released draft legislative proposals for a Digital Services Tax (DST) in December 2021. The government intends to release a revised draft of the legislative proposals for public comment before introducing a bill in Parliament. Consistent with the October 2021 Statement, the DST could be imposed as of January 1, 2024, but only if the multilateral convention implementing the Pillar One framework has not come into force. In that event, the DST would be payable as of 2024 in respect of revenues earned as of January 1, 2022. It remains the government’s hope and underlying assumption that the timely implementation of the new multilateral framework will make this unnecessary. Pillar Two – Global Minimum Tax Pillar Two is a multilateral framework for a global minimum tax regime that is designed to ensure that MNEs with annual revenues of €750 million or more are subject to a minimum effective tax rate of 15 per cent on their profits in every jurisdiction in which they operate. It is intended to reduce the incentive for MNEs to shift profits into low-tax jurisdictions and, at the same time, end the “race to the bottom” in international corporate taxation by setting a floor on tax competition. The primary charging rule for Pillar Two is known as the Income Inclusion Rule (IIR). In general terms, if the jurisdiction where the ultimate parent entity of an MNE is located has implemented the IIR, it has the primary right to impose a top-up tax on the ultimate parent entity with respect to income from the MNE’s operations in any jurisdiction where it is taxed at an effective tax rate below 15 per cent. Pillar Two also contains a “backstop” rule, known as the Undertaxed Profits Rule (UTPR). If a parent jurisdiction of an MNE has not implemented the IIR, other jurisdictions in which the MNE operates that have implemented the UTPR would impose the top-up tax on the group entities located in their jurisdiction, with the top-up tax being allocated among those jurisdictions on a formulary basis. This ensures that MNEs whose parent entities are located in non-implementing jurisdictions are nonetheless subject to top-up tax in respect of their low-taxed income. The details of the IIR and UTPR are set out in the model rules (the Global Anti-Base Erosion or GloBE Rules), and related commentary and administrative guidance, all agreed by the Inclusive Framework. The Pillar Two framework contemplates that a jurisdiction may enact a domestic minimum top-up tax that would apply a top-up tax on low-taxed income of its domestic entities. If such a tax is designed to achieve the intended outcomes under Pillar Two, it is treated as a “qualified” domestic minimum top-up tax and is creditable dollar-for-dollar against the top-up tax liability that would otherwise arise under Pillar Two. In effect, this allows a jurisdiction to collect the top-up tax applicable to any low-taxed income of its domestic entities, rather than allowing the top-up tax to accrue to the treasuries of other countries under the IIR or UTPR. A more detailed outline of the Pillar Two framework is set out in the Supplementary Information to Budget 2022 (https://www.budget.canada.ca/2022/report-rapport/tm-mf-en.html#a4), which launched a public consultation on the implementation of Pillar Two in Canada, which ended on July 7, 2022.	You can only respond to the prompt using information in the context block and no other sources. Your role is to explain complicated tax information to consumers using clear and understandable language. EVIDENCE: International Tax Reform Canada is one of 138 members of the Organisation for Economic Co-operation and Development (OECD)/Group of 20 (G20) Inclusive Framework on Base Erosion and Profit Shifting (the Inclusive Framework) that have joined a two-pillar plan for international tax reform agreed to on October 8, 2021. The historic “Statement on a Two-Pillar Solution to Address the Tax Challenges Arising from the Digitalisation of the Economy” (the October 2021 Statement) agreed to on that day has since been endorsed by G20 Finance Ministers and Leaders. Pillar One is intended to reallocate a portion of taxing rights over the profits of the largest and most profitable multinational enterprises (MNEs) to market countries (i.e., where their users and customers are located). Pillar Two is intended to ensure that the profits of large MNEs are subject to an effective tax rate of at least 15 per cent, regardless of where they are earned. The following provides an update on recent developments and upcoming implementation steps in relation to the pillars. Pillar One – Reallocation of Taxing Rights Pillar One is an update to the framework that underlies current tax treaties, which allocates the income of MNEs between countries for tax purposes. The existing framework relies on principles of connection with a country based on physical presence that were designed for traditional bricks-and-mortar businesses; they do not produce appropriate results in today’s digitalized economy. Pillar One instead uses a broader test of connection and a formulary allocation of residual profits to ensure that the largest and most profitable MNEs pay a fair share of tax in the countries where their users and customers are located. The government is working with its international partners in an OECD-led process to develop the model rules and the multilateral convention needed to establish this new multilateral tax framework and bring it into effect. To help ensure that the final rules will be effective and administrable, the OECD has been releasing draft model rules for public comment as each element reaches maturity. The draft rules were consolidated in two major progress reports released in July and October of 2022. Countries are working toward completing multilateral negotiations so that the convention to implement Pillar One can be signed by mid-2023, with a view to it entering into force in 2024. To ensure that Canadians' interests are protected, the government released draft legislative proposals for a Digital Services Tax (DST) in December 2021. The government intends to release a revised draft of the legislative proposals for public comment before introducing a bill in Parliament. Consistent with the October 2021 Statement, the DST could be imposed as of January 1, 2024, but only if the multilateral convention implementing the Pillar One framework has not come into force. In that event, the DST would be payable as of 2024 in respect of revenues earned as of January 1, 2022. It remains the government’s hope and underlying assumption that the timely implementation of the new multilateral framework will make this unnecessary. Pillar Two – Global Minimum Tax Pillar Two is a multilateral framework for a global minimum tax regime that is designed to ensure that MNEs with annual revenues of €750 million or more are subject to a minimum effective tax rate of 15 per cent on their profits in every jurisdiction in which they operate. It is intended to reduce the incentive for MNEs to shift profits into low-tax jurisdictions and, at the same time, end the “race to the bottom” in international corporate taxation by setting a floor on tax competition. The primary charging rule for Pillar Two is known as the Income Inclusion Rule (IIR). In general terms, if the jurisdiction where the ultimate parent entity of an MNE is located has implemented the IIR, it has the primary right to impose a top-up tax on the ultimate parent entity with respect to income from the MNE’s operations in any jurisdiction where it is taxed at an effective tax rate below 15 per cent. Pillar Two also contains a “backstop” rule, known as the Undertaxed Profits Rule (UTPR). If a parent jurisdiction of an MNE has not implemented the IIR, other jurisdictions in which the MNE operates that have implemented the UTPR would impose the top-up tax on the group entities located in their jurisdiction, with the top-up tax being allocated among those jurisdictions on a formulary basis. This ensures that MNEs whose parent entities are located in non-implementing jurisdictions are nonetheless subject to top-up tax in respect of their low-taxed income. The details of the IIR and UTPR are set out in the model rules (the Global Anti-Base Erosion or GloBE Rules), and related commentary and administrative guidance, all agreed by the Inclusive Framework. The Pillar Two framework contemplates that a jurisdiction may enact a domestic minimum top-up tax that would apply a top-up tax on low-taxed income of its domestic entities. If such a tax is designed to achieve the intended outcomes under Pillar Two, it is treated as a “qualified” domestic minimum top-up tax and is creditable dollar-for-dollar against the top-up tax liability that would otherwise arise under Pillar Two. In effect, this allows a jurisdiction to collect the top-up tax applicable to any low-taxed income of its domestic entities, rather than allowing the top-up tax to accrue to the treasuries of other countries under the IIR or UTPR. A more detailed outline of the Pillar Two framework is set out in the Supplementary Information to Budget 2022 (https://www.budget.canada.ca/2022/report-rapport/tm-mf-en.html#a4), which launched a public consultation on the implementation of Pillar Two in Canada, which ended on July 7, 2022. USER: Explain the rationale behind the global minimum tax on multinational enterprises for Canadian businesses as outlined in the context document. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	true	32	20	931	null	157
Do not use any external knowledge, base your answers only on the provided context block. Your role is to explain legal concepts in an easily accessible manner. Do not use pleasantries or filler text, answer the user’s question directly.	Tell me about NetChoice's legal battle over H.B. 20.	NetChoice’s Challenge to Florida’s S.B. 7072 Florida’s S.B. 7072 imposes restrictions on any information service, system, Internet search engine, or access software provider that enables access by multiple users to a computer server, is organized as a legal entity, does business in Florida, and satisfies certain specified user- or revenue-based thresholds. Thus, while the litigation about the law emphasized the limitations it imposed on social media platforms, the law applied more broadly. NetChoice challenged restrictions that generally fall into two categories: content moderation restrictions and individualized-explanation requirements. The Supreme Court’s analysis in Moody focused on the content moderation restrictions. Those provisions limit the ability of covered platforms to delete content, make content less visible to other users, or ban users. Under S.B. 7072, platforms may not “deplatform” a political candidate or deprioritize a candidate’s or “journalistic enterprise’s” posts. They must “apply censorship, deplatforming, and shadow banning standards in a consistent manner,” and they cannot change the rules or terms that apply to users more than once every 30 days. Deplatforming occurs when a platform bans a user for at least 14 days. Shadow banning occurs when a platform deletes a user’s content or makes the account’s content less visible to other users. Before S.B. 7072 took effect, NetChoice sued, alleging that the content moderation provisions, on their face, violate the First Amendment. The U.S. Court of Appeals for the Eleventh Circuit affirmed a preliminary injunction barring enforcement of the content moderation provisions while NetChoice’s challenge is litigated. The court held that the provisions likely “trigger[] First Amendment scrutiny because [S.B. 7072] restricts social-media platforms’ exercise of editorial judgment.” It decided that the challenged provisions likely fail constitutional scrutiny because they lack a “substantial or compelling interest that would justify [the provisions’] significant restrictions on platforms’ editorial judgment.” NetChoice’s Challenge to Texas’s H.B. 20 Texas’s H.B. 20 applies to social media platforms with more than 50 million monthly active users in the United States. The law defines social media platforms as public websites or applications that enable users to create accounts and communicate for the primary purpose of posting user-generated information. Internet service providers, email providers, and websites “that consist primarily of news, sports, entertainment, or other” content that is not user generated are excluded from the definition. As with Florida’s law, H.B. 20 limits when covered platforms may delete or restrict access to user-posted content. Subject to enumerated exceptions, covered platforms are prohibited from censoring a user’s content based on viewpoint or the user’s geographic location in Texas. Censor is defined to mean “block[ing], ban[ning], remove[ing], deplatform[ing], demonetiz[ing], de-boost[ing], restrict[ing], deny[ing] equal access or visibility to, or otherwise discriminat[ing] against expression.” Again, NetChoice challenged H.B. 20’s content moderation provisions on their face and asked a court to enjoin their enforcement before the law took effect. The U.S. Court of Appeals for the Fifth Circuit denied the request. Expressly disagreeing with the Eleventh Circuit’s reasoning about Florida’s law, the Fifth Circuit held that Texas’s content moderation provisions do not likely implicate First Amendment rights. According to the Fifth Circuit, NetChoice was seeking to assert a “right to censor what people say” that is not protected by the First Amendment. In the alternative, the court held that, even if the law restricted protected expression, it is a content- and viewpoint-neutral law—so subject to intermediate scrutiny—and Texas’s interest in protecting the free exchange of ideas is sufficiently important to satisfy that standard.	Do not use any external knowledge, base your answers only on the provided context block. Your role is to explain legal concepts in an easily accessible manner. Do not use pleasantries or filler text, answer the user’s question directly. NetChoice’s Challenge to Florida’s S.B. 7072 Florida’s S.B. 7072 imposes restrictions on any information service, system, Internet search engine, or access software provider that enables access by multiple users to a computer server, is organized as a legal entity, does business in Florida, and satisfies certain specified user- or revenue-based thresholds. Thus, while the litigation about the law emphasized the limitations it imposed on social media platforms, the law applied more broadly. NetChoice challenged restrictions that generally fall into two categories: content moderation restrictions and individualized-explanation requirements. The Supreme Court’s analysis in Moody focused on the content moderation restrictions. Those provisions limit the ability of covered platforms to delete content, make content less visible to other users, or ban users. Under S.B. 7072, platforms may not “deplatform” a political candidate or deprioritize a candidate’s or “journalistic enterprise’s” posts. They must “apply censorship, deplatforming, and shadow banning standards in a consistent manner,” and they cannot change the rules or terms that apply to users more than once every 30 days. Deplatforming occurs when a platform bans a user for at least 14 days. Shadow banning occurs when a platform deletes a user’s content or makes the account’s content less visible to other users. Before S.B. 7072 took effect, NetChoice sued, alleging that the content moderation provisions, on their face, violate the First Amendment. The U.S. Court of Appeals for the Eleventh Circuit affirmed a preliminary injunction barring enforcement of the content moderation provisions while NetChoice’s challenge is litigated. The court held that the provisions likely “trigger[] First Amendment scrutiny because [S.B. 7072] restricts social-media platforms’ exercise of editorial judgment.” It decided that the challenged provisions likely fail constitutional scrutiny because they lack a “substantial or compelling interest that would justify [the provisions’] significant restrictions on platforms’ editorial judgment.” NetChoice’s Challenge to Texas’s H.B. 20 Texas’s H.B. 20 applies to social media platforms with more than 50 million monthly active users in the United States. The law defines social media platforms as public websites or applications that enable users to create accounts and communicate for the primary purpose of posting user-generated information. Internet service providers, email providers, and websites “that consist primarily of news, sports, entertainment, or other” content that is not user generated are excluded from the definition. As with Florida’s law, H.B. 20 limits when covered platforms may delete or restrict access to user-posted content. Subject to enumerated exceptions, covered platforms are prohibited from censoring a user’s content based on viewpoint or the user’s geographic location in Texas. Censor is defined to mean “block[ing], ban[ning], remove[ing], deplatform[ing], demonetiz[ing], de-boost[ing], restrict[ing], deny[ing] equal access or visibility to, or otherwise discriminat[ing] against expression.” Again, NetChoice challenged H.B. 20’s content moderation provisions on their face and asked a court to enjoin their enforcement before the law took effect. The U.S. Court of Appeals for the Fifth Circuit denied the request. Expressly disagreeing with the Eleventh Circuit’s reasoning about Florida’s law, the Fifth Circuit held that Texas’s content moderation provisions do not likely implicate First Amendment rights. According to the Fifth Circuit, NetChoice was seeking to assert a “right to censor what people say” that is not protected by the First Amendment. In the alternative, the court held that, even if the law restricted protected expression, it is a content- and viewpoint-neutral law—so subject to intermediate scrutiny—and Texas’s interest in protecting the free exchange of ideas is sufficiently important to satisfy that standard. Tell me about NetChoice's legal battle over H.B. 20.	Do not use any external knowledge, base your answers only on the provided context block. Your role is to explain legal concepts in an easily accessible manner. Do not use pleasantries or filler text, answer the user’s question directly. EVIDENCE: NetChoice’s Challenge to Florida’s S.B. 7072 Florida’s S.B. 7072 imposes restrictions on any information service, system, Internet search engine, or access software provider that enables access by multiple users to a computer server, is organized as a legal entity, does business in Florida, and satisfies certain specified user- or revenue-based thresholds. Thus, while the litigation about the law emphasized the limitations it imposed on social media platforms, the law applied more broadly. NetChoice challenged restrictions that generally fall into two categories: content moderation restrictions and individualized-explanation requirements. The Supreme Court’s analysis in Moody focused on the content moderation restrictions. Those provisions limit the ability of covered platforms to delete content, make content less visible to other users, or ban users. Under S.B. 7072, platforms may not “deplatform” a political candidate or deprioritize a candidate’s or “journalistic enterprise’s” posts. They must “apply censorship, deplatforming, and shadow banning standards in a consistent manner,” and they cannot change the rules or terms that apply to users more than once every 30 days. Deplatforming occurs when a platform bans a user for at least 14 days. Shadow banning occurs when a platform deletes a user’s content or makes the account’s content less visible to other users. Before S.B. 7072 took effect, NetChoice sued, alleging that the content moderation provisions, on their face, violate the First Amendment. The U.S. Court of Appeals for the Eleventh Circuit affirmed a preliminary injunction barring enforcement of the content moderation provisions while NetChoice’s challenge is litigated. The court held that the provisions likely “trigger[] First Amendment scrutiny because [S.B. 7072] restricts social-media platforms’ exercise of editorial judgment.” It decided that the challenged provisions likely fail constitutional scrutiny because they lack a “substantial or compelling interest that would justify [the provisions’] significant restrictions on platforms’ editorial judgment.” NetChoice’s Challenge to Texas’s H.B. 20 Texas’s H.B. 20 applies to social media platforms with more than 50 million monthly active users in the United States. The law defines social media platforms as public websites or applications that enable users to create accounts and communicate for the primary purpose of posting user-generated information. Internet service providers, email providers, and websites “that consist primarily of news, sports, entertainment, or other” content that is not user generated are excluded from the definition. As with Florida’s law, H.B. 20 limits when covered platforms may delete or restrict access to user-posted content. Subject to enumerated exceptions, covered platforms are prohibited from censoring a user’s content based on viewpoint or the user’s geographic location in Texas. Censor is defined to mean “block[ing], ban[ning], remove[ing], deplatform[ing], demonetiz[ing], de-boost[ing], restrict[ing], deny[ing] equal access or visibility to, or otherwise discriminat[ing] against expression.” Again, NetChoice challenged H.B. 20’s content moderation provisions on their face and asked a court to enjoin their enforcement before the law took effect. The U.S. Court of Appeals for the Fifth Circuit denied the request. Expressly disagreeing with the Eleventh Circuit’s reasoning about Florida’s law, the Fifth Circuit held that Texas’s content moderation provisions do not likely implicate First Amendment rights. According to the Fifth Circuit, NetChoice was seeking to assert a “right to censor what people say” that is not protected by the First Amendment. In the alternative, the court held that, even if the law restricted protected expression, it is a content- and viewpoint-neutral law—so subject to intermediate scrutiny—and Texas’s interest in protecting the free exchange of ideas is sufficiently important to satisfy that standard. USER: Tell me about NetChoice's legal battle over H.B. 20. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	39	9	569	null	205
Only use the information above to answer the question. Do not use any outside sources. If you cannot answer the question with the information provided say "I cannot answer without further research." The response should be written in paragraph form unless the answer would be more beneficial in markdown format. Please answer in a simple manner that is easy for the average person to understand.	According to the information provided, Rule 1004.2 in Chapter 15 Cases, who can file a motion for a determination that the debtor’s center of main interests is other than as stated in the petition for recognition commencing the Chapter 15 case, and when should this motion be filed?	FEDERAL RULES OF BANKRUPTCY PROCEDURE Effective August 1, 1983, as amended to December 1, 2017 Rule 1001. Scope of Rules and Forms; Short Title The Bankruptcy Rules and Forms govern procedure in cases under title 11 of the United States Code. The rules shall be cited as the Federal Rules of Bankruptcy Procedure and the forms as the Official Bankruptcy Forms. These rules shall be construed, administered, and employed by the court and the parties to secure the just, speedy, and inexpensive determination of every case and proceeding. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 27, 2017, eff. Dec. 1, 2017.) PART I—COMMENCEMENT OF CASE; PROCEEDINGS RELATING TO PETITION AND ORDER FOR RELIEF Rule 1002. Commencement of Case (a) PETITION. A petition commencing a case under the Code shall be filed with the clerk. (b) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall forthwith transmit to the United States trustee a copy of the petition filed pursuant to subdivision (a) of this rule. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1003. Involuntary Petition (a) TRANSFEROR OR TRANSFEREE OF CLAIM. A transferor or transferee of a claim shall annex to the original and each copy of the petition a copy of all documents evidencing the transfer, whether transferred unconditionally, for security, or otherwise, and a signed statement that the claim was not transferred for the purpose of commencing the case and setting forth the consideration for and terms of the transfer. An entity that has transferred or acquired a claim for the purpose of commencing a case for liquidation under chapter 7 or for reorganization under chapter 11 shall not be a qualified petitioner. (b) JOINDER OF PETITIONERS AFTER FILING. If the answer to an involuntary petition filed by fewer than three creditors avers the existence of 12 or more creditors, the debtor shall file with the answer a list of all creditors with their addresses, a brief statement of the nature of their claims, and the amounts thereof. If it appears that there are 12 or more creditors as provided in § 303(b) of the Code, the court shall afford a reasonable opportunity for other creditors to join in the petition before a hearing is held thereon. (As amended Mar. 30, 1987, eff. Aug. 1, 1987.) Rule 1004. Involuntary Petition Against a Partnership After filing of an involuntary petition under § 303(b)(3) of the Code, (1) the petitioning partners or other petitioners shall promptly send to or serve on each general partner who is not a petitioner a copy of the petition; and (2) the clerk shall promptly issue a summons for service on each general partner who is not a petitioner. Rule 1010 applies to the form and service of the summons. (As amended Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 1004.1. Petition for an Infant or Incompetent Person If an infant or incompetent person has a representative, including a general guardian, committee, conservator, or similar fiduciary, the representative may file a voluntary petition on behalf of the infant or incompetent person. An infant or incompetent person who does not have a duly appointed representative may file a voluntary petition by next friend or guardian ad litem. The court shall appoint a guardian ad litem for an infant or incompetent person who is a debtor and is not otherwise represented or shall make any other order to protect the infant or incompetent debtor. (Added Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 1004.2. Petition in Chapter 15 Cases (a) DESIGNATING CENTER OF MAIN INTERESTS. A petition for recognition of a foreign proceeding under chapter 15 of the Code shall state the country where the debtor has its center of main interests. The petition shall also identify each country in which a foreign proceeding by, regarding, or against the debtor is pending. (b) CHALLENGING DESIGNATION. The United States trustee or a party in interest may file a motion for a determination that the debtor’s center of main interests is other than as stated in the petition for recognition commencing the chapter 15 case. Unless the court orders otherwise, the motion shall be filed no later than seven days before the date set for the hearing on the petition. The motion shall be transmitted to the United States trustee and served on the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor was a party as of the time the petition was filed, and such other entities as the court may direct. (Added Apr. 26, 2011, eff. Dec. 1, 2011.) Rule 1005. Caption of Petition The caption of a petition commencing a case under the Code shall contain the name of the court, the title of the case, and the docket number. The title of the case shall include the following information about the debtor: name, employer identification number, last four digits of the social-security number or individual debtor’s taxpayer-identification number, any other federal taxpayer-identification number, and all other names used within eight years before filing the petition. If the petition is not filed by 3 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 the debtor, it shall include all names used by the debtor which are known to the petitioners. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1006. Filing Fee (a) GENERAL REQUIREMENT. Every petition shall be accompanied by the filing fee except as provided in subdivisions (b) and (c) of this rule. For the purpose of this rule, ‘‘filing fee’’ means the filing fee prescribed by 28 U.S.C. § 1930(a)(1)–(a)(5) and any other fee prescribed by the Judicial Conference of the United States under 28 U.S.C. § 1930(b) that is payable to the clerk upon the commencement of a case under the Code. (b) PAYMENT OF FILING FEE IN INSTALLMENTS. (1) Application to Pay Filing Fee in Installments. A voluntary petition by an individual shall be accepted for filing, regardless of whether any portion of the filing fee is paid, if accompanied by the debtor’s signed application, prepared as prescribed by the appropriate Official Form, stating that the debtor is unable to pay the filing fee except in installments. (2) Action on Application. Prior to the meeting of creditors, the court may order the filing fee paid to the clerk or grant leave to pay in installments and fix the number, amount and dates of payment. The number of installments shall not exceed four, and the final installment shall be payable not later than 120 days after filing the petition. For cause shown, the court may extend the time of any installment, provided the last installment is paid not later than 180 days after filing the petition. (3) Postponement of Attorney’s Fees. All installments of the filing fee must be paid in full before the debtor or chapter 13 trustee may make further payments to an attorney or any other person who renders services to the debtor in connection with the case. (c) WAIVER OF FILING FEE. A voluntary chapter 7 petition filed by an individual shall be accepted for filing if accompanied by the debtor’s application requesting a waiver under 28 U.S.C. § 1930(f), prepared as prescribed by the appropriate Official Form. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 27, 2017, eff. Dec. 1, 2017.) Rule 1007. Lists, Schedules, Statements, and Other Documents; Time Limits (a) CORPORATE OWNERSHIP STATEMENT, LIST OF CREDITORS AND EQUITY SECURITY HOLDERS, AND OTHER LISTS. (1) Voluntary Case. In a voluntary case, the debtor shall file with the petition a list containing the name and address of each entity included or to be included on Schedules D, E/F, G, and H as prescribed by the Official Forms. If the debtor is a corporation, other than a governmental unit, the debtor shall file with the petition a corporate ownership statement containing the information described in Rule 7007.1. The debtor shall file a supplemental statement promptly upon any change in circumstances that renders the corporate ownership statement inaccurate. Rule 1007 FEDERAL RULES OF BANKRUPTCY PROCEDURE 4 (2) Involuntary Case. In an involuntary case, the debtor shall file, within seven days after entry of the order for relief, a list containing the name and address of each entity included or to be included on Schedules D, E/F, G, and H as prescribed by the Official Forms. (3) Equity Security Holders. In a chapter 11 reorganization case, unless the court orders otherwise, the debtor shall file within 14 days after entry of the order for relief a list of the debtor’s equity security holders of each class showing the number and kind of interests registered in the name of each holder, and the last known address or place of business of each holder. (4) Chapter 15 Case. In addition to the documents required under § 1515 of the Code, a foreign representative filing a petition for recognition under chapter 15 shall file with the petition: (A) a corporate ownership statement containing the information described in Rule 7007.1; and (B) unless the court orders otherwise, a list containing the names and addresses of all persons or bodies authorized to administer foreign proceedings of the debtor, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and all entities against whom provisional relief is being sought under § 1519 of the Code. (5) Extension of Time. Any extension of time for the filing of the lists required by this subdivision may be granted only on motion for cause shown and on notice to the United States trustee and to any trustee, committee elected under § 705 or appointed under § 1102 of the Code, or other party as the court may direct. (b) SCHEDULES, STATEMENTS, AND OTHER DOCUMENTS REQUIRED. (1) Except in a chapter 9 municipality case, the debtor, unless the court orders otherwise, shall file the following schedules, statements, and other documents, prepared as prescribed by the appropriate Official Forms, if any: (A) schedules of assets and liabilities; (B) a schedule of current income and expenditures; (C) a schedule of executory contracts and unexpired leases; (D) a statement of financial affairs; (E) copies of all payment advices or other evidence of payment, if any, received by the debtor from an employer within 60 days before the filing of the petition, with redaction of all but the last four digits of the debtor’s social-security number or individual taxpayer-identification number; and (F) a record of any interest that the debtor has in an account or program of the type specified in § 521(c) of the Code. (2) An individual debtor in a chapter 7 case shall file a statement of intention as required by § 521(a) of the Code, prepared as prescribed by the appropriate Official Form. A copy of the statement of intention shall be served on the trustee and the creditors named in the statement on or before the filing of the statement. 5 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 (3) Unless the United States trustee has determined that the credit counseling requirement of § 109(h) does not apply in the district, an individual debtor must file a statement of compliance with the credit counseling requirement, prepared as prescribed by the appropriate Official Form which must include one of the following: (A) an attached certificate and debt repayment plan, if any, required by § 521(b); (B) a statement that the debtor has received the credit counseling briefing required by § 109(h)(1) but does not have the certificate required by § 521(b); (C) a certification under § 109(h)(3); or (D) a request for a determination by the court under § 109(h)(4). (4) Unless § 707(b)(2)(D) applies, an individual debtor in a chapter 7 case shall file a statement of current monthly income prepared as prescribed by the appropriate Official Form, and, if the current monthly income exceeds the median family income for the applicable state and household size, the information, including calculations, required by § 707(b), prepared as prescribed by the appropriate Official Form. (5) An individual debtor in a chapter 11 case shall file a statement of current monthly income, prepared as prescribed by the appropriate Official Form. (6) A debtor in a chapter 13 case shall file a statement of current monthly income, prepared as prescribed by the appropriate Official Form, and, if the current monthly income exceeds the median family income for the applicable state and household size, a calculation of disposable income made in accordance with § 1325(b)(3), prepared as prescribed by the appropriate Official Form. (7) Unless an approved provider of an instructional course concerning personal financial management has notified the court that a debtor has completed the course after filing the petition: (A) An individual debtor in a chapter 7 or chapter 13 case shall file a statement of completion of the course, prepared as prescribed by the appropriate Official Form; and (B) An individual debtor in a chapter 11 case shall file the statement if § 1141(d)(3) applies. (8) If an individual debtor in a chapter 11, 12, or 13 case has claimed an exemption under § 522(b)(3)(A) in property of the kind described in § 522(p)(1) with a value in excess of the amount set out in § 522(q)(1), the debtor shall file a statement as to whether there is any proceeding pending in which the debtor may be found guilty of a felony of a kind described in § 522(q)(1)(A) or found liable for a debt of the kind described in § 522(q)(1)(B). (c) TIME LIMITS. In a voluntary case, the schedules, statements, and other documents required by subdivision (b)(1), (4), (5), and (6) shall be filed with the petition or within 14 days thereafter, except as otherwise provided in subdivisions (d), (e), (f), and (h) of this rule. In an involuntary case, the schedules, statements, and other Rule 1007 FEDERAL RULES OF BANKRUPTCY PROCEDURE 6 1So in original. Probably should be only one section symbol. documents required by subdivision (b)(1) shall be filed by the debtor within 14 days after the entry of the order for relief. In a voluntary case, the documents required by paragraphs (A), (C), and (D) of subdivision (b)(3) shall be filed with the petition. Unless the court orders otherwise, a debtor who has filed a statement under subdivision (b)(3)(B), shall file the documents required by subdivision (b)(3)(A) within 14 days of the order for relief. In a chapter 7 case, the debtor shall file the statement required by subdivision (b)(7) within 60 days after the first date set for the meeting of creditors under § 341 of the Code, and in a chapter 11 or 13 case no later than the date when the last payment was made by the debtor as required by the plan or the filing of a motion for a discharge under § 1141(d)(5)(B) or § 1328(b) of the Code. The court may, at any time and in its discretion, enlarge the time to file the statement required by subdivision (b)(7). The debtor shall file the statement required by subdivision (b)(8) no earlier than the date of the last payment made under the plan or the date of the filing of a motion for a discharge under §§ 1141(d)(5)(B),1 1228(b), or 1328(b) of the Code. Lists, schedules, statements, and other documents filed prior to the conversion of a case to another chapter shall be deemed filed in the converted case unless the court directs otherwise. Except as provided in § 1116(3), any extension of time to file schedules, statements, and other documents required under this rule may be granted only on motion for cause shown and on notice to the United States trustee, any committee elected under § 705 or appointed under § 1102 of the Code, trustee, examiner, or other party as the court may direct. Notice of an extension shall be given to the United States trustee and to any committee, trustee, or other party as the court may direct. (d) LIST OF 20 LARGEST CREDITORS IN CHAPTER 9 MUNICIPALITY CASE OR CHAPTER 11 REORGANIZATION CASE. In addition to the list required by subdivision (a) of this rule, a debtor in a chapter 9 municipality case or a debtor in a voluntary chapter 11 reorganization case shall file with the petition a list containing the name, address and claim of the creditors that hold the 20 largest unsecured claims, excluding insiders, as prescribed by the appropriate Official Form. In an involuntary chapter 11 reorganization case, such list shall be filed by the debtor within 2 days after entry of the order for relief under § 303(h) of the Code. (e) LIST IN CHAPTER 9 MUNICIPALITY CASES. The list required by subdivision (a) of this rule shall be filed by the debtor in a chapter 9 municipality case within such time as the court shall fix. If a proposed plan requires a revision of assessments so that the proportion of special assessments or special taxes to be assessed against some real property will be different from the proportion in effect at the date the petition is filed, the debtor shall also file a list showing the name and address of each known holder of title, legal or equitable, to real property adversely affected. On motion for cause shown, the court may modify the requirements of this subdivision and subdivision (a) of this rule. 7 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 (f) STATEMENT OF SOCIAL SECURITY NUMBER. An individual debtor shall submit a verified statement that sets out the debtor’s social security number, or states that the debtor does not have a social security number. In a voluntary case, the debtor shall submit the statement with the petition. In an involuntary case, the debtor shall submit the statement within 14 days after the entry of the order for relief. (g) PARTNERSHIP AND PARTNERS. The general partners of a debtor partnership shall prepare and file the list required under subdivision (a), schedules of the assets and liabilities, schedule of current income and expenditures, schedule of executory contracts and unexpired leases, and statement of financial affairs of the partnership. The court may order any general partner to file a statement of personal assets and liabilities within such time as the court may fix. (h) INTERESTS ACQUIRED OR ARISING AFTER PETITION. If, as provided by § 541(a)(5) of the Code, the debtor acquires or becomes entitled to acquire any interest in property, the debtor shall within 14 days after the information comes to the debtor’s knowledge or within such further time the court may allow, file a supplemental schedule in the chapter 7 liquidation case, chapter 11 reorganization case, chapter 12 family farmer’s debt adjustment case, or chapter 13 individual debt adjustment case. If any of the property required to be reported under this subdivision is claimed by the debtor as exempt, the debtor shall claim the exemptions in the supplemental schedule. The duty to file a supplemental schedule in accordance with this subdivision continues notwithstanding the closing of the case, except that the schedule need not be filed in a chapter 11, chapter 12, or chapter 13 case with respect to property acquired after entry of the order confirming a chapter 11 plan or discharging the debtor in a chapter 12 or chapter 13 case. (i) DISCLOSURE OF LIST OF SECURITY HOLDERS. After notice and hearing and for cause shown, the court may direct an entity other than the debtor or trustee to disclose any list of security holders of the debtor in its possession or under its control, indicating the name, address and security held by any of them. The entity possessing this list may be required either to produce the list or a true copy thereof, or permit inspection or copying, or otherwise disclose the information contained on the list. (j) IMPOUNDING OF LISTS. On motion of a party in interest and for cause shown the court may direct the impounding of the lists filed under this rule, and may refuse to permit inspection by any entity. The court may permit inspection or use of the lists, however, by any party in interest on terms prescribed by the court. (k) PREPARATION OF LIST, SCHEDULES, OR STATEMENTS ON DEFAULT OF DEBTOR. If a list, schedule, or statement, other than a statement of intention, is not prepared and filed as required by this rule, the court may order the trustee, a petitioning creditor, committee, or other party to prepare and file any of these papers within a time fixed by the court. The court may approve reimbursement of the cost incurred in complying with such an order as an administrative expense. (l) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall forthwith transmit to the United States trustee a copy of every list, schedule, and statement filed pursuant to subdivision (a)(1), (a)(2), (b), (d), or (h) of this rule. (m) INFANTS AND INCOMPETENT PERSONS. If the debtor knows that a person on the list of creditors or schedules is an infant or incompetent person, the debtor also shall include the name, address, and legal relationship of any person upon whom process would be served in an adversary proceeding against the infant or incompetent person in accordance with Rule 7004(b)(2). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 23, 2001, eff. Dec. 1, 2001; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 25, 2005, eff. Dec. 1, 2005; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 23, 2012, eff. Dec. 1, 2012: Apr. 16, 2013, eff. Dec. 1, 2013; Apr. 29, 2015, eff. Dec. 1, 2015.) Rule 1008. Verification of Petitions and Accompanying Papers All petitions, lists, schedules, statements and amendments thereto shall be verified or contain an unsworn declaration as provided in 28 U.S.C. § 1746. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1009. Amendments of Voluntary Petitions, Lists, Schedules and Statements (a) GENERAL RIGHT TO AMEND. A voluntary petition, list, schedule, or statement may be amended by the debtor as a matter of course at any time before the case is closed. The debtor shall give notice of the amendment to the trustee and to any entity affected thereby. On motion of a party in interest, after notice and a hearing, the court may order any voluntary petition, list, schedule, or statement to be amended and the clerk shall give notice of the amendment to entities designated by the court. (b) STATEMENT OF INTENTION. The statement of intention may be amended by the debtor at any time before the expiration of the period provided in § 521(a) of the Code. The debtor shall give notice of the amendment to the trustee and to any entity affected thereby. (c) STATEMENT OF SOCIAL SECURITY NUMBER. If a debtor becomes aware that the statement of social security number submitted under Rule 1007(f) is incorrect, the debtor shall promptly submit an amended verified statement setting forth the correct social security number. The debtor shall give notice of the amendment to all of the entities required to be included on the list filed under Rule 1007(a)(1) or (a)(2). (d) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall promptly transmit to the United States trustee a copy of every amendment filed or submitted under subdivision (a), (b), or (c) of this rule. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 12, 2006, eff. Dec. 1, 2006; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1010. Service of Involuntary Petition and Summons (a) SERVICE OF INVOLUNTARY PETITION AND SUMMONS. On the filing of an involuntary petition, the clerk shall forthwith issue a summons for service. When an involuntary petition is filed, service shall be made on the debtor. The summons shall be served with a copy of the petition in the manner provided for service of a summons and complaint by Rule 7004(a) or (b). If service cannot be so made, the court may order that the summons and petition be served by mailing copies to the party’s last known address, and by at least one publication in a manner and form directed by the court. The summons and petition may be served on the party anywhere. Rule 7004(e) and Rule 4(l) F.R.Civ.P. apply when service is made or attempted under this rule. (b) CORPORATE OWNERSHIP STATEMENT. Each petitioner that is a corporation shall file with the involuntary petition a corporate ownership statement containing the information described in Rule 7007.1. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1011. Responsive Pleading or Motion in Involuntary Cases (a) WHO MAY CONTEST PETITION. The debtor named in an involuntary petition may contest the petition. In the case of a petition against a partnership under Rule 1004, a nonpetitioning general partner, or a person who is alleged to be a general partner but denies the allegation, may contest the petition. (b) DEFENSES AND OBJECTIONS; WHEN PRESENTED. Defenses and objections to the petition shall be presented in the manner prescribed by Rule 12 F.R.Civ.P. and shall be filed and served within 21 days after service of the summons, except that if service is made by publication on a party or partner not residing or found within the state in which the court sits, the court shall prescribe the time for filing and serving the response. (c) EFFECT OF MOTION. Service of a motion under Rule 12(b) F.R.Civ.P. shall extend the time for filing and serving a responsive pleading as permitted by Rule 12(a) F.R.Civ.P. (d) CLAIMS AGAINST PETITIONERS. A claim against a petitioning creditor may not be asserted in the answer except for the purpose of defeating the petition. (e) OTHER PLEADINGS. No other pleadings shall be permitted, except that the court may order a reply to an answer and prescribe the time for filing and service. (f) CORPORATE OWNERSHIP STATEMENT. If the entity responding to the involuntary petition is a corporation, the entity shall file with its first appearance, pleading, motion, response, or other request addressed to the court a corporate ownership statement containing the information described in Rule 7007.1. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 26, 2004, eff. Dec. 1, 2004; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1012. Responsive Pleading in Cross-Border Cases (a) WHO MAY CONTEST PETITION. The debtor or any party in interest may contest a petition for recognition of a foreign proceeding. (b) OBJECTIONS AND RESPONSES; WHEN PRESENTED. Objections and other responses to the petition shall be presented no later Rule 1013 FEDERAL RULES OF BANKRUPTCY PROCEDURE 10 than seven days before the date set for the hearing on the petition, unless the court prescribes some other time or manner for responses. (c) CORPORATE OWNERSHIP STATEMENT. If the entity responding to the petition is a corporation, then the entity shall file a corporate ownership statement containing the information described in Rule 7007.1 with its first appearance, pleading, motion, response, or other request addressed to the court. (Added Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1013. Hearing and Disposition of a Petition in an Involuntary Case (a) CONTESTED PETITION. The court shall determine the issues of a contested petition at the earliest practicable time and forthwith enter an order for relief, dismiss the petition, or enter any other appropriate order. (b) DEFAULT. If no pleading or other defense to a petition is filed within the time provided by Rule 1011, the court, on the next day, or as soon thereafter as practicable, shall enter an order for the relief requested in the petition. [(c) ORDER FOR RELIEF] (Abrogated Apr. 22, 1993, eff. Aug. 1, 1993) (As amended Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993.) Rule 1014. Dismissal and Change of Venue (a) DISMISSAL AND TRANSFER OF CASES. (1) Cases Filed in Proper District. If a petition is filed in the proper district, the court, on the timely motion of a party in interest or on its own motion, and after hearing on notice to the petitioners, the United States trustee, and other entities as directed by the court, may transfer the case to any other district if the court determines that the transfer is in the interest of justice or for the convenience of the parties. (2) Cases Filed in Improper District. If a petition is filed in an improper district, the court, on the timely motion of a party in interest or on its own motion, and after hearing on notice to the petitioners, the United States trustee, and other entities as directed by the court, may dismiss the case or transfer it to any other district if the court determines that transfer is in the interest of justice or for the convenience of the parties. (b) PROCEDURE WHEN PETITIONS INVOLVING THE SAME DEBTOR OR RELATED DEBTORS ARE FILED IN DIFFERENT COURTS. If petitions commencing cases under the Code or seeking recognition under chapter 15 are filed in different districts by, regarding, or against (1) the same debtor, (2) a partnership and one or more of its general partners, (3) two or more general partners, or (4) a debtor and an affiliate, the court in the district in which the first-filed petition is pending may determine, in the interest of justice or for the convenience of the parties, the district or districts in which any of the cases should proceed. The court may so determine on motion and after a hearing, with notice to the following entities in the affected cases: the United States trustee, entities entitled to notice under Rule 2002(a), and other entities as the court directs. 11 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1017 The court may order the parties to the later-filed cases not to proceed further until it makes the determination. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 30, 2007, eff. Dec. 1, 2007; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 25, 2014, eff. Dec. 1, 2014.) Rule 1015. Consolidation or Joint Administration of Cases Pending in Same Court (a) CASES INVOLVING SAME DEBTOR. If two or more petitions by, regarding, or against the same debtor are pending in the same court, the court may order consolidation of the cases. (b) CASES INVOLVING TWO OR MORE RELATED DEBTORS. If a joint petition or two or more petitions are pending in the same court by or against (1) spouses, or (2) a partnership and one or more of its general partners, or (3) two or more general partners, or (4) a debtor and an affiliate, the court may order a joint administration of the estates. Prior to entering an order the court shall give consideration to protecting creditors of different estates against potential conflicts of interest. An order directing joint administration of individual cases of spouses shall, if one spouse has elected the exemptions under § 522(b)(2) of the Code and the other has elected the exemptions under § 522(b)(3), fix a reasonable time within which either may amend the election so that both shall have elected the same exemptions. The order shall notify the debtors that unless they elect the same exemptions within the time fixed by the court, they will be deemed to have elected the exemptions provided by § 522(b)(2). (c) EXPEDITING AND PROTECTIVE ORDERS. When an order for consolidation or joint administration of a joint case or two or more cases is entered pursuant to this rule, while protecting the rights of the parties under the Code, the court may enter orders as may tend to avoid unnecessary costs and delay. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 27, 2017, eff. Dec. 1, 2017.) Rule 1016. Death or Incompetency of Debtor Death or incompetency of the debtor shall not abate a liquidation case under chapter 7 of the Code. In such event the estate shall be administered and the case concluded in the same manner, so far as possible, as though the death or incompetency had not occurred. If a reorganization, family farmer’s debt adjustment, or individual’s debt adjustment case is pending under chapter 11, chapter 12, or chapter 13, the case may be dismissed; or if further administration is possible and in the best interest of the parties, the case may proceed and be concluded in the same manner, so far as possible, as though the death or incompetency had not occurred. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1017. Dismissal or Conversion of Case; Suspension (a) VOLUNTARY DISMISSAL; DISMISSAL FOR WANT OF PROSECUTION OR OTHER CAUSE. Except as provided in §§ 707(a)(3), 707(b), 1208(b), and 1307(b) of the Code, and in Rule 1017(b), (c), and (e), a case Rule 1017 FEDERAL RULES OF BANKRUPTCY PROCEDURE 12 shall not be dismissed on motion of the petitioner, for want of prosecution or other cause, or by consent of the parties, before a hearing on notice as provided in Rule 2002. For the purpose of the notice, the debtor shall file a list of creditors with their addresses within the time fixed by the court unless the list was previously filed. If the debtor fails to file the list, the court may order the debtor or another entity to prepare and file it. (b) DISMISSAL FOR FAILURE TO PAY FILING FEE. (1) If any installment of the filing fee has not been paid, the court may, after a hearing on notice to the debtor and the trustee, dismiss the case. (2) If the case is dismissed or closed without full payment of the filing fee, the installments collected shall be distributed in the same manner and proportions as if the filing fee had been paid in full. (c) DISMISSAL OF VOLUNTARY CHAPTER 7 OR CHAPTER 13 CASE FOR FAILURE TO TIMELY FILE LIST OF CREDITORS, SCHEDULES, AND STATEMENT OF FINANCIAL AFFAIRS. The court may dismiss a voluntary chapter 7 or chapter 13 case under § 707(a)(3) or § 1307(c)(9) after a hearing on notice served by the United States trustee on the debtor, the trustee, and any other entities as the court directs. (d) SUSPENSION. The court shall not dismiss a case or suspend proceedings under § 305 before a hearing on notice as provided in Rule 2002(a). (e) DISMISSAL OF AN INDIVIDUAL DEBTOR’S CHAPTER 7 CASE, OR CONVERSION TO A CASE UNDER CHAPTER 11 OR 13, FOR ABUSE. The court may dismiss or, with the debtor’s consent, convert an individual debtor’s case for abuse under § 707(b) only on motion and after a hearing on notice to the debtor, the trustee, the United States trustee, and any other entity as the court directs. (1) Except as otherwise provided in § 704(b)(2), a motion to dismiss a case for abuse under § 707(b) or (c) may be filed only within 60 days after the first date set for the meeting of creditors under § 341(a), unless, on request filed before the time has expired, the court for cause extends the time for filing the motion to dismiss. The party filing the motion shall set forth in the motion all matters to be considered at the hearing. In addition, a motion to dismiss under § 707(b)(1) and (3) shall state with particularity the circumstances alleged to constitute abuse. (2) If the hearing is set on the court’s own motion, notice of the hearing shall be served on the debtor no later than 60 days after the first date set for the meeting of creditors under § 341(a). The notice shall set forth all matters to be considered by the court at the hearing. (f) PROCEDURE FOR DISMISSAL, CONVERSION, OR SUSPENSION. (1) Rule 9014 governs a proceeding to dismiss or suspend a case, or to convert a case to another chapter, except under §§ 706(a), 1112(a), 1208(a) or (b), or 1307(a) or (b). (2) Conversion or dismissal under §§ 706(a), 1112(a), 1208(b), or 1307(b) shall be on motion filed and served as required by Rule 9013. (3) A chapter 12 or chapter 13 case shall be converted without court order when the debtor files a notice of conversion under 13 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1019 §§ 1208(a) or 1307(a). The filing date of the notice becomes the date of the conversion order for the purposes of applying § 348(c) and Rule 1019. The clerk shall promptly transmit a copy of the notice to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 17, 2000, eff. Dec. 1, 2000; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1018. Contested Involuntary Petitions; Contested Petitions Commencing Chapter 15 Cases; Proceedings to Vacate Order for Relief; Applicability of Rules in Part VII Governing Adversary Proceedings Unless the court otherwise directs and except as otherwise prescribed in Part I of these rules, the following rules in Part VII apply to all proceedings contesting an involuntary petition or a chapter 15 petition for recognition, and to all proceedings to vacate an order for relief: Rules 7005, 7008–7010, 7015, 7016, 7024–7026, 7028–7037, 7052, 7054, 7056, and 7062. The court may direct that other rules in Part VII shall also apply. For the purposes of this rule a reference in the Part VII rules to adversary proceedings shall be read as a reference to proceedings contesting an involuntary petition or a chapter 15 petition for recognition, or proceedings to vacate an order for relief. Reference in the Federal Rules of Civil Procedure to the complaint shall be read as a reference to the petition. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 28, 2010, eff. Dec. 1, 2010.) Rule 1019. Conversion of a Chapter 11 Reorganization Case, Chapter 12 Family Farmer’s Debt Adjustment Case, or Chapter 13 Individual’s Debt Adjustment Case to a Chapter 7 Liquidation Case When a chapter 11, chapter 12, or chapter 13 case has been converted or reconverted to a chapter 7 case: (1) Filing of Lists, Inventories, Schedules, Statements. (A) Lists, inventories, schedules, and statements of financial affairs theretofore filed shall be deemed to be filed in the chapter 7 case, unless the court directs otherwise. If they have not been previously filed, the debtor shall comply with Rule 1007 as if an order for relief had been entered on an involuntary petition on the date of the entry of the order directing that the case continue under chapter 7. (B) If a statement of intention is required, it shall be filed within 30 days after entry of the order of conversion or before the first date set for the meeting of creditors, whichever is earlier. The court may grant an extension of time for cause only on written motion filed, or oral request made during a hearing, before the time has expired. Notice of an extension shall be given to the United States trustee and to any committee, trustee, or other party as the court may direct. (2) New Filing Periods. (A) A new time period for filing a motion under § 707(b) or (c), a claim, a complaint objecting to discharge, or a Rule 1019 FEDERAL RULES OF BANKRUPTCY PROCEDURE 14 1So in original. Probably should be ‘‘Rule’’. complaint to obtain a determination of dischargeability of any debt shall commence under Rules 1 1017, 3002, 4004, or 4007, but a new time period shall not commence if a chapter 7 case had been converted to a chapter 11, 12, or 13 case and thereafter reconverted to a chapter 7 case and the time for filing a motion under § 707(b) or (c), a claim, a complaint objecting to discharge, or a complaint to obtain a determination of the dischargeability of any debt, or any extension thereof, expired in the original chapter 7 case. (B) A new time period for filing an objection to a claim of exemptions shall commence under Rule 4003(b) after conversion of a case to chapter 7 unless: (i) the case was converted to chapter 7 more than one year after the entry of the first order confirming a plan under chapter 11, 12, or 13; or (ii) the case was previously pending in chapter 7 and the time to object to a claimed exemption had expired in the original chapter 7 case. (3) Claims Filed Before Conversion. All claims actually filed by a creditor before conversion of the case are deemed filed in the chapter 7 case. (4) Turnover of Records and Property. After qualification of, or assumption of duties by the chapter 7 trustee, any debtor in possession or trustee previously acting in the chapter 11, 12, or 13 case shall, forthwith, unless otherwise ordered, turn over to the chapter 7 trustee all records and property of the estate in the possession or control of the debtor in possession or trustee. (5) Filing Final Report and Schedule of Postpetition Debts. (A) Conversion of Chapter 11 or Chapter 12 Case. Unless the court directs otherwise, if a chapter 11 or chapter 12 case is converted to chapter 7, the debtor in possession or, if the debtor is not a debtor in possession, the trustee serving at the time of conversion, shall: (i) not later than 14 days after conversion of the case, file a schedule of unpaid debts incurred after the filing of the petition and before conversion of the case, including the name and address of each holder of a claim; and (ii) not later than 30 days after conversion of the case, file and transmit to the United States trustee a final report and account; (B) Conversion of Chapter 13 Case. Unless the court directs otherwise, if a chapter 13 case is converted to chapter 7, (i) the debtor, not later than 14 days after conversion of the case, shall file a schedule of unpaid debts incurred after the filing of the petition and before conversion of the case, including the name and address of each holder of a claim; and (ii) the trustee, not later than 30 days after conversion of the case, shall file and transmit to the United States trustee a final report and account; 15 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1020 (C) Conversion After Confirmation of a Plan. Unless the court orders otherwise, if a chapter 11, chapter 12, or chapter 13 case is converted to chapter 7 after confirmation of a plan, the debtor shall file: (i) a schedule of property not listed in the final report and account acquired after the filing of the petition but before conversion, except if the case is converted from chapter 13 to chapter 7 and § 348(f)(2) does not apply; (ii) a schedule of unpaid debts not listed in the final report and account incurred after confirmation but before the conversion; and (iii) a schedule of executory contracts and unexpired leases entered into or assumed after the filing of the petition but before conversion. (D) Transmission to United States Trustee. The clerk shall forthwith transmit to the United States trustee a copy of every schedule filed pursuant to Rule 1019(5). (6) Postpetition Claims; Preconversion Administrative Expenses; Notice. A request for payment of an administrative expense incurred before conversion of the case is timely filed under § 503(a) of the Code if it is filed before conversion or a time fixed by the court. If the request is filed by a governmental unit, it is timely if it is filed before conversion or within the later of a time fixed by the court or 180 days after the date of the conversion. A claim of a kind specified in § 348(d) may be filed in accordance with Rules 3001(a)–(d) and 3002. Upon the filing of the schedule of unpaid debts incurred after commencement of the case and before conversion, the clerk, or some other person as the court may direct, shall give notice to those entities listed on the schedule of the time for filing a request for payment of an administrative expense and, unless a notice of insufficient assets to pay a dividend is mailed in accordance with Rule 2002(e), the time for filing a claim of a kind specified in § 348(d). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2010, eff. Dec. 1, 2010.) Rule 1020. Small Business Chapter 11 Reorganization Case (a) SMALL BUSINESS DEBTOR DESIGNATION. In a voluntary chapter 11 case, the debtor shall state in the petition whether the debtor is a small business debtor. In an involuntary chapter 11 case, the debtor shall file within 14 days after entry of the order for relief a statement as to whether the debtor is a small business debtor. Except as provided in subdivision (c), the status of the case as a small business case shall be in accordance with the debtor’s statement under this subdivision, unless and until the court enters an order finding that the debtor’s statement is incorrect. (b) OBJECTING TO DESIGNATION. Except as provided in subdivision (c), the United States trustee or a party in interest may file an objection to the debtor’s statement under subdivision (a) no later than 30 days after the conclusion of the meeting of creditors held Rule 1021 FEDERAL RULES OF BANKRUPTCY PROCEDURE 16 under § 341(a) of the Code, or within 30 days after any amendment to the statement, whichever is later. (c) APPOINTMENT OF COMMITTEE OF UNSECURED CREDITORS. If a committee of unsecured creditors has been appointed under § 1102(a)(1), the case shall proceed as a small business case only if, and from the time when, the court enters an order determining that the committee has not been sufficiently active and representative to provide effective oversight of the debtor and that the debtor satisfies all the other requirements for being a small business. A request for a determination under this subdivision may be filed by the United States trustee or a party in interest only within a reasonable time after the failure of the committee to be sufficiently active and representative. The debtor may file a request for a determination at any time as to whether the committee has been sufficiently active and representative. (d) PROCEDURE FOR OBJECTION OR DETERMINATION. Any objection or request for a determination under this rule shall be governed by Rule 9014 and served on: the debtor; the debtor’s attorney; the United States trustee; the trustee; any committee appointed under § 1102 or its authorized agent, or, if no committee of unsecured creditors has been appointed under § 1102, the creditors included on the list filed under Rule 1007(d); and any other entity as the court directs. (Added Apr. 11, 1997, eff. Dec. 1, 1997; amended Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 1021. Health Care Business Case (a) HEALTH CARE BUSINESS DESIGNATION. Unless the court orders otherwise, if a petition in a case under chapter 7, chapter 9, or chapter 11 states that the debtor is a health care business, the case shall proceed as a case in which the debtor is a health care business. (b) MOTION. The United States trustee or a party in interest may file a motion to determine whether the debtor is a health care business. The motion shall be transmitted to the United States trustee and served on: the debtor; the trustee; any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, the creditors included on the list filed under Rule 1007(d); and any other entity as the court directs. The motion shall be governed by Rule 9014. (Added Apr. 23, 2008, eff. Dec. 1, 2008.) PART II—OFFICERS AND ADMINISTRATION; NOTICES; MEETINGS; EXAMINATIONS; ELECTIONS; ATTORNEYS AND ACCOUNTANTS Rule 2001. Appointment of Interim Trustee Before Order for Relief in a Chapter 7 Liquidation Case (a) APPOINTMENT. At any time following the commencement of an involuntary liquidation case and before an order for relief, the court on written motion of a party in interest may order the appointment of an interim trustee under § 303(g) of the Code. The 17 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 motion shall set forth the necessity for the appointment and may be granted only after hearing on notice to the debtor, the petitioning creditors, the United States trustee, and other parties in interest as the court may designate. (b) BOND OF MOVANT. An interim trustee may not be appointed under this rule unless the movant furnishes a bond in an amount approved by the court, conditioned to indemnify the debtor for costs, attorney’s fee, expenses, and damages allowable under § 303(i) of the Code. (c) ORDER OF APPOINTMENT. The order directing the appointment of an interim trustee shall state the reason the appointment is necessary and shall specify the trustee’s duties. (d) TURNOVER AND REPORT. Following qualification of the trustee selected under § 702 of the Code, the interim trustee, unless otherwise ordered, shall (1) forthwith deliver to the trustee all the records and property of the estate in possession or subject to control of the interim trustee and, (2) within 30 days thereafter file a final report and account. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2002. Notices to Creditors, Equity Security Holders, Administrators in Foreign Proceedings, Persons Against Whom Provisional Relief is Sought in Ancillary and Other Cross-Border Cases, United States, and United States Trustee (a) TWENTY-ONE-DAY NOTICES TO PARTIES IN INTEREST. Except as provided in subdivisions (h), (i), (l), (p), and (q) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, the trustee, all creditors and indenture trustees at least 21 days’ notice by mail of: (1) the meeting of creditors under § 341 or § 1104(b) of the Code, which notice, unless the court orders otherwise, shall include the debtor’s employer identification number, social security number, and any other federal taxpayer identification number; (2) a proposed use, sale, or lease of property of the estate other than in the ordinary course of business, unless the court for cause shown shortens the time or directs another method of giving notice; (3) the hearing on approval of a compromise or settlement of a controversy other than approval of an agreement pursuant to Rule 4001(d), unless the court for cause shown directs that notice not be sent; (4) in a chapter 7 liquidation, a chapter 11 reorganization case, or a chapter 12 family farmer debt adjustment case, the hearing on the dismissal of the case or the conversion of the case to another chapter, unless the hearing is under § 707(a)(3) or § 707(b) or is on dismissal of the case for failure to pay the filing fee; (5) the time fixed to accept or reject a proposed modification of a plan; (6) a hearing on any entity’s request for compensation or reimbursement of expenses if the request exceeds $1,000; (7) the time fixed for filing proofs of claims pursuant to Rule 3003(c); Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 18 (8) the time fixed for filing objections and the hearing to consider confirmation of a chapter 12 plan; and (9) the time fixed for filing objections to confirmation of a chapter 13 plan. (b) TWENTY-EIGHT-DAY NOTICES TO PARTIES IN INTEREST. Except as provided in subdivision (l) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, the trustee, all creditors and indenture trustees not less than 28 days’ notice by mail of the time fixed (1) for filing objections and the hearing to consider approval of a disclosure statement or, under § 1125(f), to make a final determination whether the plan provides adequate information so that a separate disclosure statement is not necessary; (2) for filing objections and the hearing to consider confirmation of a chapter 9 or chapter 11 plan; and (3) for the hearing to consider confirmation of a chapter 13 plan. (c) CONTENT OF NOTICE. (1) Proposed Use, Sale, or Lease of Property. Subject to Rule 6004, the notice of a proposed use, sale, or lease of property required by subdivision (a)(2) of this rule shall include the time and place of any public sale, the terms and conditions of any private sale and the time fixed for filing objections. The notice of a proposed use, sale, or lease of property, including real estate, is sufficient if it generally describes the property. The notice of a proposed sale or lease of personally identifiable information under § 363(b)(1) of the Code shall state whether the sale is consistent with any policy prohibiting the transfer of the information. (2) Notice of Hearing on Compensation. The notice of a hearing on an application for compensation or reimbursement of expenses required by subdivision (a)(6) of this rule shall identify the applicant and the amounts requested. (3) Notice of Hearing on Confirmation When Plan Provides for an Injunction. If a plan provides for an injunction against conduct not otherwise enjoined under the Code, the notice required under Rule 2002(b)(2) shall: (A) include in conspicuous language (bold, italic, or underlined text) a statement that the plan proposes an injunction; (B) describe briefly the nature of the injunction; and (C) identify the entities that would be subject to the injunction. (d) NOTICE TO EQUITY SECURITY HOLDERS. In a chapter 11 reorganization case, unless otherwise ordered by the court, the clerk, or some other person as the court may direct, shall in the manner and form directed by the court give notice to all equity security holders of (1) the order for relief; (2) any meeting of equity security holders held pursuant to § 341 of the Code; (3) the hearing on the proposed sale of all or substantially all of the debtor’s assets; (4) the hearing on the dismissal or conversion of a case to another chapter; (5) the time fixed for filing objections to and the hearing to consider approval of a disclosure statement; (6) the time fixed for filing objections to and the hearing to consider confirmation of a plan; and (7) the time fixed to accept or reject a proposed modification of a plan. 19 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 (e) NOTICE OF NO DIVIDEND. In a chapter 7 liquidation case, if it appears from the schedules that there are no assets from which a dividend can be paid, the notice of the meeting of creditors may include a statement to that effect; that it is unnecessary to file claims; and that if sufficient assets become available for the payment of a dividend, further notice will be given for the filing of claims. (f) OTHER NOTICES. Except as provided in subdivision (l) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, all creditors, and indenture trustees notice by mail of: (1) the order for relief; (2) the dismissal or the conversion of the case to another chapter, or the suspension of proceedings under § 305; (3) the time allowed for filing claims pursuant to Rule 3002; (4) the time fixed for filing a complaint objecting to the debtor’s discharge pursuant to § 727 of the Code as provided in Rule 4004; (5) the time fixed for filing a complaint to determine the dischargeability of a debt pursuant to § 523 of the Code as provided in Rule 4007; (6) the waiver, denial, or revocation of a discharge as provided in Rule 4006; (7) entry of an order confirming a chapter 9, 11, or 12 plan; (8) a summary of the trustee’s final report in a chapter 7 case if the net proceeds realized exceed $1,500; (9) a notice under Rule 5008 regarding the presumption of abuse; (10) a statement under § 704(b)(1) as to whether the debtor’s case would be presumed to be an abuse under § 707(b); and (11) the time to request a delay in the entry of the discharge under §§ 1141(d)(5)(C), 1228(f), and 1328(h). Notice of the time fixed for accepting or rejecting a plan pursuant to Rule 3017(c) shall be given in accordance with Rule 3017(d). (g) ADDRESSING NOTICES. (1) Notices required to be mailed under Rule 2002 to a creditor, indenture trustee, or equity security holder shall be addressed as such entity or an authorized agent has directed in its last request filed in the particular case. For the purposes of this subdivision— (A) a proof of claim filed by a creditor or indenture trustee that designates a mailing address constitutes a filed request to mail notices to that address, unless a notice of no dividend has been given under Rule 2002(e) and a later notice of possible dividend under Rule 3002(c)(5) has not been given; and (B) a proof of interest filed by an equity security holder that designates a mailing address constitutes a filed request to mail notices to that address. (2) Except as provided in § 342(f) of the Code, if a creditor or indenture trustee has not filed a request designating a mailing address under Rule 2002(g)(1) or Rule 5003(e), the notices shall be mailed to the address shown on the list of creditors or schedule of liabilities, whichever is filed later. If an equity security holder has not filed a request designating a mailing address under Rule 2002(g)(1) or Rule 5003(e), the notices shall be Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 20 mailed to the address shown on the list of equity security holders. (3) If a list or schedule filed under Rule 1007 includes the name and address of a legal representative of an infant or incompetent person, and a person other than that representative files a request or proof of claim designating a name and mailing address that differs from the name and address of the representative included in the list or schedule, unless the court orders otherwise, notices under Rule 2002 shall be mailed to the representative included in the list or schedules and to the name and address designated in the request or proof of claim. (4) Notwithstanding Rule 2002(g)(1)–(3), an entity and a notice provider may agree that when the notice provider is directed by the court to give a notice, the notice provider shall give the notice to the entity in the manner agreed to and at the address or addresses the entity supplies to the notice provider. That address is conclusively presumed to be a proper address for the notice. The notice provider’s failure to use the supplied address does not invalidate any notice that is otherwise effective under applicable law. (5) A creditor may treat a notice as not having been brought to the creditor’s attention under § 342(g)(1) only if, prior to issuance of the notice, the creditor has filed a statement that designates the name and address of the person or organizational subdivision of the creditor responsible for receiving notices under the Code, and that describes the procedures established by the creditor to cause such notices to be delivered to the designated person or subdivision. (h) NOTICES TO CREDITORS WHOSE CLAIMS ARE FILED. In a chapter 7 case, after 90 days following the first date set for the meeting of creditors under § 341 of the Code, the court may direct that all notices required by subdivision (a) of this rule be mailed only to the debtor, the trustee, all indenture trustees, creditors that hold claims for which proofs of claim have been filed, and creditors, if any, that are still permitted to file claims by reason of an extension granted pursuant to Rule 3002(c)(1) or (c)(2). In a case where notice of insufficient assets to pay a dividend has been given to creditors pursuant to subdivision (e) of this rule, after 90 days following the mailing of a notice of the time for filing claims pursuant to Rule 3002(c)(5), the court may direct that notices be mailed only to the entities specified in the preceding sentence. (i) NOTICES TO COMMITTEES. Copies of all notices required to be mailed pursuant to this rule shall be mailed to the committees elected under § 705 or appointed under § 1102 of the Code or to their authorized agents. Notwithstanding the foregoing subdivisions, the court may order that notices required by subdivision (a)(2), (3) and (6) of this rule be transmitted to the United States trustee and be mailed only to the committees elected under § 705 or appointed under § 1102 of the Code or to their authorized agents and to the creditors and equity security holders who serve on the trustee or debtor in possession and file a request that all notices be mailed to them. A committee appointed under § 1114 shall receive copies of all notices required by subdivisions (a)(1), (a)(5), (b), (f)(2), and (f)(7), and such other notices as the court may direct. 21 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 1So in original. Period probably should not appear. (j) NOTICES TO THE UNITED STATES. Copies of notices required to be mailed to all creditors under this rule shall be mailed (1) in a chapter 11 reorganization case, to the Securities and Exchange Commission at any place the Commission designates, if the Commission has filed either a notice of appearance in the case or a written request to receive notices; (2) in a commodity broker case, to the Commodity Futures Trading Commission at Washington, D.C.; (3) in a chapter 11 case, to the Internal Revenue Service at its address set out in the register maintained under Rule 5003(e) for the district in which the case is pending; (4) if the papers in the case disclose a debt to the United States other than for taxes, to the United States attorney for the district in which the case is pending and to the department, agency, or instrumentality of the United States through which the debtor became indebted; or (5) if the filed papers disclose a stock interest of the United States, to the Secretary of the Treasury at Washington, D.C. (k) NOTICES TO UNITED STATES TRUSTEE. Unless the case is a chapter 9 municipality case or unless the United States trustee requests otherwise, the clerk, or some other person as the court may direct, shall transmit to the United States trustee notice of the matters described in subdivisions (a)(2), (a)(3), (a)(4), (a)(8), (b), (f)(1), (f)(2), (f)(4), (f)(6), (f)(7), (f)(8), and (q) of this rule and notice of hearings on all applications for compensation or reimbursement of expenses. Notices to the United States trustee shall be transmitted within the time prescribed in subdivision (a) or (b) of this rule. The United States trustee shall also receive notice of any other matter if such notice is requested by the United States trustee or ordered by the court. Nothing in these rules requires the clerk or any other person to transmit to the United States trustee any notice, schedule, report, application or other document in a case under the Securities Investor Protection Act, 15 U.S.C. § 78aaa et. 1 seq. (l) NOTICE BY PUBLICATION. The court may order notice by publication if it finds that notice by mail is impracticable or that it is desirable to supplement the notice. (m) ORDERS DESIGNATING MATTER OF NOTICES. The court may from time to time enter orders designating the matters in respect to which, the entity to whom, and the form and manner in which notices shall be sent except as otherwise provided by these rules. (n) CAPTION. The caption of every notice given under this rule shall comply with Rule 1005. The caption of every notice required to be given by the debtor to a creditor shall include the information required to be in the notice by § 342(c) of the Code. (o) NOTICE OF ORDER FOR RELIEF IN CONSUMER CASE. In a voluntary case commenced by an individual debtor whose debts are primarily consumer debts, the clerk or some other person as the court may direct shall give the trustee and all creditors notice by mail of the order for relief within 21 days from the date thereof. (p) NOTICE TO A CREDITOR WITH A FOREIGN ADDRESS. (1) If, at the request of the United States trustee or a party in interest, or on its own initiative, the court finds that a notice mailed within the time prescribed by these rules would Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 22 not be sufficient to give a creditor with a foreign address to which notices under these rules are mailed reasonable notice under the circumstances, the court may order that the notice be supplemented with notice by other means or that the time prescribed for the notice by mail be enlarged. (2) Unless the court for cause orders otherwise, a creditor with a foreign address to which notices under this rule are mailed shall be given at least 30 days’ notice of the time fixed for filing a proof of claim under Rule 3002(c) or Rule 3003(c). (3) Unless the court for cause orders otherwise, the mailing address of a creditor with a foreign address shall be determined under Rule 2002(g). (q) NOTICE OF PETITION FOR RECOGNITION OF FOREIGN PROCEEDING AND OF COURT’S INTENTION TO COMMUNICATE WITH FOREIGN COURTS AND FOREIGN REPRESENTATIVES. (1) Notice of Petition for Recognition. After the filing of a petition for recognition of a foreign proceeding, the court shall promptly schedule and hold a hearing on the petition. The clerk, or some other person as the court may direct, shall forthwith give the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and such other entities as the court may direct, at least 21 days’ notice by mail of the hearing. The notice shall state whether the petition seeks recognition as a foreign main proceeding or foreign nonmain proceeding and shall include the petition and any other document the court may require. If the court consolidates the hearing on the petition with the hearing on a request for provisional relief, the court may set a shorter notice period, with notice to the entities listed in this subdivision. (2) Notice of Court’s Intention to Communicate with Foreign Courts and Foreign Representatives. The clerk, or some other person as the court may direct, shall give the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and such other entities as the court may direct, notice by mail of the court’s intention to communicate with a foreign court or foreign representative. (As amended Pub. L. 98–91, § 2(a), Aug. 30, 1983, 97 Stat. 607; Pub. L. 98–353, title III, § 321, July 10, 1984, 98 Stat. 357; Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 17, 2000, eff. Dec. 1, 2000; Apr. 23, 2001, eff. Dec. 1, 2001; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 26, 2004, eff. Dec. 1, 2004; Apr. 25, 2005, eff. Dec. 1, 2005; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2016, eff. Dec. 1, 2016; Apr. 27, 2017, eff. Dec. 1, 2017.) 23 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2003 Rule 2003. Meeting of Creditors or Equity Security Holders (a) DATE AND PLACE. Except as otherwise provided in § 341(e) of the Code, in a chapter 7 liquidation or a chapter 11 reorganization case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 40 days after the order for relief. In a chapter 12 family farmer debt adjustment case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 35 days after the order for relief. In a chapter 13 individual’s debt adjustment case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 50 days after the order for relief. If there is an appeal from or a motion to vacate the order for relief, or if there is a motion to dismiss the case, the United States trustee may set a later date for the meeting. The meeting may be held at a regular place for holding court or at any other place designated by the United States trustee within the district convenient for the parties in interest. If the United States trustee designates a place for the meeting which is not regularly staffed by the United States trustee or an assistant who may preside at the meeting, the meeting may be held not more than 60 days after the order for relief. (b) ORDER OF MEETING. (1) Meeting of Creditors. The United States trustee shall preside at the meeting of creditors. The business of the meeting shall include the examination of the debtor under oath and, in a chapter 7 liquidation case, may include the election of a creditors’ committee and, if the case is not under subchapter V of chapter 7, the election of a trustee. The presiding officer shall have the authority to administer oaths. (2) Meeting of Equity Security Holders. If the United States trustee convenes a meeting of equity security holders pursuant to § 341(b) of the Code, the United States trustee shall fix a date for the meeting and shall preside. (3) Right To Vote. In a chapter 7 liquidation case, a creditor is entitled to vote at a meeting if, at or before the meeting, the creditor has filed a proof of claim or a writing setting forth facts evidencing a right to vote pursuant to § 702(a) of the Code unless objection is made to the claim or the proof of claim is insufficient on its face. A creditor of a partnership may file a proof of claim or writing evidencing a right to vote for the trustee for the estate of the general partner notwithstanding that a trustee for the estate of the partnership has previously qualified. In the event of an objection to the amount or allowability of a claim for the purpose of voting, unless the court orders otherwise, the United States trustee shall tabulate the votes for each alternative presented by the dispute and, if resolution of such dispute is necessary to determine the result of the election, the tabulations for each alternative shall be reported to the court. (c) RECORD OF MEETING. Any examination under oath at the meeting of creditors held pursuant to § 341(a) of the Code shall be recorded verbatim by the United States trustee using electronic sound recording equipment or other means of recording, and such record shall be preserved by the United States trustee and available for public access until two years after the conclusion of the Rule 2004 FEDERAL RULES OF BANKRUPTCY PROCEDURE 24 meeting of creditors. Upon request of any entity, the United States trustee shall certify and provide a copy or transcript of such recording at the entity’s expense. (d) REPORT OF ELECTION AND RESOLUTION OF DISPUTES IN A CHAPTER 7 CASE. (1) Report of Undisputed Election. In a chapter 7 case, if the election of a trustee or a member of a creditors’ committee is not disputed, the United States trustee shall promptly file a report of the election, including the name and address of the person or entity elected and a statement that the election is undisputed. (2) Disputed Election. If the election is disputed, the United States trustee shall promptly file a report stating that the election is disputed, informing the court of the nature of the dispute, and listing the name and address of any candidate elected under any alternative presented by the dispute. No later than the date on which the report is filed, the United States trustee shall mail a copy of the report to any party in interest that has made a request to receive a copy of the report. Pending disposition by the court of a disputed election for trustee, the interim trustee shall continue in office. Unless a motion for the resolution of the dispute is filed no later than 14 days after the United States trustee files a report of a disputed election for trustee, the interim trustee shall serve as trustee in the case. (e) ADJOURNMENT. The meeting may be adjourned from time to time by announcement at the meeting of the adjourned date and time. The presiding official shall promptly file a statement specifying the date and time to which the meeting is adjourned. (f) SPECIAL MEETINGS. The United States trustee may call a special meeting of creditors on request of a party in interest or on the United States trustee’s own initiative. (g) FINAL MEETING. If the United States trustee calls a final meeting of creditors in a case in which the net proceeds realized exceed $1,500, the clerk shall mail a summary of the trustee’s final account to the creditors with a notice of the meeting, together with a statement of the amount of the claims allowed. The trustee shall attend the final meeting and shall, if requested, report on the administration of the estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 26, 1999, eff. Dec. 1, 1999; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 26, 2011, eff. Dec. 1, 2011.) Rule 2004. Examination (a) EXAMINATION ON MOTION. On motion of any party in interest, the court may order the examination of any entity. (b) SCOPE OF EXAMINATION. The examination of an entity under this rule or of the debtor under § 343 of the Code may relate only to the acts, conduct, or property or to the liabilities and financial condition of the debtor, or to any matter which may affect the administration of the debtor’s estate, or to the debtor’s right to a discharge. In a family farmer’s debt adjustment case under chapter 12, an individual’s debt adjustment case under chapter 13, or 25 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2005 a reorganization case under chapter 11 of the Code, other than for the reorganization of a railroad, the examination may also relate to the operation of any business and the desirability of its continuance, the source of any money or property acquired or to be acquired by the debtor for purposes of consummating a plan and the consideration given or offered therefor, and any other matter relevant to the case or to the formulation of a plan. (c) COMPELLING ATTENDANCE AND PRODUCTION OF DOCUMENTS. The attendance of an entity for examination and for the production of documents, whether the examination is to be conducted within or without the district in which the case is pending, may be compelled as provided in Rule 9016 for the attendance of a witness at a hearing or trial. As an officer of the court, an attorney may issue and sign a subpoena on behalf of the court for the district in which the examination is to be held if the attorney is admitted to practice in that court or in the court in which the case is pending. (d) TIME AND PLACE OF EXAMINATION OF DEBTOR. The court may for cause shown and on terms as it may impose order the debtor to be examined under this rule at any time or place it designates, whether within or without the district wherein the case is pending. (e) MILEAGE. An entity other than a debtor shall not be required to attend as a witness unless lawful mileage and witness fee for one day’s attendance shall be first tendered. If the debtor resides more than 100 miles from the place of examination when required to appear for an examination under this rule, the mileage allowed by law to a witness shall be tendered for any distance more than 100 miles from the debtor’s residence at the date of the filing of the first petition commencing a case under the Code or the residence at the time the debtor is required to appear for the examination, whichever is the lesser. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 2005. Apprehension and Removal of Debtor to Compel Attendance for Examination (a) ORDER TO COMPEL ATTENDANCE FOR EXAMINATION. On motion of any party in interest supported by an affidavit alleging (1) that the examination of the debtor is necessary for the proper administration of the estate and that there is reasonable cause to believe that the debtor is about to leave or has left the debtor’s residence or principal place of business to avoid examination, or (2) that the debtor has evaded service of a subpoena or of an order to attend for examination, or (3) that the debtor has willfully disobeyed a subpoena or order to attend for examination, duly served, the court may issue to the marshal, or some other officer authorized by law, an order directing the officer to bring the debtor before the court without unnecessary delay. If, after hearing, the court finds the allegations to be true, the court shall thereupon cause the debtor to be examined forthwith. If necessary, the court shall fix conditions for further examination and for the debtor’s obedience to all orders made in reference thereto. (b) REMOVAL. Whenever any order to bring the debtor before the court is issued under this rule and the debtor is found in a district Rule 2006 FEDERAL RULES OF BANKRUPTCY PROCEDURE 26 other than that of the court issuing the order, the debtor may be taken into custody under the order and removed in accordance with the following rules: (1) If the debtor is taken into custody under the order at a place less than 100 miles from the place of issue of the order, the debtor shall be brought forthwith before the court that issued the order. (2) If the debtor is taken into custody under the order at a place 100 miles or more from the place of issue of the order, the debtor shall be brought without unnecessary delay before the nearest available United States magistrate judge, bankruptcy judge, or district judge. If, after hearing, the magistrate judge, bankruptcy judge, or district judge finds that an order has issued under this rule and that the person in custody is the debtor, or if the person in custody waives a hearing, the magistrate judge, bankruptcy judge, or district judge shall order removal, and the person in custody shall be released on conditions ensuring prompt appearance before the court that issued the order to compel the attendance. (c) CONDITIONS OF RELEASE. In determining what conditions will reasonably assure attendance or obedience under subdivision (a) of this rule or appearance under subdivision (b) of this rule, the court shall be governed by the provisions and policies of title 18, U.S.C., § 3146(a) and (b). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 22, 1993, eff. Aug. 1, 1993.) Rule 2006. Solicitation and Voting of Proxies in Chapter 7 Liquidation Cases (a) APPLICABILITY. This rule applies only in a liquidation case pending under chapter 7 of the Code. (b) DEFINITIONS. (1) Proxy. A proxy is a written power of attorney authorizing any entity to vote the claim or otherwise act as the owner’s attorney in fact in connection with the administration of the estate. (2) Solicitation of Proxy. The solicitation of a proxy is any communication, other than one from an attorney to a regular client who owns a claim or from an attorney to the owner of a claim who has requested the attorney to represent the owner, by which a creditor is asked, directly or indirectly, to give a proxy after or in contemplation of the filing of a petition by or against the debtor. (c) AUTHORIZED SOLICITATION. (1) A proxy may be solicited only by (A) a creditor owning an allowable unsecured claim against the estate on the date of the filing of the petition; (B) a committee elected pursuant to § 705 of the Code; (C) a committee of creditors selected by a majority in number and amount of claims of creditors (i) whose claims are not contingent or unliquidated, (ii) who are not disqualified from voting under § 702(a) of the Code and (iii) who were present or represented at a meeting of which all creditors having claims of over $500 or the 100 creditors having the largest claims had at least seven days’ notice in writing 27 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2006 and of which meeting written minutes were kept and are available reporting the names of the creditors present or represented and voting and the amounts of their claims; or (D) a bona fide trade or credit association, but such association may solicit only creditors who were its members or subscribers in good standing and had allowable unsecured claims on the date of the filing of the petition. (2) A proxy may be solicited only in writing. (d) SOLICITATION NOT AUTHORIZED. This rule does not permit solicitation (1) in any interest other than that of general creditors; (2) by or on behalf of any custodian; (3) by the interim trustee or by or on behalf of any entity not qualified to vote under § 702(a) of the Code; (4) by or on behalf of an attorney at law; or (5) by or on behalf of a transferee of a claim for collection only. (e) DATA REQUIRED FROM HOLDERS OF MULTIPLE PROXIES. At any time before the voting commences at any meeting of creditors pursuant to § 341(a) of the Code, or at any other time as the court may direct, a holder of two or more proxies shall file and transmit to the United States trustee a verified list of the proxies to be voted and a verified statement of the pertinent facts and circumstances in connection with the execution and delivery of each proxy, including: (1) a copy of the solicitation; (2) identification of the solicitor, the forwarder, if the forwarder is neither the solicitor nor the owner of the claim, and the proxyholder, including their connections with the debtor and with each other. If the solicitor, forwarder, or proxyholder is an association, there shall also be included a statement that the creditors whose claims have been solicited and the creditors whose claims are to be voted were members or subscribers in good standing and had allowable unsecured claims on the date of the filing of the petition. If the solicitor, forwarder, or proxyholder is a committee of creditors, the statement shall also set forth the date and place the committee was organized, that the committee was organized in accordance with clause (B) or (C) of paragraph (c)(1) of this rule, the members of the committee, the amounts of their claims, when the claims were acquired, the amounts paid therefor, and the extent to which the claims of the committee members are secured or entitled to priority; (3) a statement that no consideration has been paid or promised by the proxyholder for the proxy; (4) a statement as to whether there is any agreement and, if so, the particulars thereof, between the proxyholder and any other entity for the payment of any consideration in connection with voting the proxy, or for the sharing of compensation with any entity, other than a member or regular associate of the proxyholder’s law firm, which may be allowed the trustee or any entity for services rendered in the case, or for the employment of any person as attorney, accountant, appraiser, auctioneer, or other employee for the estate; (5) if the proxy was solicited by an entity other than the proxyholder, or forwarded to the holder by an entity who is neither a solicitor of the proxy nor the owner of the claim, a statement signed and verified by the solicitor or forwarder that no consideration has been paid or promised for the proxy, and whether there is any agreement, and, if so, the particulars thereof, between the solicitor or forwarder and any other entity for the payment of any consideration in connection with voting the proxy, or for sharing compensation with any entity other than a member or regular associate of the solicitor’s or forwarder’s law firm which may be allowed the trustee or any entity for services rendered in the case, or for the employment of any person as attorney, accountant, appraiser, auctioneer, or other employee for the estate; (6) if the solicitor, forwarder, or proxyholder is a committee, a statement signed and verified by each member as to the amount and source of any consideration paid or to be paid to such member in connection with the case other than by way of dividend on the member’s claim. (f) ENFORCEMENT OF RESTRICTIONS ON SOLICITATION. On motion of any party in interest or on its own initiative, the court may determine whether there has been a failure to comply with the provisions of this rule or any other impropriety in connection with the solicitation or voting of a proxy. After notice and a hearing the court may reject any proxy for cause, vacate any order entered in consequence of the voting of any proxy which should have been rejected, or take any other appropriate action. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2007. Review of Appointment of Creditors’ Committee Organized Before Commencement of the Case (a) MOTION TO REVIEW APPOINTMENT. If a committee appointed by the United States trustee pursuant to § 1102(a) of the Code consists of the members of a committee organized by creditors before the commencement of a chapter 9 or chapter 11 case, on motion of a party in interest and after a hearing on notice to the United States trustee and other entities as the court may direct, the court may determine whether the appointment of the committee satisfies the requirements of § 1102(b)(1) of the Code. (b) SELECTION OF MEMBERS OF COMMITTEE. The court may find that a committee organized by unsecured creditors before the commencement of a chapter 9 or chapter 11 case was fairly chosen if: (1) it was selected by a majority in number and amount of claims of unsecured creditors who may vote under § 702(a) of the Code and were present in person or represented at a meeting of which all creditors having unsecured claims of over $1,000 or the 100 unsecured creditors having the largest claims had at least seven days’ notice in writing, and of which meeting written minutes reporting the names of the creditors present or represented and voting and the amounts of their claims were kept and are available for inspection; (2) all proxies voted at the meeting for the elected committee were solicited pursuant to Rule 2006 and the lists and statements required by subdivision (e) thereof have been transmitted to the United States trustee; and (3) the organization of the committee was in all other respects fair and proper. 29 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2007.1 (c) FAILURE TO COMPLY WITH REQUIREMENTS FOR APPOINTMENT. After a hearing on notice pursuant to subdivision (a) of this rule, the court shall direct the United States trustee to vacate the appointment of the committee and may order other appropriate action if the court finds that such appointment failed to satisfy the requirements of § 1102(b)(1) of the Code. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2007.1. Appointment of Trustee or Examiner in a Chapter 11 Reorganization Case (a) ORDER TO APPOINT TRUSTEE OR EXAMINER. In a chapter 11 reorganization case, a motion for an order to appoint a trustee or an examiner under § 1104(a) or § 1104(c) of the Code shall be made in accordance with Rule 9014. (b) ELECTION OF TRUSTEE. (1) Request for an Election. A request to convene a meeting of creditors for the purpose of electing a trustee in a chapter 11 reorganization case shall be filed and transmitted to the United States trustee in accordance with Rule 5005 within the time prescribed by § 1104(b) of the Code. Pending court approval of the person elected, any person appointed by the United States trustee under § 1104(d) and approved in accordance with subdivision (c) of this rule shall serve as trustee. (2) Manner of Election and Notice. An election of a trustee under § 1104(b) of the Code shall be conducted in the manner provided in Rules 2003(b)(3) and 2006. Notice of the meeting of creditors convened under § 1104(b) shall be given as provided in Rule 2002. The United States trustee shall preside at the meeting. A proxy for the purpose of voting in the election may be solicited only by a committee of creditors appointed under § 1102 of the Code or by any other party entitled to solicit a proxy pursuant to Rule 2006. (3) Report of Election and Resolution of Disputes. (A) Report of Undisputed Election. If no dispute arises out of the election, the United States trustee shall promptly file a report certifying the election, including the name and address of the person elected and a statement that the election is undisputed. The report shall be accompanied by a verified statement of the person elected setting forth that person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (B) Dispute Arising Out of an Election. If a dispute arises out of an election, the United States trustee shall promptly file a report stating that the election is disputed, informing the court of the nature of the dispute, and listing the name and address of any candidate elected under any alternative presented by the dispute. The report shall be accompanied by a verified statement by each candidate elected under each alternative presented by the dispute, setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any Rule 2007.2 FEDERAL RULES OF BANKRUPTCY PROCEDURE 30 person employed in the office of the United States trustee. Not later than the date on which the report of the disputed election is filed, the United States trustee shall mail a copy of the report and each verified statement to any party in interest that has made a request to convene a meeting under § 1104(b) or to receive a copy of the report, and to any committee appointed under § 1102 of the Code. (c) APPROVAL OF APPOINTMENT. An order approving the appointment of a trustee or an examiner under § 1104(d) of the Code shall be made on application of the United States trustee. The application shall state the name of the person appointed and, to the best of the applicant’s knowledge, all the person’s connections with the debtor, creditors, any other parties in interest, their respective attorneys and accountants, the United States trustee, or persons employed in the office of the United States trustee. The application shall state the names of the parties in interest with whom the United States trustee consulted regarding the appointment. The application shall be accompanied by a verified statement of the person appointed setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (Added Apr. 30, 1991, eff. Aug. 1, 1991; amended Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 2007.2. Appointment of Patient Care Ombudsman in a Health Care Business Case (a) ORDER TO APPOINT PATIENT CARE OMBUDSMAN. In a chapter 7, chapter 9, or chapter 11 case in which the debtor is a health care business, the court shall order the appointment of a patient care ombudsman under § 333 of the Code, unless the court, on motion of the United States trustee or a party in interest filed no later than 21 days after the commencement of the case or within another time fixed by the court, finds that the appointment of a patient care ombudsman is not necessary under the specific circumstances of the case for the protection of patients. (b) MOTION FOR ORDER TO APPOINT OMBUDSMAN. If the court has found that the appointment of an ombudsman is not necessary, or has terminated the appointment, the court, on motion of the United States trustee or a party in interest, may order the appointment at a later time if it finds that the appointment has become necessary to protect patients. (c) NOTICE OF APPOINTMENT. If a patient care ombudsman is appointed under § 333, the United States trustee shall promptly file a notice of the appointment, including the name and address of the person appointed. Unless the person appointed is a State Long-Term Care Ombudsman, the notice shall be accompanied by a verified statement of the person appointed setting forth the person’s connections with the debtor, creditors, patients, any other party in interest, their respective attorneys and accountants, the United States trustee, and any person employed in the office of the United States trustee. (d) TERMINATION OF APPOINTMENT. On motion of the United States trustee or a party in interest, the court may terminate the 31 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2009 appointment of a patient care ombudsman if the court finds that the appointment is not necessary to protect patients. (e) MOTION. A motion under this rule shall be governed by Rule 9014. The motion shall be transmitted to the United States trustee and served on: the debtor; the trustee; any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, on the creditors included on the list filed under Rule 1007(d); and such other entities as the court may direct. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2008. Notice to Trustee of Selection The United States trustee shall immediately notify the person selected as trustee how to qualify and, if applicable, the amount of the trustee’s bond. A trustee that has filed a blanket bond pursuant to Rule 2010 and has been selected as trustee in a chapter 7, chapter 12, or chapter 13 case that does not notify the court and the United States trustee in writing of rejection of the office within seven days after receipt of notice of selection shall be deemed to have accepted the office. Any other person selected as trustee shall notify the court and the United States trustee in writing of acceptance of the office within seven days after receipt of notice of selection or shall be deemed to have rejected the office. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2009. Trustees for Estates When Joint Administration Ordered (a) ELECTION OF SINGLE TRUSTEE FOR ESTATES BEING JOINTLY ADMINISTERED. If the court orders a joint administration of two or more estates under Rule 1015(b), creditors may elect a single trustee for the estates being jointly administered, unless the case is under subchapter V of chapter 7 of the Code. (b) RIGHT OF CREDITORS TO ELECT SEPARATE TRUSTEE. Notwithstanding entry of an order for joint administration under Rule 1015(b), the creditors of any debtor may elect a separate trustee for the estate of the debtor as provided in § 702 of the Code, unless the case is under subchapter V of chapter 7. (c) APPOINTMENT OF TRUSTEES FOR ESTATES BEING JOINTLY ADMINISTERED. (1) Chapter 7 Liquidation Cases. Except in a case governed by subchapter V of chapter 7, the United States trustee may appoint one or more interim trustees for estates being jointly administered in chapter 7 cases. (2) Chapter 11 Reorganization Cases. If the appointment of a trustee is ordered, the United States trustee may appoint one or more trustees for estates being jointly administered in chapter 11 cases. (3) Chapter 12 Family Farmer’s Debt Adjustment Cases. The United States trustee may appoint one or more trustees for estates being jointly administered in chapter 12 cases. Rule 2010 FEDERAL RULES OF BANKRUPTCY PROCEDURE 32 (4) Chapter 13 Individual’s Debt Adjustment Cases. The United States trustee may appoint one or more trustees for estates being jointly administered in chapter 13 cases. (d) POTENTIAL CONFLICTS OF INTEREST. On a showing that creditors or equity security holders of the different estates will be prejudiced by conflicts of interest of a common trustee who has been elected or appointed, the court shall order the selection of separate trustees for estates being jointly administered. (e) SEPARATE ACCOUNTS. The trustee or trustees of estates being jointly administered shall keep separate accounts of the property and distribution of each estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 27, 2003, eff. Dec. 1, 2003.) Rule 2010. Qualification by Trustee; Proceeding on Bond (a) BLANKET BOND. The United States trustee may authorize a blanket bond in favor of the United States conditioned on the faithful performance of official duties by the trustee or trustees to cover (1) a person who qualifies as trustee in a number of cases, and (2) a number of trustees each of whom qualifies in a different case. (b) PROCEEDING ON BOND. A proceeding on the trustee’s bond may be brought by any party in interest in the name of the United States for the use of the entity injured by the breach of the condition. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2011. Evidence of Debtor in Possession or Qualification of Trustee (a) Whenever evidence is required that a debtor is a debtor in possession or that a trustee has qualified, the clerk may so certify and the certificate shall constitute conclusive evidence of that fact. (b) If a person elected or appointed as trustee does not qualify within the time prescribed by § 322(a) of the Code, the clerk shall so notify the court and the United States trustee. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2012. Substitution of Trustee or Successor Trustee; Accounting (a) TRUSTEE. If a trustee is appointed in a chapter 11 case or the debtor is removed as debtor in possession in a chapter 12 case, the trustee is substituted automatically for the debtor in possession as a party in any pending action, proceeding, or matter. (b) SUCCESSOR TRUSTEE. When a trustee dies, resigns, is removed, or otherwise ceases to hold office during the pendency of a case under the Code (1) the successor is automatically substituted as a party in any pending action, proceeding, or matter; and (2) the successor trustee shall prepare, file, and transmit to the United States trustee an accounting of the prior administration of the estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) 33 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2014 Rule 2013. Public Record of Compensation Awarded to Trustees, Examiners, and Professionals (a) RECORD TO BE KEPT. The clerk shall maintain a public record listing fees awarded by the court (1) to trustees and attorneys, accountants, appraisers, auctioneers and other professionals employed by trustees, and (2) to examiners. The record shall include the name and docket number of the case, the name of the individual or firm receiving the fee and the amount of the fee awarded. The record shall be maintained chronologically and shall be kept current and open to examination by the public without charge. ‘‘Trustees,’’ as used in this rule, does not include debtors in possession. (b) SUMMARY OF RECORD. At the close of each annual period, the clerk shall prepare a summary of the public record by individual or firm name, to reflect total fees awarded during the preceding year. The summary shall be open to examination by the public without charge. The clerk shall transmit a copy of the summary to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2014. Employment of Professional Persons (a) APPLICATION FOR AND ORDER OF EMPLOYMENT. An order approving the employment of attorneys, accountants, appraisers, auctioneers, agents, or other professionals pursuant to § 327, § 1103, or § 1114 of the Code shall be made only on application of the trustee or committee. The application shall be filed and, unless the case is a chapter 9 municipality case, a copy of the application shall be transmitted by the applicant to the United States trustee. The application shall state the specific facts showing the necessity for the employment, the name of the person to be employed, the reasons for the selection, the professional services to be rendered, any proposed arrangement for compensation, and, to the best of the applicant’s knowledge, all of the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. The application shall be accompanied by a verified statement of the person to be employed setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (b) SERVICES RENDERED BY MEMBER OR ASSOCIATE OF FIRM OF ATTORNEYS OR ACCOUNTANTS. If, under the Code and this rule, a law partnership or corporation is employed as an attorney, or an accounting partnership or corporation is employed as an accountant, or if a named attorney or accountant is employed, any partner, member, or regular associate of the partnership, corporation, or individual may act as attorney or accountant so employed, without further order of the court. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2015 FEDERAL RULES OF BANKRUPTCY PROCEDURE 34 Rule 2015. Duty to Keep Records, Make Reports, and Give Notice of Case or Change of Status (a) TRUSTEE OR DEBTOR IN POSSESSION. A trustee or debtor in possession shall: (1) in a chapter 7 liquidation case and, if the court directs, in a chapter 11 reorganization case file and transmit to the United States trustee a complete inventory of the property of the debtor within 30 days after qualifying as a trustee or debtor in possession, unless such an inventory has already been filed; (2) keep a record of receipts and the disposition of money and property received; (3) file the reports and summaries required by § 704(a)(8) of the Code, which shall include a statement, if payments are made to employees, of the amounts of deductions for all taxes required to be withheld or paid for and in behalf of employees and the place where these amounts are deposited; (4) as soon as possible after the commencement of the case, give notice of the case to every entity known to be holding money or property subject to withdrawal or order of the debtor, including every bank, savings or building and loan association, public utility company, and landlord with whom the debtor has a deposit, and to every insurance company which has issued a policy having a cash surrender value payable to the debtor, except that notice need not be given to any entity who has knowledge or has previously been notified of the case; (5) in a chapter 11 reorganization case, on or before the last day of the month after each calendar quarter during which there is a duty to pay fees under 28 U.S.C. § 1930(a)(6), file and transmit to the United States trustee a statement of any disbursements made during that quarter and of any fees payable under 28 U.S.C. § 1930(a)(6) for that quarter; and (6) in a chapter 11 small business case, unless the court, for cause, sets another reporting interval, file and transmit to the United States trustee for each calendar month after the order for relief, on the appropriate Official Form, the report required by § 308. If the order for relief is within the first 15 days of a calendar month, a report shall be filed for the portion of the month that follows the order for relief. If the order for relief is after the 15th day of a calendar month, the period for the remainder of the month shall be included in the report for the next calendar month. Each report shall be filed no later than 21 days after the last day of the calendar month following the month covered by the report. The obligation to file reports under this subparagraph terminates on the effective date of the plan, or conversion or dismissal of the case. (b) CHAPTER 12 TRUSTEE AND DEBTOR IN POSSESSION. In a chapter 12 family farmer’s debt adjustment case, the debtor in possession shall perform the duties prescribed in clauses (2)–(4) of subdivision (a) of this rule and, if the court directs, shall file and transmit to the United States trustee a complete inventory of the property of the debtor within the time fixed by the court. If the debtor is removed as debtor in possession, the trustee shall perform the duties of the debtor in possession prescribed in this paragraph. 35 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2015.1 (c) CHAPTER 13 TRUSTEE AND DEBTOR. (1) Business Cases. In a chapter 13 individual’s debt adjustment case, when the debtor is engaged in business, the debtor shall perform the duties prescribed by clauses (2)–(4) of subdivision (a) of this rule and, if the court directs, shall file and transmit to the United States trustee a complete inventory of the property of the debtor within the time fixed by the court. (2) Nonbusiness Cases. In a chapter 13 individual’s debt adjustment case, when the debtor is not engaged in business, the trustee shall perform the duties prescribed by clause (2) of subdivision (a) of this rule. (d) FOREIGN REPRESENTATIVE. In a case in which the court has granted recognition of a foreign proceeding under chapter 15, the foreign representative shall file any notice required under § 1518 of the Code within 14 days after the date when the representative becomes aware of the subsequent information. (e) TRANSMISSION OF REPORTS. In a chapter 11 case the court may direct that copies or summaries of annual reports and copies or summaries of other reports shall be mailed to the creditors, equity security holders, and indenture trustees. The court may also direct the publication of summaries of any such reports. A copy of every report or summary mailed or published pursuant to this subdivision shall be transmitted to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 29, 2002, eff. Dec. 1, 2002; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 23, 2012, eff. Dec. 1, 2012.) Rule 2015.1. Patient Care Ombudsman (a) REPORTS. A patient care ombudsman, at least 14 days before making a report under § 333(b)(2) of the Code, shall give notice that the report will be made to the court, unless the court orders otherwise. The notice shall be transmitted to the United States trustee, posted conspicuously at the health care facility that is the subject of the report, and served on: the debtor; the trustee; all patients; and any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, on the creditors included on the list filed under Rule 1007(d); and such other entities as the court may direct. The notice shall state the date and time when the report will be made, the manner in which the report will be made, and, if the report is in writing, the name, address, telephone number, email address, and website, if any, of the person from whom a copy of the report may be obtained at the debtor’s expense. (b) AUTHORIZATION TO REVIEW CONFIDENTIAL PATIENT RECORDS. A motion by a patient care ombudsman under § 333(c) to review confidential patient records shall be governed by Rule 9014, served on the patient and any family member or other contact person whose name and address have been given to the trustee or the debtor for the purpose of providing information regarding the patient’s health care, and transmitted to the United States trustee subject Rule 2015.2 FEDERAL RULES OF BANKRUPTCY PROCEDURE 36 to applicable nonbankruptcy law relating to patient privacy. Unless the court orders otherwise, a hearing on the motion may not be commenced earlier than 14 days after service of the motion. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2015.2. Transfer of Patient in Health Care Business Case Unless the court orders otherwise, if the debtor is a health care business, the trustee may not transfer a patient to another health care business under § 704(a)(12) of the Code unless the trustee gives at least 14 days’ notice of the transfer to the patient care ombudsman, if any, the patient, and any family member or other contact person whose name and address has been given to the trustee or the debtor for the purpose of providing information regarding the patient’s health care. The notice is subject to applicable nonbankruptcy law relating to patient privacy. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2015.3. Reports of Financial Information on Entities in Which a Chapter 11 Estate Holds a Controlling or Substantial Interest (a) REPORTING REQUIREMENT. In a chapter 11 case, the trustee or debtor in possession shall file periodic financial reports of the value, operations, and profitability of each entity that is not a publicly traded corporation or a debtor in a case under title 11, and in which the estate holds a substantial or controlling interest. The reports shall be prepared as prescribed by the appropriate Official Form, and shall be based upon the most recent information reasonably available to the trustee or debtor in possession. (b) TIME FOR FILING; SERVICE. The first report required by this rule shall be filed no later than seven days before the first date set for the meeting of creditors under § 341 of the Code. Subsequent reports shall be filed no less frequently than every six months thereafter, until the effective date of a plan or the case is dismissed or converted. Copies of the report shall be served on the United States trustee, any committee appointed under § 1102 of the Code, and any other party in interest that has filed a request therefor. (c) PRESUMPTION OF SUBSTANTIAL OR CONTROLLING INTEREST; JUDICIAL DETERMINATION. For purposes of this rule, an entity of which the estate controls or owns at least a 20 percent interest, shall be presumed to be an entity in which the estate has a substantial or controlling interest. An entity in which the estate controls or owns less than a 20 percent interest shall be presumed not to be an entity in which the estate has a substantial or controlling interest. Upon motion, the entity, any holder of an interest therein, the United States trustee, or any other party in interest may seek to rebut either presumption, and the court shall, after notice and a hearing, determine whether the estate’s interest in the entity is substantial or controlling. (d) MODIFICATION OF REPORTING REQUIREMENT. The court may, after notice and a hearing, vary the reporting requirement established by subdivision (a) of this rule for cause, including that the 37 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2016 trustee or debtor in possession is not able, after a good faith effort, to comply with those reporting requirements, or that the information required by subdivision (a) is publicly available. (e) NOTICE AND PROTECTIVE ORDERS. No later than 14 days before filing the first report required by this rule, the trustee or debtor in possession shall send notice to the entity in which the estate has a substantial or controlling interest, and to all holders— known to the trustee or debtor in possession—of an interest in that entity, that the trustee or debtor in possession expects to file and serve financial information relating to the entity in accordance with this rule. The entity in which the estate has a substantial or controlling interest, or a person holding an interest in that entity, may request protection of the information under § 107 of the Code. (f) EFFECT OF REQUEST. Unless the court orders otherwise, the pendency of a request under subdivisions (c), (d), or (e) of this rule shall not alter or stay the requirements of subdivision (a). (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2016. Compensation for Services Rendered and Reimbursement of Expenses (a) APPLICATION FOR COMPENSATION OR REIMBURSEMENT. An entity seeking interim or final compensation for services, or reimbursement of necessary expenses, from the estate shall file an application setting forth a detailed statement of (1) the services rendered, time expended and expenses incurred, and (2) the amounts requested. An application for compensation shall include a statement as to what payments have theretofore been made or promised to the applicant for services rendered or to be rendered in any capacity whatsoever in connection with the case, the source of the compensation so paid or promised, whether any compensation previously received has been shared and whether an agreement or understanding exists between the applicant and any other entity for the sharing of compensation received or to be received for services rendered in or in connection with the case, and the particulars of any sharing of compensation or agreement or understanding therefor, except that details of any agreement by the applicant for the sharing of compensation as a member or regular associate of a firm of lawyers or accountants shall not be required. The requirements of this subdivision shall apply to an application for compensation for services rendered by an attorney or accountant even though the application is filed by a creditor or other entity. Unless the case is a chapter 9 municipality case, the applicant shall transmit to the United States trustee a copy of the application. (b) DISCLOSURE OF COMPENSATION PAID OR PROMISED TO ATTORNEY FOR DEBTOR. Every attorney for a debtor, whether or not the attorney applies for compensation, shall file and transmit to the United States trustee within 14 days after the order for relief, or at another time as the court may direct, the statement required by § 329 of the Code including whether the attorney has shared or agreed to share the compensation with any other entity. The statement shall include the particulars of any such sharing or Rule 2017 FEDERAL RULES OF BANKRUPTCY PROCEDURE 38 agreement to share by the attorney, but the details of any agreement for the sharing of the compensation with a member or regular associate of the attorney’s law firm shall not be required. A supplemental statement shall be filed and transmitted to the United States trustee within 14 days after any payment or agreement not previously disclosed. (c) DISCLOSURE OF COMPENSATION PAID OR PROMISED TO BANKRUPTCY PETITION PREPARER. Before a petition is filed, every bankruptcy petition preparer for a debtor shall deliver to the debtor, the declaration under penalty of perjury required by § 110(h)(2). The declaration shall disclose any fee, and the source of any fee, received from or on behalf of the debtor within 12 months of the filing of the case and all unpaid fees charged to the debtor. The declaration shall also describe the services performed and documents prepared or caused to be prepared by the bankruptcy petition preparer. The declaration shall be filed with the petition. The petition preparer shall file a supplemental statement within 14 days after any payment or agreement not previously disclosed. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 27, 2003, eff. Dec. 1, 2003; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2017. Examination of Debtor’s Transactions with Debtor’s Attorney	Only use the information above to answer the question. Do not use any outside sources. If you cannot answer the question with the information provided say "I cannot answer without further research." The response should be written in paragraph form unless the answer would be more beneficial in markdown format. Please answer in a simple manner that is easy for the average person to understand. FEDERAL RULES OF BANKRUPTCY PROCEDURE Effective August 1, 1983, as amended to December 1, 2017 Rule 1001. Scope of Rules and Forms; Short Title The Bankruptcy Rules and Forms govern procedure in cases under title 11 of the United States Code. The rules shall be cited as the Federal Rules of Bankruptcy Procedure and the forms as the Official Bankruptcy Forms. These rules shall be construed, administered, and employed by the court and the parties to secure the just, speedy, and inexpensive determination of every case and proceeding. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 27, 2017, eff. Dec. 1, 2017.) PART I—COMMENCEMENT OF CASE; PROCEEDINGS RELATING TO PETITION AND ORDER FOR RELIEF Rule 1002. Commencement of Case (a) PETITION. A petition commencing a case under the Code shall be filed with the clerk. (b) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall forthwith transmit to the United States trustee a copy of the petition filed pursuant to subdivision (a) of this rule. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1003. Involuntary Petition (a) TRANSFEROR OR TRANSFEREE OF CLAIM. A transferor or transferee of a claim shall annex to the original and each copy of the petition a copy of all documents evidencing the transfer, whether transferred unconditionally, for security, or otherwise, and a signed statement that the claim was not transferred for the purpose of commencing the case and setting forth the consideration for and terms of the transfer. An entity that has transferred or acquired a claim for the purpose of commencing a case for liquidation under chapter 7 or for reorganization under chapter 11 shall not be a qualified petitioner. (b) JOINDER OF PETITIONERS AFTER FILING. If the answer to an involuntary petition filed by fewer than three creditors avers the existence of 12 or more creditors, the debtor shall file with the answer a list of all creditors with their addresses, a brief statement of the nature of their claims, and the amounts thereof. If it appears that there are 12 or more creditors as provided in § 303(b) of the Code, the court shall afford a reasonable opportunity for other creditors to join in the petition before a hearing is held thereon. (As amended Mar. 30, 1987, eff. Aug. 1, 1987.) Rule 1004. Involuntary Petition Against a Partnership After filing of an involuntary petition under § 303(b)(3) of the Code, (1) the petitioning partners or other petitioners shall promptly send to or serve on each general partner who is not a petitioner a copy of the petition; and (2) the clerk shall promptly issue a summons for service on each general partner who is not a petitioner. Rule 1010 applies to the form and service of the summons. (As amended Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 1004.1. Petition for an Infant or Incompetent Person If an infant or incompetent person has a representative, including a general guardian, committee, conservator, or similar fiduciary, the representative may file a voluntary petition on behalf of the infant or incompetent person. An infant or incompetent person who does not have a duly appointed representative may file a voluntary petition by next friend or guardian ad litem. The court shall appoint a guardian ad litem for an infant or incompetent person who is a debtor and is not otherwise represented or shall make any other order to protect the infant or incompetent debtor. (Added Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 1004.2. Petition in Chapter 15 Cases (a) DESIGNATING CENTER OF MAIN INTERESTS. A petition for recognition of a foreign proceeding under chapter 15 of the Code shall state the country where the debtor has its center of main interests. The petition shall also identify each country in which a foreign proceeding by, regarding, or against the debtor is pending. (b) CHALLENGING DESIGNATION. The United States trustee or a party in interest may file a motion for a determination that the debtor’s center of main interests is other than as stated in the petition for recognition commencing the chapter 15 case. Unless the court orders otherwise, the motion shall be filed no later than seven days before the date set for the hearing on the petition. The motion shall be transmitted to the United States trustee and served on the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor was a party as of the time the petition was filed, and such other entities as the court may direct. (Added Apr. 26, 2011, eff. Dec. 1, 2011.) Rule 1005. Caption of Petition The caption of a petition commencing a case under the Code shall contain the name of the court, the title of the case, and the docket number. The title of the case shall include the following information about the debtor: name, employer identification number, last four digits of the social-security number or individual debtor’s taxpayer-identification number, any other federal taxpayer-identification number, and all other names used within eight years before filing the petition. If the petition is not filed by 3 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 the debtor, it shall include all names used by the debtor which are known to the petitioners. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1006. Filing Fee (a) GENERAL REQUIREMENT. Every petition shall be accompanied by the filing fee except as provided in subdivisions (b) and (c) of this rule. For the purpose of this rule, ‘‘filing fee’’ means the filing fee prescribed by 28 U.S.C. § 1930(a)(1)–(a)(5) and any other fee prescribed by the Judicial Conference of the United States under 28 U.S.C. § 1930(b) that is payable to the clerk upon the commencement of a case under the Code. (b) PAYMENT OF FILING FEE IN INSTALLMENTS. (1) Application to Pay Filing Fee in Installments. A voluntary petition by an individual shall be accepted for filing, regardless of whether any portion of the filing fee is paid, if accompanied by the debtor’s signed application, prepared as prescribed by the appropriate Official Form, stating that the debtor is unable to pay the filing fee except in installments. (2) Action on Application. Prior to the meeting of creditors, the court may order the filing fee paid to the clerk or grant leave to pay in installments and fix the number, amount and dates of payment. The number of installments shall not exceed four, and the final installment shall be payable not later than 120 days after filing the petition. For cause shown, the court may extend the time of any installment, provided the last installment is paid not later than 180 days after filing the petition. (3) Postponement of Attorney’s Fees. All installments of the filing fee must be paid in full before the debtor or chapter 13 trustee may make further payments to an attorney or any other person who renders services to the debtor in connection with the case. (c) WAIVER OF FILING FEE. A voluntary chapter 7 petition filed by an individual shall be accepted for filing if accompanied by the debtor’s application requesting a waiver under 28 U.S.C. § 1930(f), prepared as prescribed by the appropriate Official Form. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 27, 2017, eff. Dec. 1, 2017.) Rule 1007. Lists, Schedules, Statements, and Other Documents; Time Limits (a) CORPORATE OWNERSHIP STATEMENT, LIST OF CREDITORS AND EQUITY SECURITY HOLDERS, AND OTHER LISTS. (1) Voluntary Case. In a voluntary case, the debtor shall file with the petition a list containing the name and address of each entity included or to be included on Schedules D, E/F, G, and H as prescribed by the Official Forms. If the debtor is a corporation, other than a governmental unit, the debtor shall file with the petition a corporate ownership statement containing the information described in Rule 7007.1. The debtor shall file a supplemental statement promptly upon any change in circumstances that renders the corporate ownership statement inaccurate. Rule 1007 FEDERAL RULES OF BANKRUPTCY PROCEDURE 4 (2) Involuntary Case. In an involuntary case, the debtor shall file, within seven days after entry of the order for relief, a list containing the name and address of each entity included or to be included on Schedules D, E/F, G, and H as prescribed by the Official Forms. (3) Equity Security Holders. In a chapter 11 reorganization case, unless the court orders otherwise, the debtor shall file within 14 days after entry of the order for relief a list of the debtor’s equity security holders of each class showing the number and kind of interests registered in the name of each holder, and the last known address or place of business of each holder. (4) Chapter 15 Case. In addition to the documents required under § 1515 of the Code, a foreign representative filing a petition for recognition under chapter 15 shall file with the petition: (A) a corporate ownership statement containing the information described in Rule 7007.1; and (B) unless the court orders otherwise, a list containing the names and addresses of all persons or bodies authorized to administer foreign proceedings of the debtor, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and all entities against whom provisional relief is being sought under § 1519 of the Code. (5) Extension of Time. Any extension of time for the filing of the lists required by this subdivision may be granted only on motion for cause shown and on notice to the United States trustee and to any trustee, committee elected under § 705 or appointed under § 1102 of the Code, or other party as the court may direct. (b) SCHEDULES, STATEMENTS, AND OTHER DOCUMENTS REQUIRED. (1) Except in a chapter 9 municipality case, the debtor, unless the court orders otherwise, shall file the following schedules, statements, and other documents, prepared as prescribed by the appropriate Official Forms, if any: (A) schedules of assets and liabilities; (B) a schedule of current income and expenditures; (C) a schedule of executory contracts and unexpired leases; (D) a statement of financial affairs; (E) copies of all payment advices or other evidence of payment, if any, received by the debtor from an employer within 60 days before the filing of the petition, with redaction of all but the last four digits of the debtor’s social-security number or individual taxpayer-identification number; and (F) a record of any interest that the debtor has in an account or program of the type specified in § 521(c) of the Code. (2) An individual debtor in a chapter 7 case shall file a statement of intention as required by § 521(a) of the Code, prepared as prescribed by the appropriate Official Form. A copy of the statement of intention shall be served on the trustee and the creditors named in the statement on or before the filing of the statement. 5 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 (3) Unless the United States trustee has determined that the credit counseling requirement of § 109(h) does not apply in the district, an individual debtor must file a statement of compliance with the credit counseling requirement, prepared as prescribed by the appropriate Official Form which must include one of the following: (A) an attached certificate and debt repayment plan, if any, required by § 521(b); (B) a statement that the debtor has received the credit counseling briefing required by § 109(h)(1) but does not have the certificate required by § 521(b); (C) a certification under § 109(h)(3); or (D) a request for a determination by the court under § 109(h)(4). (4) Unless § 707(b)(2)(D) applies, an individual debtor in a chapter 7 case shall file a statement of current monthly income prepared as prescribed by the appropriate Official Form, and, if the current monthly income exceeds the median family income for the applicable state and household size, the information, including calculations, required by § 707(b), prepared as prescribed by the appropriate Official Form. (5) An individual debtor in a chapter 11 case shall file a statement of current monthly income, prepared as prescribed by the appropriate Official Form. (6) A debtor in a chapter 13 case shall file a statement of current monthly income, prepared as prescribed by the appropriate Official Form, and, if the current monthly income exceeds the median family income for the applicable state and household size, a calculation of disposable income made in accordance with § 1325(b)(3), prepared as prescribed by the appropriate Official Form. (7) Unless an approved provider of an instructional course concerning personal financial management has notified the court that a debtor has completed the course after filing the petition: (A) An individual debtor in a chapter 7 or chapter 13 case shall file a statement of completion of the course, prepared as prescribed by the appropriate Official Form; and (B) An individual debtor in a chapter 11 case shall file the statement if § 1141(d)(3) applies. (8) If an individual debtor in a chapter 11, 12, or 13 case has claimed an exemption under § 522(b)(3)(A) in property of the kind described in § 522(p)(1) with a value in excess of the amount set out in § 522(q)(1), the debtor shall file a statement as to whether there is any proceeding pending in which the debtor may be found guilty of a felony of a kind described in § 522(q)(1)(A) or found liable for a debt of the kind described in § 522(q)(1)(B). (c) TIME LIMITS. In a voluntary case, the schedules, statements, and other documents required by subdivision (b)(1), (4), (5), and (6) shall be filed with the petition or within 14 days thereafter, except as otherwise provided in subdivisions (d), (e), (f), and (h) of this rule. In an involuntary case, the schedules, statements, and other Rule 1007 FEDERAL RULES OF BANKRUPTCY PROCEDURE 6 1So in original. Probably should be only one section symbol. documents required by subdivision (b)(1) shall be filed by the debtor within 14 days after the entry of the order for relief. In a voluntary case, the documents required by paragraphs (A), (C), and (D) of subdivision (b)(3) shall be filed with the petition. Unless the court orders otherwise, a debtor who has filed a statement under subdivision (b)(3)(B), shall file the documents required by subdivision (b)(3)(A) within 14 days of the order for relief. In a chapter 7 case, the debtor shall file the statement required by subdivision (b)(7) within 60 days after the first date set for the meeting of creditors under § 341 of the Code, and in a chapter 11 or 13 case no later than the date when the last payment was made by the debtor as required by the plan or the filing of a motion for a discharge under § 1141(d)(5)(B) or § 1328(b) of the Code. The court may, at any time and in its discretion, enlarge the time to file the statement required by subdivision (b)(7). The debtor shall file the statement required by subdivision (b)(8) no earlier than the date of the last payment made under the plan or the date of the filing of a motion for a discharge under §§ 1141(d)(5)(B),1 1228(b), or 1328(b) of the Code. Lists, schedules, statements, and other documents filed prior to the conversion of a case to another chapter shall be deemed filed in the converted case unless the court directs otherwise. Except as provided in § 1116(3), any extension of time to file schedules, statements, and other documents required under this rule may be granted only on motion for cause shown and on notice to the United States trustee, any committee elected under § 705 or appointed under § 1102 of the Code, trustee, examiner, or other party as the court may direct. Notice of an extension shall be given to the United States trustee and to any committee, trustee, or other party as the court may direct. (d) LIST OF 20 LARGEST CREDITORS IN CHAPTER 9 MUNICIPALITY CASE OR CHAPTER 11 REORGANIZATION CASE. In addition to the list required by subdivision (a) of this rule, a debtor in a chapter 9 municipality case or a debtor in a voluntary chapter 11 reorganization case shall file with the petition a list containing the name, address and claim of the creditors that hold the 20 largest unsecured claims, excluding insiders, as prescribed by the appropriate Official Form. In an involuntary chapter 11 reorganization case, such list shall be filed by the debtor within 2 days after entry of the order for relief under § 303(h) of the Code. (e) LIST IN CHAPTER 9 MUNICIPALITY CASES. The list required by subdivision (a) of this rule shall be filed by the debtor in a chapter 9 municipality case within such time as the court shall fix. If a proposed plan requires a revision of assessments so that the proportion of special assessments or special taxes to be assessed against some real property will be different from the proportion in effect at the date the petition is filed, the debtor shall also file a list showing the name and address of each known holder of title, legal or equitable, to real property adversely affected. On motion for cause shown, the court may modify the requirements of this subdivision and subdivision (a) of this rule. 7 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 (f) STATEMENT OF SOCIAL SECURITY NUMBER. An individual debtor shall submit a verified statement that sets out the debtor’s social security number, or states that the debtor does not have a social security number. In a voluntary case, the debtor shall submit the statement with the petition. In an involuntary case, the debtor shall submit the statement within 14 days after the entry of the order for relief. (g) PARTNERSHIP AND PARTNERS. The general partners of a debtor partnership shall prepare and file the list required under subdivision (a), schedules of the assets and liabilities, schedule of current income and expenditures, schedule of executory contracts and unexpired leases, and statement of financial affairs of the partnership. The court may order any general partner to file a statement of personal assets and liabilities within such time as the court may fix. (h) INTERESTS ACQUIRED OR ARISING AFTER PETITION. If, as provided by § 541(a)(5) of the Code, the debtor acquires or becomes entitled to acquire any interest in property, the debtor shall within 14 days after the information comes to the debtor’s knowledge or within such further time the court may allow, file a supplemental schedule in the chapter 7 liquidation case, chapter 11 reorganization case, chapter 12 family farmer’s debt adjustment case, or chapter 13 individual debt adjustment case. If any of the property required to be reported under this subdivision is claimed by the debtor as exempt, the debtor shall claim the exemptions in the supplemental schedule. The duty to file a supplemental schedule in accordance with this subdivision continues notwithstanding the closing of the case, except that the schedule need not be filed in a chapter 11, chapter 12, or chapter 13 case with respect to property acquired after entry of the order confirming a chapter 11 plan or discharging the debtor in a chapter 12 or chapter 13 case. (i) DISCLOSURE OF LIST OF SECURITY HOLDERS. After notice and hearing and for cause shown, the court may direct an entity other than the debtor or trustee to disclose any list of security holders of the debtor in its possession or under its control, indicating the name, address and security held by any of them. The entity possessing this list may be required either to produce the list or a true copy thereof, or permit inspection or copying, or otherwise disclose the information contained on the list. (j) IMPOUNDING OF LISTS. On motion of a party in interest and for cause shown the court may direct the impounding of the lists filed under this rule, and may refuse to permit inspection by any entity. The court may permit inspection or use of the lists, however, by any party in interest on terms prescribed by the court. (k) PREPARATION OF LIST, SCHEDULES, OR STATEMENTS ON DEFAULT OF DEBTOR. If a list, schedule, or statement, other than a statement of intention, is not prepared and filed as required by this rule, the court may order the trustee, a petitioning creditor, committee, or other party to prepare and file any of these papers within a time fixed by the court. The court may approve reimbursement of the cost incurred in complying with such an order as an administrative expense. (l) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall forthwith transmit to the United States trustee a copy of every list, schedule, and statement filed pursuant to subdivision (a)(1), (a)(2), (b), (d), or (h) of this rule. (m) INFANTS AND INCOMPETENT PERSONS. If the debtor knows that a person on the list of creditors or schedules is an infant or incompetent person, the debtor also shall include the name, address, and legal relationship of any person upon whom process would be served in an adversary proceeding against the infant or incompetent person in accordance with Rule 7004(b)(2). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 23, 2001, eff. Dec. 1, 2001; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 25, 2005, eff. Dec. 1, 2005; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 23, 2012, eff. Dec. 1, 2012: Apr. 16, 2013, eff. Dec. 1, 2013; Apr. 29, 2015, eff. Dec. 1, 2015.) Rule 1008. Verification of Petitions and Accompanying Papers All petitions, lists, schedules, statements and amendments thereto shall be verified or contain an unsworn declaration as provided in 28 U.S.C. § 1746. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1009. Amendments of Voluntary Petitions, Lists, Schedules and Statements (a) GENERAL RIGHT TO AMEND. A voluntary petition, list, schedule, or statement may be amended by the debtor as a matter of course at any time before the case is closed. The debtor shall give notice of the amendment to the trustee and to any entity affected thereby. On motion of a party in interest, after notice and a hearing, the court may order any voluntary petition, list, schedule, or statement to be amended and the clerk shall give notice of the amendment to entities designated by the court. (b) STATEMENT OF INTENTION. The statement of intention may be amended by the debtor at any time before the expiration of the period provided in § 521(a) of the Code. The debtor shall give notice of the amendment to the trustee and to any entity affected thereby. (c) STATEMENT OF SOCIAL SECURITY NUMBER. If a debtor becomes aware that the statement of social security number submitted under Rule 1007(f) is incorrect, the debtor shall promptly submit an amended verified statement setting forth the correct social security number. The debtor shall give notice of the amendment to all of the entities required to be included on the list filed under Rule 1007(a)(1) or (a)(2). (d) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall promptly transmit to the United States trustee a copy of every amendment filed or submitted under subdivision (a), (b), or (c) of this rule. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 12, 2006, eff. Dec. 1, 2006; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1010. Service of Involuntary Petition and Summons (a) SERVICE OF INVOLUNTARY PETITION AND SUMMONS. On the filing of an involuntary petition, the clerk shall forthwith issue a summons for service. When an involuntary petition is filed, service shall be made on the debtor. The summons shall be served with a copy of the petition in the manner provided for service of a summons and complaint by Rule 7004(a) or (b). If service cannot be so made, the court may order that the summons and petition be served by mailing copies to the party’s last known address, and by at least one publication in a manner and form directed by the court. The summons and petition may be served on the party anywhere. Rule 7004(e) and Rule 4(l) F.R.Civ.P. apply when service is made or attempted under this rule. (b) CORPORATE OWNERSHIP STATEMENT. Each petitioner that is a corporation shall file with the involuntary petition a corporate ownership statement containing the information described in Rule 7007.1. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1011. Responsive Pleading or Motion in Involuntary Cases (a) WHO MAY CONTEST PETITION. The debtor named in an involuntary petition may contest the petition. In the case of a petition against a partnership under Rule 1004, a nonpetitioning general partner, or a person who is alleged to be a general partner but denies the allegation, may contest the petition. (b) DEFENSES AND OBJECTIONS; WHEN PRESENTED. Defenses and objections to the petition shall be presented in the manner prescribed by Rule 12 F.R.Civ.P. and shall be filed and served within 21 days after service of the summons, except that if service is made by publication on a party or partner not residing or found within the state in which the court sits, the court shall prescribe the time for filing and serving the response. (c) EFFECT OF MOTION. Service of a motion under Rule 12(b) F.R.Civ.P. shall extend the time for filing and serving a responsive pleading as permitted by Rule 12(a) F.R.Civ.P. (d) CLAIMS AGAINST PETITIONERS. A claim against a petitioning creditor may not be asserted in the answer except for the purpose of defeating the petition. (e) OTHER PLEADINGS. No other pleadings shall be permitted, except that the court may order a reply to an answer and prescribe the time for filing and service. (f) CORPORATE OWNERSHIP STATEMENT. If the entity responding to the involuntary petition is a corporation, the entity shall file with its first appearance, pleading, motion, response, or other request addressed to the court a corporate ownership statement containing the information described in Rule 7007.1. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 26, 2004, eff. Dec. 1, 2004; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1012. Responsive Pleading in Cross-Border Cases (a) WHO MAY CONTEST PETITION. The debtor or any party in interest may contest a petition for recognition of a foreign proceeding. (b) OBJECTIONS AND RESPONSES; WHEN PRESENTED. Objections and other responses to the petition shall be presented no later Rule 1013 FEDERAL RULES OF BANKRUPTCY PROCEDURE 10 than seven days before the date set for the hearing on the petition, unless the court prescribes some other time or manner for responses. (c) CORPORATE OWNERSHIP STATEMENT. If the entity responding to the petition is a corporation, then the entity shall file a corporate ownership statement containing the information described in Rule 7007.1 with its first appearance, pleading, motion, response, or other request addressed to the court. (Added Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1013. Hearing and Disposition of a Petition in an Involuntary Case (a) CONTESTED PETITION. The court shall determine the issues of a contested petition at the earliest practicable time and forthwith enter an order for relief, dismiss the petition, or enter any other appropriate order. (b) DEFAULT. If no pleading or other defense to a petition is filed within the time provided by Rule 1011, the court, on the next day, or as soon thereafter as practicable, shall enter an order for the relief requested in the petition. [(c) ORDER FOR RELIEF] (Abrogated Apr. 22, 1993, eff. Aug. 1, 1993) (As amended Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993.) Rule 1014. Dismissal and Change of Venue (a) DISMISSAL AND TRANSFER OF CASES. (1) Cases Filed in Proper District. If a petition is filed in the proper district, the court, on the timely motion of a party in interest or on its own motion, and after hearing on notice to the petitioners, the United States trustee, and other entities as directed by the court, may transfer the case to any other district if the court determines that the transfer is in the interest of justice or for the convenience of the parties. (2) Cases Filed in Improper District. If a petition is filed in an improper district, the court, on the timely motion of a party in interest or on its own motion, and after hearing on notice to the petitioners, the United States trustee, and other entities as directed by the court, may dismiss the case or transfer it to any other district if the court determines that transfer is in the interest of justice or for the convenience of the parties. (b) PROCEDURE WHEN PETITIONS INVOLVING THE SAME DEBTOR OR RELATED DEBTORS ARE FILED IN DIFFERENT COURTS. If petitions commencing cases under the Code or seeking recognition under chapter 15 are filed in different districts by, regarding, or against (1) the same debtor, (2) a partnership and one or more of its general partners, (3) two or more general partners, or (4) a debtor and an affiliate, the court in the district in which the first-filed petition is pending may determine, in the interest of justice or for the convenience of the parties, the district or districts in which any of the cases should proceed. The court may so determine on motion and after a hearing, with notice to the following entities in the affected cases: the United States trustee, entities entitled to notice under Rule 2002(a), and other entities as the court directs. 11 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1017 The court may order the parties to the later-filed cases not to proceed further until it makes the determination. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 30, 2007, eff. Dec. 1, 2007; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 25, 2014, eff. Dec. 1, 2014.) Rule 1015. Consolidation or Joint Administration of Cases Pending in Same Court (a) CASES INVOLVING SAME DEBTOR. If two or more petitions by, regarding, or against the same debtor are pending in the same court, the court may order consolidation of the cases. (b) CASES INVOLVING TWO OR MORE RELATED DEBTORS. If a joint petition or two or more petitions are pending in the same court by or against (1) spouses, or (2) a partnership and one or more of its general partners, or (3) two or more general partners, or (4) a debtor and an affiliate, the court may order a joint administration of the estates. Prior to entering an order the court shall give consideration to protecting creditors of different estates against potential conflicts of interest. An order directing joint administration of individual cases of spouses shall, if one spouse has elected the exemptions under § 522(b)(2) of the Code and the other has elected the exemptions under § 522(b)(3), fix a reasonable time within which either may amend the election so that both shall have elected the same exemptions. The order shall notify the debtors that unless they elect the same exemptions within the time fixed by the court, they will be deemed to have elected the exemptions provided by § 522(b)(2). (c) EXPEDITING AND PROTECTIVE ORDERS. When an order for consolidation or joint administration of a joint case or two or more cases is entered pursuant to this rule, while protecting the rights of the parties under the Code, the court may enter orders as may tend to avoid unnecessary costs and delay. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 27, 2017, eff. Dec. 1, 2017.) Rule 1016. Death or Incompetency of Debtor Death or incompetency of the debtor shall not abate a liquidation case under chapter 7 of the Code. In such event the estate shall be administered and the case concluded in the same manner, so far as possible, as though the death or incompetency had not occurred. If a reorganization, family farmer’s debt adjustment, or individual’s debt adjustment case is pending under chapter 11, chapter 12, or chapter 13, the case may be dismissed; or if further administration is possible and in the best interest of the parties, the case may proceed and be concluded in the same manner, so far as possible, as though the death or incompetency had not occurred. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1017. Dismissal or Conversion of Case; Suspension (a) VOLUNTARY DISMISSAL; DISMISSAL FOR WANT OF PROSECUTION OR OTHER CAUSE. Except as provided in §§ 707(a)(3), 707(b), 1208(b), and 1307(b) of the Code, and in Rule 1017(b), (c), and (e), a case Rule 1017 FEDERAL RULES OF BANKRUPTCY PROCEDURE 12 shall not be dismissed on motion of the petitioner, for want of prosecution or other cause, or by consent of the parties, before a hearing on notice as provided in Rule 2002. For the purpose of the notice, the debtor shall file a list of creditors with their addresses within the time fixed by the court unless the list was previously filed. If the debtor fails to file the list, the court may order the debtor or another entity to prepare and file it. (b) DISMISSAL FOR FAILURE TO PAY FILING FEE. (1) If any installment of the filing fee has not been paid, the court may, after a hearing on notice to the debtor and the trustee, dismiss the case. (2) If the case is dismissed or closed without full payment of the filing fee, the installments collected shall be distributed in the same manner and proportions as if the filing fee had been paid in full. (c) DISMISSAL OF VOLUNTARY CHAPTER 7 OR CHAPTER 13 CASE FOR FAILURE TO TIMELY FILE LIST OF CREDITORS, SCHEDULES, AND STATEMENT OF FINANCIAL AFFAIRS. The court may dismiss a voluntary chapter 7 or chapter 13 case under § 707(a)(3) or § 1307(c)(9) after a hearing on notice served by the United States trustee on the debtor, the trustee, and any other entities as the court directs. (d) SUSPENSION. The court shall not dismiss a case or suspend proceedings under § 305 before a hearing on notice as provided in Rule 2002(a). (e) DISMISSAL OF AN INDIVIDUAL DEBTOR’S CHAPTER 7 CASE, OR CONVERSION TO A CASE UNDER CHAPTER 11 OR 13, FOR ABUSE. The court may dismiss or, with the debtor’s consent, convert an individual debtor’s case for abuse under § 707(b) only on motion and after a hearing on notice to the debtor, the trustee, the United States trustee, and any other entity as the court directs. (1) Except as otherwise provided in § 704(b)(2), a motion to dismiss a case for abuse under § 707(b) or (c) may be filed only within 60 days after the first date set for the meeting of creditors under § 341(a), unless, on request filed before the time has expired, the court for cause extends the time for filing the motion to dismiss. The party filing the motion shall set forth in the motion all matters to be considered at the hearing. In addition, a motion to dismiss under § 707(b)(1) and (3) shall state with particularity the circumstances alleged to constitute abuse. (2) If the hearing is set on the court’s own motion, notice of the hearing shall be served on the debtor no later than 60 days after the first date set for the meeting of creditors under § 341(a). The notice shall set forth all matters to be considered by the court at the hearing. (f) PROCEDURE FOR DISMISSAL, CONVERSION, OR SUSPENSION. (1) Rule 9014 governs a proceeding to dismiss or suspend a case, or to convert a case to another chapter, except under §§ 706(a), 1112(a), 1208(a) or (b), or 1307(a) or (b). (2) Conversion or dismissal under §§ 706(a), 1112(a), 1208(b), or 1307(b) shall be on motion filed and served as required by Rule 9013. (3) A chapter 12 or chapter 13 case shall be converted without court order when the debtor files a notice of conversion under 13 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1019 §§ 1208(a) or 1307(a). The filing date of the notice becomes the date of the conversion order for the purposes of applying § 348(c) and Rule 1019. The clerk shall promptly transmit a copy of the notice to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 17, 2000, eff. Dec. 1, 2000; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1018. Contested Involuntary Petitions; Contested Petitions Commencing Chapter 15 Cases; Proceedings to Vacate Order for Relief; Applicability of Rules in Part VII Governing Adversary Proceedings Unless the court otherwise directs and except as otherwise prescribed in Part I of these rules, the following rules in Part VII apply to all proceedings contesting an involuntary petition or a chapter 15 petition for recognition, and to all proceedings to vacate an order for relief: Rules 7005, 7008–7010, 7015, 7016, 7024–7026, 7028–7037, 7052, 7054, 7056, and 7062. The court may direct that other rules in Part VII shall also apply. For the purposes of this rule a reference in the Part VII rules to adversary proceedings shall be read as a reference to proceedings contesting an involuntary petition or a chapter 15 petition for recognition, or proceedings to vacate an order for relief. Reference in the Federal Rules of Civil Procedure to the complaint shall be read as a reference to the petition. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 28, 2010, eff. Dec. 1, 2010.) Rule 1019. Conversion of a Chapter 11 Reorganization Case, Chapter 12 Family Farmer’s Debt Adjustment Case, or Chapter 13 Individual’s Debt Adjustment Case to a Chapter 7 Liquidation Case When a chapter 11, chapter 12, or chapter 13 case has been converted or reconverted to a chapter 7 case: (1) Filing of Lists, Inventories, Schedules, Statements. (A) Lists, inventories, schedules, and statements of financial affairs theretofore filed shall be deemed to be filed in the chapter 7 case, unless the court directs otherwise. If they have not been previously filed, the debtor shall comply with Rule 1007 as if an order for relief had been entered on an involuntary petition on the date of the entry of the order directing that the case continue under chapter 7. (B) If a statement of intention is required, it shall be filed within 30 days after entry of the order of conversion or before the first date set for the meeting of creditors, whichever is earlier. The court may grant an extension of time for cause only on written motion filed, or oral request made during a hearing, before the time has expired. Notice of an extension shall be given to the United States trustee and to any committee, trustee, or other party as the court may direct. (2) New Filing Periods. (A) A new time period for filing a motion under § 707(b) or (c), a claim, a complaint objecting to discharge, or a Rule 1019 FEDERAL RULES OF BANKRUPTCY PROCEDURE 14 1So in original. Probably should be ‘‘Rule’’. complaint to obtain a determination of dischargeability of any debt shall commence under Rules 1 1017, 3002, 4004, or 4007, but a new time period shall not commence if a chapter 7 case had been converted to a chapter 11, 12, or 13 case and thereafter reconverted to a chapter 7 case and the time for filing a motion under § 707(b) or (c), a claim, a complaint objecting to discharge, or a complaint to obtain a determination of the dischargeability of any debt, or any extension thereof, expired in the original chapter 7 case. (B) A new time period for filing an objection to a claim of exemptions shall commence under Rule 4003(b) after conversion of a case to chapter 7 unless: (i) the case was converted to chapter 7 more than one year after the entry of the first order confirming a plan under chapter 11, 12, or 13; or (ii) the case was previously pending in chapter 7 and the time to object to a claimed exemption had expired in the original chapter 7 case. (3) Claims Filed Before Conversion. All claims actually filed by a creditor before conversion of the case are deemed filed in the chapter 7 case. (4) Turnover of Records and Property. After qualification of, or assumption of duties by the chapter 7 trustee, any debtor in possession or trustee previously acting in the chapter 11, 12, or 13 case shall, forthwith, unless otherwise ordered, turn over to the chapter 7 trustee all records and property of the estate in the possession or control of the debtor in possession or trustee. (5) Filing Final Report and Schedule of Postpetition Debts. (A) Conversion of Chapter 11 or Chapter 12 Case. Unless the court directs otherwise, if a chapter 11 or chapter 12 case is converted to chapter 7, the debtor in possession or, if the debtor is not a debtor in possession, the trustee serving at the time of conversion, shall: (i) not later than 14 days after conversion of the case, file a schedule of unpaid debts incurred after the filing of the petition and before conversion of the case, including the name and address of each holder of a claim; and (ii) not later than 30 days after conversion of the case, file and transmit to the United States trustee a final report and account; (B) Conversion of Chapter 13 Case. Unless the court directs otherwise, if a chapter 13 case is converted to chapter 7, (i) the debtor, not later than 14 days after conversion of the case, shall file a schedule of unpaid debts incurred after the filing of the petition and before conversion of the case, including the name and address of each holder of a claim; and (ii) the trustee, not later than 30 days after conversion of the case, shall file and transmit to the United States trustee a final report and account; 15 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1020 (C) Conversion After Confirmation of a Plan. Unless the court orders otherwise, if a chapter 11, chapter 12, or chapter 13 case is converted to chapter 7 after confirmation of a plan, the debtor shall file: (i) a schedule of property not listed in the final report and account acquired after the filing of the petition but before conversion, except if the case is converted from chapter 13 to chapter 7 and § 348(f)(2) does not apply; (ii) a schedule of unpaid debts not listed in the final report and account incurred after confirmation but before the conversion; and (iii) a schedule of executory contracts and unexpired leases entered into or assumed after the filing of the petition but before conversion. (D) Transmission to United States Trustee. The clerk shall forthwith transmit to the United States trustee a copy of every schedule filed pursuant to Rule 1019(5). (6) Postpetition Claims; Preconversion Administrative Expenses; Notice. A request for payment of an administrative expense incurred before conversion of the case is timely filed under § 503(a) of the Code if it is filed before conversion or a time fixed by the court. If the request is filed by a governmental unit, it is timely if it is filed before conversion or within the later of a time fixed by the court or 180 days after the date of the conversion. A claim of a kind specified in § 348(d) may be filed in accordance with Rules 3001(a)–(d) and 3002. Upon the filing of the schedule of unpaid debts incurred after commencement of the case and before conversion, the clerk, or some other person as the court may direct, shall give notice to those entities listed on the schedule of the time for filing a request for payment of an administrative expense and, unless a notice of insufficient assets to pay a dividend is mailed in accordance with Rule 2002(e), the time for filing a claim of a kind specified in § 348(d). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2010, eff. Dec. 1, 2010.) Rule 1020. Small Business Chapter 11 Reorganization Case (a) SMALL BUSINESS DEBTOR DESIGNATION. In a voluntary chapter 11 case, the debtor shall state in the petition whether the debtor is a small business debtor. In an involuntary chapter 11 case, the debtor shall file within 14 days after entry of the order for relief a statement as to whether the debtor is a small business debtor. Except as provided in subdivision (c), the status of the case as a small business case shall be in accordance with the debtor’s statement under this subdivision, unless and until the court enters an order finding that the debtor’s statement is incorrect. (b) OBJECTING TO DESIGNATION. Except as provided in subdivision (c), the United States trustee or a party in interest may file an objection to the debtor’s statement under subdivision (a) no later than 30 days after the conclusion of the meeting of creditors held Rule 1021 FEDERAL RULES OF BANKRUPTCY PROCEDURE 16 under § 341(a) of the Code, or within 30 days after any amendment to the statement, whichever is later. (c) APPOINTMENT OF COMMITTEE OF UNSECURED CREDITORS. If a committee of unsecured creditors has been appointed under § 1102(a)(1), the case shall proceed as a small business case only if, and from the time when, the court enters an order determining that the committee has not been sufficiently active and representative to provide effective oversight of the debtor and that the debtor satisfies all the other requirements for being a small business. A request for a determination under this subdivision may be filed by the United States trustee or a party in interest only within a reasonable time after the failure of the committee to be sufficiently active and representative. The debtor may file a request for a determination at any time as to whether the committee has been sufficiently active and representative. (d) PROCEDURE FOR OBJECTION OR DETERMINATION. Any objection or request for a determination under this rule shall be governed by Rule 9014 and served on: the debtor; the debtor’s attorney; the United States trustee; the trustee; any committee appointed under § 1102 or its authorized agent, or, if no committee of unsecured creditors has been appointed under § 1102, the creditors included on the list filed under Rule 1007(d); and any other entity as the court directs. (Added Apr. 11, 1997, eff. Dec. 1, 1997; amended Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 1021. Health Care Business Case (a) HEALTH CARE BUSINESS DESIGNATION. Unless the court orders otherwise, if a petition in a case under chapter 7, chapter 9, or chapter 11 states that the debtor is a health care business, the case shall proceed as a case in which the debtor is a health care business. (b) MOTION. The United States trustee or a party in interest may file a motion to determine whether the debtor is a health care business. The motion shall be transmitted to the United States trustee and served on: the debtor; the trustee; any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, the creditors included on the list filed under Rule 1007(d); and any other entity as the court directs. The motion shall be governed by Rule 9014. (Added Apr. 23, 2008, eff. Dec. 1, 2008.) PART II—OFFICERS AND ADMINISTRATION; NOTICES; MEETINGS; EXAMINATIONS; ELECTIONS; ATTORNEYS AND ACCOUNTANTS Rule 2001. Appointment of Interim Trustee Before Order for Relief in a Chapter 7 Liquidation Case (a) APPOINTMENT. At any time following the commencement of an involuntary liquidation case and before an order for relief, the court on written motion of a party in interest may order the appointment of an interim trustee under § 303(g) of the Code. The 17 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 motion shall set forth the necessity for the appointment and may be granted only after hearing on notice to the debtor, the petitioning creditors, the United States trustee, and other parties in interest as the court may designate. (b) BOND OF MOVANT. An interim trustee may not be appointed under this rule unless the movant furnishes a bond in an amount approved by the court, conditioned to indemnify the debtor for costs, attorney’s fee, expenses, and damages allowable under § 303(i) of the Code. (c) ORDER OF APPOINTMENT. The order directing the appointment of an interim trustee shall state the reason the appointment is necessary and shall specify the trustee’s duties. (d) TURNOVER AND REPORT. Following qualification of the trustee selected under § 702 of the Code, the interim trustee, unless otherwise ordered, shall (1) forthwith deliver to the trustee all the records and property of the estate in possession or subject to control of the interim trustee and, (2) within 30 days thereafter file a final report and account. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2002. Notices to Creditors, Equity Security Holders, Administrators in Foreign Proceedings, Persons Against Whom Provisional Relief is Sought in Ancillary and Other Cross-Border Cases, United States, and United States Trustee (a) TWENTY-ONE-DAY NOTICES TO PARTIES IN INTEREST. Except as provided in subdivisions (h), (i), (l), (p), and (q) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, the trustee, all creditors and indenture trustees at least 21 days’ notice by mail of: (1) the meeting of creditors under § 341 or § 1104(b) of the Code, which notice, unless the court orders otherwise, shall include the debtor’s employer identification number, social security number, and any other federal taxpayer identification number; (2) a proposed use, sale, or lease of property of the estate other than in the ordinary course of business, unless the court for cause shown shortens the time or directs another method of giving notice; (3) the hearing on approval of a compromise or settlement of a controversy other than approval of an agreement pursuant to Rule 4001(d), unless the court for cause shown directs that notice not be sent; (4) in a chapter 7 liquidation, a chapter 11 reorganization case, or a chapter 12 family farmer debt adjustment case, the hearing on the dismissal of the case or the conversion of the case to another chapter, unless the hearing is under § 707(a)(3) or § 707(b) or is on dismissal of the case for failure to pay the filing fee; (5) the time fixed to accept or reject a proposed modification of a plan; (6) a hearing on any entity’s request for compensation or reimbursement of expenses if the request exceeds $1,000; (7) the time fixed for filing proofs of claims pursuant to Rule 3003(c); Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 18 (8) the time fixed for filing objections and the hearing to consider confirmation of a chapter 12 plan; and (9) the time fixed for filing objections to confirmation of a chapter 13 plan. (b) TWENTY-EIGHT-DAY NOTICES TO PARTIES IN INTEREST. Except as provided in subdivision (l) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, the trustee, all creditors and indenture trustees not less than 28 days’ notice by mail of the time fixed (1) for filing objections and the hearing to consider approval of a disclosure statement or, under § 1125(f), to make a final determination whether the plan provides adequate information so that a separate disclosure statement is not necessary; (2) for filing objections and the hearing to consider confirmation of a chapter 9 or chapter 11 plan; and (3) for the hearing to consider confirmation of a chapter 13 plan. (c) CONTENT OF NOTICE. (1) Proposed Use, Sale, or Lease of Property. Subject to Rule 6004, the notice of a proposed use, sale, or lease of property required by subdivision (a)(2) of this rule shall include the time and place of any public sale, the terms and conditions of any private sale and the time fixed for filing objections. The notice of a proposed use, sale, or lease of property, including real estate, is sufficient if it generally describes the property. The notice of a proposed sale or lease of personally identifiable information under § 363(b)(1) of the Code shall state whether the sale is consistent with any policy prohibiting the transfer of the information. (2) Notice of Hearing on Compensation. The notice of a hearing on an application for compensation or reimbursement of expenses required by subdivision (a)(6) of this rule shall identify the applicant and the amounts requested. (3) Notice of Hearing on Confirmation When Plan Provides for an Injunction. If a plan provides for an injunction against conduct not otherwise enjoined under the Code, the notice required under Rule 2002(b)(2) shall: (A) include in conspicuous language (bold, italic, or underlined text) a statement that the plan proposes an injunction; (B) describe briefly the nature of the injunction; and (C) identify the entities that would be subject to the injunction. (d) NOTICE TO EQUITY SECURITY HOLDERS. In a chapter 11 reorganization case, unless otherwise ordered by the court, the clerk, or some other person as the court may direct, shall in the manner and form directed by the court give notice to all equity security holders of (1) the order for relief; (2) any meeting of equity security holders held pursuant to § 341 of the Code; (3) the hearing on the proposed sale of all or substantially all of the debtor’s assets; (4) the hearing on the dismissal or conversion of a case to another chapter; (5) the time fixed for filing objections to and the hearing to consider approval of a disclosure statement; (6) the time fixed for filing objections to and the hearing to consider confirmation of a plan; and (7) the time fixed to accept or reject a proposed modification of a plan. 19 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 (e) NOTICE OF NO DIVIDEND. In a chapter 7 liquidation case, if it appears from the schedules that there are no assets from which a dividend can be paid, the notice of the meeting of creditors may include a statement to that effect; that it is unnecessary to file claims; and that if sufficient assets become available for the payment of a dividend, further notice will be given for the filing of claims. (f) OTHER NOTICES. Except as provided in subdivision (l) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, all creditors, and indenture trustees notice by mail of: (1) the order for relief; (2) the dismissal or the conversion of the case to another chapter, or the suspension of proceedings under § 305; (3) the time allowed for filing claims pursuant to Rule 3002; (4) the time fixed for filing a complaint objecting to the debtor’s discharge pursuant to § 727 of the Code as provided in Rule 4004; (5) the time fixed for filing a complaint to determine the dischargeability of a debt pursuant to § 523 of the Code as provided in Rule 4007; (6) the waiver, denial, or revocation of a discharge as provided in Rule 4006; (7) entry of an order confirming a chapter 9, 11, or 12 plan; (8) a summary of the trustee’s final report in a chapter 7 case if the net proceeds realized exceed $1,500; (9) a notice under Rule 5008 regarding the presumption of abuse; (10) a statement under § 704(b)(1) as to whether the debtor’s case would be presumed to be an abuse under § 707(b); and (11) the time to request a delay in the entry of the discharge under §§ 1141(d)(5)(C), 1228(f), and 1328(h). Notice of the time fixed for accepting or rejecting a plan pursuant to Rule 3017(c) shall be given in accordance with Rule 3017(d). (g) ADDRESSING NOTICES. (1) Notices required to be mailed under Rule 2002 to a creditor, indenture trustee, or equity security holder shall be addressed as such entity or an authorized agent has directed in its last request filed in the particular case. For the purposes of this subdivision— (A) a proof of claim filed by a creditor or indenture trustee that designates a mailing address constitutes a filed request to mail notices to that address, unless a notice of no dividend has been given under Rule 2002(e) and a later notice of possible dividend under Rule 3002(c)(5) has not been given; and (B) a proof of interest filed by an equity security holder that designates a mailing address constitutes a filed request to mail notices to that address. (2) Except as provided in § 342(f) of the Code, if a creditor or indenture trustee has not filed a request designating a mailing address under Rule 2002(g)(1) or Rule 5003(e), the notices shall be mailed to the address shown on the list of creditors or schedule of liabilities, whichever is filed later. If an equity security holder has not filed a request designating a mailing address under Rule 2002(g)(1) or Rule 5003(e), the notices shall be Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 20 mailed to the address shown on the list of equity security holders. (3) If a list or schedule filed under Rule 1007 includes the name and address of a legal representative of an infant or incompetent person, and a person other than that representative files a request or proof of claim designating a name and mailing address that differs from the name and address of the representative included in the list or schedule, unless the court orders otherwise, notices under Rule 2002 shall be mailed to the representative included in the list or schedules and to the name and address designated in the request or proof of claim. (4) Notwithstanding Rule 2002(g)(1)–(3), an entity and a notice provider may agree that when the notice provider is directed by the court to give a notice, the notice provider shall give the notice to the entity in the manner agreed to and at the address or addresses the entity supplies to the notice provider. That address is conclusively presumed to be a proper address for the notice. The notice provider’s failure to use the supplied address does not invalidate any notice that is otherwise effective under applicable law. (5) A creditor may treat a notice as not having been brought to the creditor’s attention under § 342(g)(1) only if, prior to issuance of the notice, the creditor has filed a statement that designates the name and address of the person or organizational subdivision of the creditor responsible for receiving notices under the Code, and that describes the procedures established by the creditor to cause such notices to be delivered to the designated person or subdivision. (h) NOTICES TO CREDITORS WHOSE CLAIMS ARE FILED. In a chapter 7 case, after 90 days following the first date set for the meeting of creditors under § 341 of the Code, the court may direct that all notices required by subdivision (a) of this rule be mailed only to the debtor, the trustee, all indenture trustees, creditors that hold claims for which proofs of claim have been filed, and creditors, if any, that are still permitted to file claims by reason of an extension granted pursuant to Rule 3002(c)(1) or (c)(2). In a case where notice of insufficient assets to pay a dividend has been given to creditors pursuant to subdivision (e) of this rule, after 90 days following the mailing of a notice of the time for filing claims pursuant to Rule 3002(c)(5), the court may direct that notices be mailed only to the entities specified in the preceding sentence. (i) NOTICES TO COMMITTEES. Copies of all notices required to be mailed pursuant to this rule shall be mailed to the committees elected under § 705 or appointed under § 1102 of the Code or to their authorized agents. Notwithstanding the foregoing subdivisions, the court may order that notices required by subdivision (a)(2), (3) and (6) of this rule be transmitted to the United States trustee and be mailed only to the committees elected under § 705 or appointed under § 1102 of the Code or to their authorized agents and to the creditors and equity security holders who serve on the trustee or debtor in possession and file a request that all notices be mailed to them. A committee appointed under § 1114 shall receive copies of all notices required by subdivisions (a)(1), (a)(5), (b), (f)(2), and (f)(7), and such other notices as the court may direct. 21 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 1So in original. Period probably should not appear. (j) NOTICES TO THE UNITED STATES. Copies of notices required to be mailed to all creditors under this rule shall be mailed (1) in a chapter 11 reorganization case, to the Securities and Exchange Commission at any place the Commission designates, if the Commission has filed either a notice of appearance in the case or a written request to receive notices; (2) in a commodity broker case, to the Commodity Futures Trading Commission at Washington, D.C.; (3) in a chapter 11 case, to the Internal Revenue Service at its address set out in the register maintained under Rule 5003(e) for the district in which the case is pending; (4) if the papers in the case disclose a debt to the United States other than for taxes, to the United States attorney for the district in which the case is pending and to the department, agency, or instrumentality of the United States through which the debtor became indebted; or (5) if the filed papers disclose a stock interest of the United States, to the Secretary of the Treasury at Washington, D.C. (k) NOTICES TO UNITED STATES TRUSTEE. Unless the case is a chapter 9 municipality case or unless the United States trustee requests otherwise, the clerk, or some other person as the court may direct, shall transmit to the United States trustee notice of the matters described in subdivisions (a)(2), (a)(3), (a)(4), (a)(8), (b), (f)(1), (f)(2), (f)(4), (f)(6), (f)(7), (f)(8), and (q) of this rule and notice of hearings on all applications for compensation or reimbursement of expenses. Notices to the United States trustee shall be transmitted within the time prescribed in subdivision (a) or (b) of this rule. The United States trustee shall also receive notice of any other matter if such notice is requested by the United States trustee or ordered by the court. Nothing in these rules requires the clerk or any other person to transmit to the United States trustee any notice, schedule, report, application or other document in a case under the Securities Investor Protection Act, 15 U.S.C. § 78aaa et. 1 seq. (l) NOTICE BY PUBLICATION. The court may order notice by publication if it finds that notice by mail is impracticable or that it is desirable to supplement the notice. (m) ORDERS DESIGNATING MATTER OF NOTICES. The court may from time to time enter orders designating the matters in respect to which, the entity to whom, and the form and manner in which notices shall be sent except as otherwise provided by these rules. (n) CAPTION. The caption of every notice given under this rule shall comply with Rule 1005. The caption of every notice required to be given by the debtor to a creditor shall include the information required to be in the notice by § 342(c) of the Code. (o) NOTICE OF ORDER FOR RELIEF IN CONSUMER CASE. In a voluntary case commenced by an individual debtor whose debts are primarily consumer debts, the clerk or some other person as the court may direct shall give the trustee and all creditors notice by mail of the order for relief within 21 days from the date thereof. (p) NOTICE TO A CREDITOR WITH A FOREIGN ADDRESS. (1) If, at the request of the United States trustee or a party in interest, or on its own initiative, the court finds that a notice mailed within the time prescribed by these rules would Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 22 not be sufficient to give a creditor with a foreign address to which notices under these rules are mailed reasonable notice under the circumstances, the court may order that the notice be supplemented with notice by other means or that the time prescribed for the notice by mail be enlarged. (2) Unless the court for cause orders otherwise, a creditor with a foreign address to which notices under this rule are mailed shall be given at least 30 days’ notice of the time fixed for filing a proof of claim under Rule 3002(c) or Rule 3003(c). (3) Unless the court for cause orders otherwise, the mailing address of a creditor with a foreign address shall be determined under Rule 2002(g). (q) NOTICE OF PETITION FOR RECOGNITION OF FOREIGN PROCEEDING AND OF COURT’S INTENTION TO COMMUNICATE WITH FOREIGN COURTS AND FOREIGN REPRESENTATIVES. (1) Notice of Petition for Recognition. After the filing of a petition for recognition of a foreign proceeding, the court shall promptly schedule and hold a hearing on the petition. The clerk, or some other person as the court may direct, shall forthwith give the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and such other entities as the court may direct, at least 21 days’ notice by mail of the hearing. The notice shall state whether the petition seeks recognition as a foreign main proceeding or foreign nonmain proceeding and shall include the petition and any other document the court may require. If the court consolidates the hearing on the petition with the hearing on a request for provisional relief, the court may set a shorter notice period, with notice to the entities listed in this subdivision. (2) Notice of Court’s Intention to Communicate with Foreign Courts and Foreign Representatives. The clerk, or some other person as the court may direct, shall give the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and such other entities as the court may direct, notice by mail of the court’s intention to communicate with a foreign court or foreign representative. (As amended Pub. L. 98–91, § 2(a), Aug. 30, 1983, 97 Stat. 607; Pub. L. 98–353, title III, § 321, July 10, 1984, 98 Stat. 357; Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 17, 2000, eff. Dec. 1, 2000; Apr. 23, 2001, eff. Dec. 1, 2001; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 26, 2004, eff. Dec. 1, 2004; Apr. 25, 2005, eff. Dec. 1, 2005; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2016, eff. Dec. 1, 2016; Apr. 27, 2017, eff. Dec. 1, 2017.) 23 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2003 Rule 2003. Meeting of Creditors or Equity Security Holders (a) DATE AND PLACE. Except as otherwise provided in § 341(e) of the Code, in a chapter 7 liquidation or a chapter 11 reorganization case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 40 days after the order for relief. In a chapter 12 family farmer debt adjustment case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 35 days after the order for relief. In a chapter 13 individual’s debt adjustment case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 50 days after the order for relief. If there is an appeal from or a motion to vacate the order for relief, or if there is a motion to dismiss the case, the United States trustee may set a later date for the meeting. The meeting may be held at a regular place for holding court or at any other place designated by the United States trustee within the district convenient for the parties in interest. If the United States trustee designates a place for the meeting which is not regularly staffed by the United States trustee or an assistant who may preside at the meeting, the meeting may be held not more than 60 days after the order for relief. (b) ORDER OF MEETING. (1) Meeting of Creditors. The United States trustee shall preside at the meeting of creditors. The business of the meeting shall include the examination of the debtor under oath and, in a chapter 7 liquidation case, may include the election of a creditors’ committee and, if the case is not under subchapter V of chapter 7, the election of a trustee. The presiding officer shall have the authority to administer oaths. (2) Meeting of Equity Security Holders. If the United States trustee convenes a meeting of equity security holders pursuant to § 341(b) of the Code, the United States trustee shall fix a date for the meeting and shall preside. (3) Right To Vote. In a chapter 7 liquidation case, a creditor is entitled to vote at a meeting if, at or before the meeting, the creditor has filed a proof of claim or a writing setting forth facts evidencing a right to vote pursuant to § 702(a) of the Code unless objection is made to the claim or the proof of claim is insufficient on its face. A creditor of a partnership may file a proof of claim or writing evidencing a right to vote for the trustee for the estate of the general partner notwithstanding that a trustee for the estate of the partnership has previously qualified. In the event of an objection to the amount or allowability of a claim for the purpose of voting, unless the court orders otherwise, the United States trustee shall tabulate the votes for each alternative presented by the dispute and, if resolution of such dispute is necessary to determine the result of the election, the tabulations for each alternative shall be reported to the court. (c) RECORD OF MEETING. Any examination under oath at the meeting of creditors held pursuant to § 341(a) of the Code shall be recorded verbatim by the United States trustee using electronic sound recording equipment or other means of recording, and such record shall be preserved by the United States trustee and available for public access until two years after the conclusion of the Rule 2004 FEDERAL RULES OF BANKRUPTCY PROCEDURE 24 meeting of creditors. Upon request of any entity, the United States trustee shall certify and provide a copy or transcript of such recording at the entity’s expense. (d) REPORT OF ELECTION AND RESOLUTION OF DISPUTES IN A CHAPTER 7 CASE. (1) Report of Undisputed Election. In a chapter 7 case, if the election of a trustee or a member of a creditors’ committee is not disputed, the United States trustee shall promptly file a report of the election, including the name and address of the person or entity elected and a statement that the election is undisputed. (2) Disputed Election. If the election is disputed, the United States trustee shall promptly file a report stating that the election is disputed, informing the court of the nature of the dispute, and listing the name and address of any candidate elected under any alternative presented by the dispute. No later than the date on which the report is filed, the United States trustee shall mail a copy of the report to any party in interest that has made a request to receive a copy of the report. Pending disposition by the court of a disputed election for trustee, the interim trustee shall continue in office. Unless a motion for the resolution of the dispute is filed no later than 14 days after the United States trustee files a report of a disputed election for trustee, the interim trustee shall serve as trustee in the case. (e) ADJOURNMENT. The meeting may be adjourned from time to time by announcement at the meeting of the adjourned date and time. The presiding official shall promptly file a statement specifying the date and time to which the meeting is adjourned. (f) SPECIAL MEETINGS. The United States trustee may call a special meeting of creditors on request of a party in interest or on the United States trustee’s own initiative. (g) FINAL MEETING. If the United States trustee calls a final meeting of creditors in a case in which the net proceeds realized exceed $1,500, the clerk shall mail a summary of the trustee’s final account to the creditors with a notice of the meeting, together with a statement of the amount of the claims allowed. The trustee shall attend the final meeting and shall, if requested, report on the administration of the estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 26, 1999, eff. Dec. 1, 1999; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 26, 2011, eff. Dec. 1, 2011.) Rule 2004. Examination (a) EXAMINATION ON MOTION. On motion of any party in interest, the court may order the examination of any entity. (b) SCOPE OF EXAMINATION. The examination of an entity under this rule or of the debtor under § 343 of the Code may relate only to the acts, conduct, or property or to the liabilities and financial condition of the debtor, or to any matter which may affect the administration of the debtor’s estate, or to the debtor’s right to a discharge. In a family farmer’s debt adjustment case under chapter 12, an individual’s debt adjustment case under chapter 13, or 25 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2005 a reorganization case under chapter 11 of the Code, other than for the reorganization of a railroad, the examination may also relate to the operation of any business and the desirability of its continuance, the source of any money or property acquired or to be acquired by the debtor for purposes of consummating a plan and the consideration given or offered therefor, and any other matter relevant to the case or to the formulation of a plan. (c) COMPELLING ATTENDANCE AND PRODUCTION OF DOCUMENTS. The attendance of an entity for examination and for the production of documents, whether the examination is to be conducted within or without the district in which the case is pending, may be compelled as provided in Rule 9016 for the attendance of a witness at a hearing or trial. As an officer of the court, an attorney may issue and sign a subpoena on behalf of the court for the district in which the examination is to be held if the attorney is admitted to practice in that court or in the court in which the case is pending. (d) TIME AND PLACE OF EXAMINATION OF DEBTOR. The court may for cause shown and on terms as it may impose order the debtor to be examined under this rule at any time or place it designates, whether within or without the district wherein the case is pending. (e) MILEAGE. An entity other than a debtor shall not be required to attend as a witness unless lawful mileage and witness fee for one day’s attendance shall be first tendered. If the debtor resides more than 100 miles from the place of examination when required to appear for an examination under this rule, the mileage allowed by law to a witness shall be tendered for any distance more than 100 miles from the debtor’s residence at the date of the filing of the first petition commencing a case under the Code or the residence at the time the debtor is required to appear for the examination, whichever is the lesser. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 2005. Apprehension and Removal of Debtor to Compel Attendance for Examination (a) ORDER TO COMPEL ATTENDANCE FOR EXAMINATION. On motion of any party in interest supported by an affidavit alleging (1) that the examination of the debtor is necessary for the proper administration of the estate and that there is reasonable cause to believe that the debtor is about to leave or has left the debtor’s residence or principal place of business to avoid examination, or (2) that the debtor has evaded service of a subpoena or of an order to attend for examination, or (3) that the debtor has willfully disobeyed a subpoena or order to attend for examination, duly served, the court may issue to the marshal, or some other officer authorized by law, an order directing the officer to bring the debtor before the court without unnecessary delay. If, after hearing, the court finds the allegations to be true, the court shall thereupon cause the debtor to be examined forthwith. If necessary, the court shall fix conditions for further examination and for the debtor’s obedience to all orders made in reference thereto. (b) REMOVAL. Whenever any order to bring the debtor before the court is issued under this rule and the debtor is found in a district Rule 2006 FEDERAL RULES OF BANKRUPTCY PROCEDURE 26 other than that of the court issuing the order, the debtor may be taken into custody under the order and removed in accordance with the following rules: (1) If the debtor is taken into custody under the order at a place less than 100 miles from the place of issue of the order, the debtor shall be brought forthwith before the court that issued the order. (2) If the debtor is taken into custody under the order at a place 100 miles or more from the place of issue of the order, the debtor shall be brought without unnecessary delay before the nearest available United States magistrate judge, bankruptcy judge, or district judge. If, after hearing, the magistrate judge, bankruptcy judge, or district judge finds that an order has issued under this rule and that the person in custody is the debtor, or if the person in custody waives a hearing, the magistrate judge, bankruptcy judge, or district judge shall order removal, and the person in custody shall be released on conditions ensuring prompt appearance before the court that issued the order to compel the attendance. (c) CONDITIONS OF RELEASE. In determining what conditions will reasonably assure attendance or obedience under subdivision (a) of this rule or appearance under subdivision (b) of this rule, the court shall be governed by the provisions and policies of title 18, U.S.C., § 3146(a) and (b). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 22, 1993, eff. Aug. 1, 1993.) Rule 2006. Solicitation and Voting of Proxies in Chapter 7 Liquidation Cases (a) APPLICABILITY. This rule applies only in a liquidation case pending under chapter 7 of the Code. (b) DEFINITIONS. (1) Proxy. A proxy is a written power of attorney authorizing any entity to vote the claim or otherwise act as the owner’s attorney in fact in connection with the administration of the estate. (2) Solicitation of Proxy. The solicitation of a proxy is any communication, other than one from an attorney to a regular client who owns a claim or from an attorney to the owner of a claim who has requested the attorney to represent the owner, by which a creditor is asked, directly or indirectly, to give a proxy after or in contemplation of the filing of a petition by or against the debtor. (c) AUTHORIZED SOLICITATION. (1) A proxy may be solicited only by (A) a creditor owning an allowable unsecured claim against the estate on the date of the filing of the petition; (B) a committee elected pursuant to § 705 of the Code; (C) a committee of creditors selected by a majority in number and amount of claims of creditors (i) whose claims are not contingent or unliquidated, (ii) who are not disqualified from voting under § 702(a) of the Code and (iii) who were present or represented at a meeting of which all creditors having claims of over $500 or the 100 creditors having the largest claims had at least seven days’ notice in writing 27 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2006 and of which meeting written minutes were kept and are available reporting the names of the creditors present or represented and voting and the amounts of their claims; or (D) a bona fide trade or credit association, but such association may solicit only creditors who were its members or subscribers in good standing and had allowable unsecured claims on the date of the filing of the petition. (2) A proxy may be solicited only in writing. (d) SOLICITATION NOT AUTHORIZED. This rule does not permit solicitation (1) in any interest other than that of general creditors; (2) by or on behalf of any custodian; (3) by the interim trustee or by or on behalf of any entity not qualified to vote under § 702(a) of the Code; (4) by or on behalf of an attorney at law; or (5) by or on behalf of a transferee of a claim for collection only. (e) DATA REQUIRED FROM HOLDERS OF MULTIPLE PROXIES. At any time before the voting commences at any meeting of creditors pursuant to § 341(a) of the Code, or at any other time as the court may direct, a holder of two or more proxies shall file and transmit to the United States trustee a verified list of the proxies to be voted and a verified statement of the pertinent facts and circumstances in connection with the execution and delivery of each proxy, including: (1) a copy of the solicitation; (2) identification of the solicitor, the forwarder, if the forwarder is neither the solicitor nor the owner of the claim, and the proxyholder, including their connections with the debtor and with each other. If the solicitor, forwarder, or proxyholder is an association, there shall also be included a statement that the creditors whose claims have been solicited and the creditors whose claims are to be voted were members or subscribers in good standing and had allowable unsecured claims on the date of the filing of the petition. If the solicitor, forwarder, or proxyholder is a committee of creditors, the statement shall also set forth the date and place the committee was organized, that the committee was organized in accordance with clause (B) or (C) of paragraph (c)(1) of this rule, the members of the committee, the amounts of their claims, when the claims were acquired, the amounts paid therefor, and the extent to which the claims of the committee members are secured or entitled to priority; (3) a statement that no consideration has been paid or promised by the proxyholder for the proxy; (4) a statement as to whether there is any agreement and, if so, the particulars thereof, between the proxyholder and any other entity for the payment of any consideration in connection with voting the proxy, or for the sharing of compensation with any entity, other than a member or regular associate of the proxyholder’s law firm, which may be allowed the trustee or any entity for services rendered in the case, or for the employment of any person as attorney, accountant, appraiser, auctioneer, or other employee for the estate; (5) if the proxy was solicited by an entity other than the proxyholder, or forwarded to the holder by an entity who is neither a solicitor of the proxy nor the owner of the claim, a statement signed and verified by the solicitor or forwarder that no consideration has been paid or promised for the proxy, and whether there is any agreement, and, if so, the particulars thereof, between the solicitor or forwarder and any other entity for the payment of any consideration in connection with voting the proxy, or for sharing compensation with any entity other than a member or regular associate of the solicitor’s or forwarder’s law firm which may be allowed the trustee or any entity for services rendered in the case, or for the employment of any person as attorney, accountant, appraiser, auctioneer, or other employee for the estate; (6) if the solicitor, forwarder, or proxyholder is a committee, a statement signed and verified by each member as to the amount and source of any consideration paid or to be paid to such member in connection with the case other than by way of dividend on the member’s claim. (f) ENFORCEMENT OF RESTRICTIONS ON SOLICITATION. On motion of any party in interest or on its own initiative, the court may determine whether there has been a failure to comply with the provisions of this rule or any other impropriety in connection with the solicitation or voting of a proxy. After notice and a hearing the court may reject any proxy for cause, vacate any order entered in consequence of the voting of any proxy which should have been rejected, or take any other appropriate action. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2007. Review of Appointment of Creditors’ Committee Organized Before Commencement of the Case (a) MOTION TO REVIEW APPOINTMENT. If a committee appointed by the United States trustee pursuant to § 1102(a) of the Code consists of the members of a committee organized by creditors before the commencement of a chapter 9 or chapter 11 case, on motion of a party in interest and after a hearing on notice to the United States trustee and other entities as the court may direct, the court may determine whether the appointment of the committee satisfies the requirements of § 1102(b)(1) of the Code. (b) SELECTION OF MEMBERS OF COMMITTEE. The court may find that a committee organized by unsecured creditors before the commencement of a chapter 9 or chapter 11 case was fairly chosen if: (1) it was selected by a majority in number and amount of claims of unsecured creditors who may vote under § 702(a) of the Code and were present in person or represented at a meeting of which all creditors having unsecured claims of over $1,000 or the 100 unsecured creditors having the largest claims had at least seven days’ notice in writing, and of which meeting written minutes reporting the names of the creditors present or represented and voting and the amounts of their claims were kept and are available for inspection; (2) all proxies voted at the meeting for the elected committee were solicited pursuant to Rule 2006 and the lists and statements required by subdivision (e) thereof have been transmitted to the United States trustee; and (3) the organization of the committee was in all other respects fair and proper. 29 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2007.1 (c) FAILURE TO COMPLY WITH REQUIREMENTS FOR APPOINTMENT. After a hearing on notice pursuant to subdivision (a) of this rule, the court shall direct the United States trustee to vacate the appointment of the committee and may order other appropriate action if the court finds that such appointment failed to satisfy the requirements of § 1102(b)(1) of the Code. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2007.1. Appointment of Trustee or Examiner in a Chapter 11 Reorganization Case (a) ORDER TO APPOINT TRUSTEE OR EXAMINER. In a chapter 11 reorganization case, a motion for an order to appoint a trustee or an examiner under § 1104(a) or § 1104(c) of the Code shall be made in accordance with Rule 9014. (b) ELECTION OF TRUSTEE. (1) Request for an Election. A request to convene a meeting of creditors for the purpose of electing a trustee in a chapter 11 reorganization case shall be filed and transmitted to the United States trustee in accordance with Rule 5005 within the time prescribed by § 1104(b) of the Code. Pending court approval of the person elected, any person appointed by the United States trustee under § 1104(d) and approved in accordance with subdivision (c) of this rule shall serve as trustee. (2) Manner of Election and Notice. An election of a trustee under § 1104(b) of the Code shall be conducted in the manner provided in Rules 2003(b)(3) and 2006. Notice of the meeting of creditors convened under § 1104(b) shall be given as provided in Rule 2002. The United States trustee shall preside at the meeting. A proxy for the purpose of voting in the election may be solicited only by a committee of creditors appointed under § 1102 of the Code or by any other party entitled to solicit a proxy pursuant to Rule 2006. (3) Report of Election and Resolution of Disputes. (A) Report of Undisputed Election. If no dispute arises out of the election, the United States trustee shall promptly file a report certifying the election, including the name and address of the person elected and a statement that the election is undisputed. The report shall be accompanied by a verified statement of the person elected setting forth that person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (B) Dispute Arising Out of an Election. If a dispute arises out of an election, the United States trustee shall promptly file a report stating that the election is disputed, informing the court of the nature of the dispute, and listing the name and address of any candidate elected under any alternative presented by the dispute. The report shall be accompanied by a verified statement by each candidate elected under each alternative presented by the dispute, setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any Rule 2007.2 FEDERAL RULES OF BANKRUPTCY PROCEDURE 30 person employed in the office of the United States trustee. Not later than the date on which the report of the disputed election is filed, the United States trustee shall mail a copy of the report and each verified statement to any party in interest that has made a request to convene a meeting under § 1104(b) or to receive a copy of the report, and to any committee appointed under § 1102 of the Code. (c) APPROVAL OF APPOINTMENT. An order approving the appointment of a trustee or an examiner under § 1104(d) of the Code shall be made on application of the United States trustee. The application shall state the name of the person appointed and, to the best of the applicant’s knowledge, all the person’s connections with the debtor, creditors, any other parties in interest, their respective attorneys and accountants, the United States trustee, or persons employed in the office of the United States trustee. The application shall state the names of the parties in interest with whom the United States trustee consulted regarding the appointment. The application shall be accompanied by a verified statement of the person appointed setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (Added Apr. 30, 1991, eff. Aug. 1, 1991; amended Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 2007.2. Appointment of Patient Care Ombudsman in a Health Care Business Case (a) ORDER TO APPOINT PATIENT CARE OMBUDSMAN. In a chapter 7, chapter 9, or chapter 11 case in which the debtor is a health care business, the court shall order the appointment of a patient care ombudsman under § 333 of the Code, unless the court, on motion of the United States trustee or a party in interest filed no later than 21 days after the commencement of the case or within another time fixed by the court, finds that the appointment of a patient care ombudsman is not necessary under the specific circumstances of the case for the protection of patients. (b) MOTION FOR ORDER TO APPOINT OMBUDSMAN. If the court has found that the appointment of an ombudsman is not necessary, or has terminated the appointment, the court, on motion of the United States trustee or a party in interest, may order the appointment at a later time if it finds that the appointment has become necessary to protect patients. (c) NOTICE OF APPOINTMENT. If a patient care ombudsman is appointed under § 333, the United States trustee shall promptly file a notice of the appointment, including the name and address of the person appointed. Unless the person appointed is a State Long-Term Care Ombudsman, the notice shall be accompanied by a verified statement of the person appointed setting forth the person’s connections with the debtor, creditors, patients, any other party in interest, their respective attorneys and accountants, the United States trustee, and any person employed in the office of the United States trustee. (d) TERMINATION OF APPOINTMENT. On motion of the United States trustee or a party in interest, the court may terminate the 31 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2009 appointment of a patient care ombudsman if the court finds that the appointment is not necessary to protect patients. (e) MOTION. A motion under this rule shall be governed by Rule 9014. The motion shall be transmitted to the United States trustee and served on: the debtor; the trustee; any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, on the creditors included on the list filed under Rule 1007(d); and such other entities as the court may direct. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2008. Notice to Trustee of Selection The United States trustee shall immediately notify the person selected as trustee how to qualify and, if applicable, the amount of the trustee’s bond. A trustee that has filed a blanket bond pursuant to Rule 2010 and has been selected as trustee in a chapter 7, chapter 12, or chapter 13 case that does not notify the court and the United States trustee in writing of rejection of the office within seven days after receipt of notice of selection shall be deemed to have accepted the office. Any other person selected as trustee shall notify the court and the United States trustee in writing of acceptance of the office within seven days after receipt of notice of selection or shall be deemed to have rejected the office. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2009. Trustees for Estates When Joint Administration Ordered (a) ELECTION OF SINGLE TRUSTEE FOR ESTATES BEING JOINTLY ADMINISTERED. If the court orders a joint administration of two or more estates under Rule 1015(b), creditors may elect a single trustee for the estates being jointly administered, unless the case is under subchapter V of chapter 7 of the Code. (b) RIGHT OF CREDITORS TO ELECT SEPARATE TRUSTEE. Notwithstanding entry of an order for joint administration under Rule 1015(b), the creditors of any debtor may elect a separate trustee for the estate of the debtor as provided in § 702 of the Code, unless the case is under subchapter V of chapter 7. (c) APPOINTMENT OF TRUSTEES FOR ESTATES BEING JOINTLY ADMINISTERED. (1) Chapter 7 Liquidation Cases. Except in a case governed by subchapter V of chapter 7, the United States trustee may appoint one or more interim trustees for estates being jointly administered in chapter 7 cases. (2) Chapter 11 Reorganization Cases. If the appointment of a trustee is ordered, the United States trustee may appoint one or more trustees for estates being jointly administered in chapter 11 cases. (3) Chapter 12 Family Farmer’s Debt Adjustment Cases. The United States trustee may appoint one or more trustees for estates being jointly administered in chapter 12 cases. Rule 2010 FEDERAL RULES OF BANKRUPTCY PROCEDURE 32 (4) Chapter 13 Individual’s Debt Adjustment Cases. The United States trustee may appoint one or more trustees for estates being jointly administered in chapter 13 cases. (d) POTENTIAL CONFLICTS OF INTEREST. On a showing that creditors or equity security holders of the different estates will be prejudiced by conflicts of interest of a common trustee who has been elected or appointed, the court shall order the selection of separate trustees for estates being jointly administered. (e) SEPARATE ACCOUNTS. The trustee or trustees of estates being jointly administered shall keep separate accounts of the property and distribution of each estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 27, 2003, eff. Dec. 1, 2003.) Rule 2010. Qualification by Trustee; Proceeding on Bond (a) BLANKET BOND. The United States trustee may authorize a blanket bond in favor of the United States conditioned on the faithful performance of official duties by the trustee or trustees to cover (1) a person who qualifies as trustee in a number of cases, and (2) a number of trustees each of whom qualifies in a different case. (b) PROCEEDING ON BOND. A proceeding on the trustee’s bond may be brought by any party in interest in the name of the United States for the use of the entity injured by the breach of the condition. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2011. Evidence of Debtor in Possession or Qualification of Trustee (a) Whenever evidence is required that a debtor is a debtor in possession or that a trustee has qualified, the clerk may so certify and the certificate shall constitute conclusive evidence of that fact. (b) If a person elected or appointed as trustee does not qualify within the time prescribed by § 322(a) of the Code, the clerk shall so notify the court and the United States trustee. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2012. Substitution of Trustee or Successor Trustee; Accounting (a) TRUSTEE. If a trustee is appointed in a chapter 11 case or the debtor is removed as debtor in possession in a chapter 12 case, the trustee is substituted automatically for the debtor in possession as a party in any pending action, proceeding, or matter. (b) SUCCESSOR TRUSTEE. When a trustee dies, resigns, is removed, or otherwise ceases to hold office during the pendency of a case under the Code (1) the successor is automatically substituted as a party in any pending action, proceeding, or matter; and (2) the successor trustee shall prepare, file, and transmit to the United States trustee an accounting of the prior administration of the estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) 33 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2014 Rule 2013. Public Record of Compensation Awarded to Trustees, Examiners, and Professionals (a) RECORD TO BE KEPT. The clerk shall maintain a public record listing fees awarded by the court (1) to trustees and attorneys, accountants, appraisers, auctioneers and other professionals employed by trustees, and (2) to examiners. The record shall include the name and docket number of the case, the name of the individual or firm receiving the fee and the amount of the fee awarded. The record shall be maintained chronologically and shall be kept current and open to examination by the public without charge. ‘‘Trustees,’’ as used in this rule, does not include debtors in possession. (b) SUMMARY OF RECORD. At the close of each annual period, the clerk shall prepare a summary of the public record by individual or firm name, to reflect total fees awarded during the preceding year. The summary shall be open to examination by the public without charge. The clerk shall transmit a copy of the summary to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2014. Employment of Professional Persons (a) APPLICATION FOR AND ORDER OF EMPLOYMENT. An order approving the employment of attorneys, accountants, appraisers, auctioneers, agents, or other professionals pursuant to § 327, § 1103, or § 1114 of the Code shall be made only on application of the trustee or committee. The application shall be filed and, unless the case is a chapter 9 municipality case, a copy of the application shall be transmitted by the applicant to the United States trustee. The application shall state the specific facts showing the necessity for the employment, the name of the person to be employed, the reasons for the selection, the professional services to be rendered, any proposed arrangement for compensation, and, to the best of the applicant’s knowledge, all of the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. The application shall be accompanied by a verified statement of the person to be employed setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (b) SERVICES RENDERED BY MEMBER OR ASSOCIATE OF FIRM OF ATTORNEYS OR ACCOUNTANTS. If, under the Code and this rule, a law partnership or corporation is employed as an attorney, or an accounting partnership or corporation is employed as an accountant, or if a named attorney or accountant is employed, any partner, member, or regular associate of the partnership, corporation, or individual may act as attorney or accountant so employed, without further order of the court. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2015 FEDERAL RULES OF BANKRUPTCY PROCEDURE 34 Rule 2015. Duty to Keep Records, Make Reports, and Give Notice of Case or Change of Status (a) TRUSTEE OR DEBTOR IN POSSESSION. A trustee or debtor in possession shall: (1) in a chapter 7 liquidation case and, if the court directs, in a chapter 11 reorganization case file and transmit to the United States trustee a complete inventory of the property of the debtor within 30 days after qualifying as a trustee or debtor in possession, unless such an inventory has already been filed; (2) keep a record of receipts and the disposition of money and property received; (3) file the reports and summaries required by § 704(a)(8) of the Code, which shall include a statement, if payments are made to employees, of the amounts of deductions for all taxes required to be withheld or paid for and in behalf of employees and the place where these amounts are deposited; (4) as soon as possible after the commencement of the case, give notice of the case to every entity known to be holding money or property subject to withdrawal or order of the debtor, including every bank, savings or building and loan association, public utility company, and landlord with whom the debtor has a deposit, and to every insurance company which has issued a policy having a cash surrender value payable to the debtor, except that notice need not be given to any entity who has knowledge or has previously been notified of the case; (5) in a chapter 11 reorganization case, on or before the last day of the month after each calendar quarter during which there is a duty to pay fees under 28 U.S.C. § 1930(a)(6), file and transmit to the United States trustee a statement of any disbursements made during that quarter and of any fees payable under 28 U.S.C. § 1930(a)(6) for that quarter; and (6) in a chapter 11 small business case, unless the court, for cause, sets another reporting interval, file and transmit to the United States trustee for each calendar month after the order for relief, on the appropriate Official Form, the report required by § 308. If the order for relief is within the first 15 days of a calendar month, a report shall be filed for the portion of the month that follows the order for relief. If the order for relief is after the 15th day of a calendar month, the period for the remainder of the month shall be included in the report for the next calendar month. Each report shall be filed no later than 21 days after the last day of the calendar month following the month covered by the report. The obligation to file reports under this subparagraph terminates on the effective date of the plan, or conversion or dismissal of the case. (b) CHAPTER 12 TRUSTEE AND DEBTOR IN POSSESSION. In a chapter 12 family farmer’s debt adjustment case, the debtor in possession shall perform the duties prescribed in clauses (2)–(4) of subdivision (a) of this rule and, if the court directs, shall file and transmit to the United States trustee a complete inventory of the property of the debtor within the time fixed by the court. If the debtor is removed as debtor in possession, the trustee shall perform the duties of the debtor in possession prescribed in this paragraph. 35 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2015.1 (c) CHAPTER 13 TRUSTEE AND DEBTOR. (1) Business Cases. In a chapter 13 individual’s debt adjustment case, when the debtor is engaged in business, the debtor shall perform the duties prescribed by clauses (2)–(4) of subdivision (a) of this rule and, if the court directs, shall file and transmit to the United States trustee a complete inventory of the property of the debtor within the time fixed by the court. (2) Nonbusiness Cases. In a chapter 13 individual’s debt adjustment case, when the debtor is not engaged in business, the trustee shall perform the duties prescribed by clause (2) of subdivision (a) of this rule. (d) FOREIGN REPRESENTATIVE. In a case in which the court has granted recognition of a foreign proceeding under chapter 15, the foreign representative shall file any notice required under § 1518 of the Code within 14 days after the date when the representative becomes aware of the subsequent information. (e) TRANSMISSION OF REPORTS. In a chapter 11 case the court may direct that copies or summaries of annual reports and copies or summaries of other reports shall be mailed to the creditors, equity security holders, and indenture trustees. The court may also direct the publication of summaries of any such reports. A copy of every report or summary mailed or published pursuant to this subdivision shall be transmitted to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 29, 2002, eff. Dec. 1, 2002; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 23, 2012, eff. Dec. 1, 2012.) Rule 2015.1. Patient Care Ombudsman (a) REPORTS. A patient care ombudsman, at least 14 days before making a report under § 333(b)(2) of the Code, shall give notice that the report will be made to the court, unless the court orders otherwise. The notice shall be transmitted to the United States trustee, posted conspicuously at the health care facility that is the subject of the report, and served on: the debtor; the trustee; all patients; and any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, on the creditors included on the list filed under Rule 1007(d); and such other entities as the court may direct. The notice shall state the date and time when the report will be made, the manner in which the report will be made, and, if the report is in writing, the name, address, telephone number, email address, and website, if any, of the person from whom a copy of the report may be obtained at the debtor’s expense. (b) AUTHORIZATION TO REVIEW CONFIDENTIAL PATIENT RECORDS. A motion by a patient care ombudsman under § 333(c) to review confidential patient records shall be governed by Rule 9014, served on the patient and any family member or other contact person whose name and address have been given to the trustee or the debtor for the purpose of providing information regarding the patient’s health care, and transmitted to the United States trustee subject Rule 2015.2 FEDERAL RULES OF BANKRUPTCY PROCEDURE 36 to applicable nonbankruptcy law relating to patient privacy. Unless the court orders otherwise, a hearing on the motion may not be commenced earlier than 14 days after service of the motion. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2015.2. Transfer of Patient in Health Care Business Case Unless the court orders otherwise, if the debtor is a health care business, the trustee may not transfer a patient to another health care business under § 704(a)(12) of the Code unless the trustee gives at least 14 days’ notice of the transfer to the patient care ombudsman, if any, the patient, and any family member or other contact person whose name and address has been given to the trustee or the debtor for the purpose of providing information regarding the patient’s health care. The notice is subject to applicable nonbankruptcy law relating to patient privacy. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2015.3. Reports of Financial Information on Entities in Which a Chapter 11 Estate Holds a Controlling or Substantial Interest (a) REPORTING REQUIREMENT. In a chapter 11 case, the trustee or debtor in possession shall file periodic financial reports of the value, operations, and profitability of each entity that is not a publicly traded corporation or a debtor in a case under title 11, and in which the estate holds a substantial or controlling interest. The reports shall be prepared as prescribed by the appropriate Official Form, and shall be based upon the most recent information reasonably available to the trustee or debtor in possession. (b) TIME FOR FILING; SERVICE. The first report required by this rule shall be filed no later than seven days before the first date set for the meeting of creditors under § 341 of the Code. Subsequent reports shall be filed no less frequently than every six months thereafter, until the effective date of a plan or the case is dismissed or converted. Copies of the report shall be served on the United States trustee, any committee appointed under § 1102 of the Code, and any other party in interest that has filed a request therefor. (c) PRESUMPTION OF SUBSTANTIAL OR CONTROLLING INTEREST; JUDICIAL DETERMINATION. For purposes of this rule, an entity of which the estate controls or owns at least a 20 percent interest, shall be presumed to be an entity in which the estate has a substantial or controlling interest. An entity in which the estate controls or owns less than a 20 percent interest shall be presumed not to be an entity in which the estate has a substantial or controlling interest. Upon motion, the entity, any holder of an interest therein, the United States trustee, or any other party in interest may seek to rebut either presumption, and the court shall, after notice and a hearing, determine whether the estate’s interest in the entity is substantial or controlling. (d) MODIFICATION OF REPORTING REQUIREMENT. The court may, after notice and a hearing, vary the reporting requirement established by subdivision (a) of this rule for cause, including that the 37 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2016 trustee or debtor in possession is not able, after a good faith effort, to comply with those reporting requirements, or that the information required by subdivision (a) is publicly available. (e) NOTICE AND PROTECTIVE ORDERS. No later than 14 days before filing the first report required by this rule, the trustee or debtor in possession shall send notice to the entity in which the estate has a substantial or controlling interest, and to all holders— known to the trustee or debtor in possession—of an interest in that entity, that the trustee or debtor in possession expects to file and serve financial information relating to the entity in accordance with this rule. The entity in which the estate has a substantial or controlling interest, or a person holding an interest in that entity, may request protection of the information under § 107 of the Code. (f) EFFECT OF REQUEST. Unless the court orders otherwise, the pendency of a request under subdivisions (c), (d), or (e) of this rule shall not alter or stay the requirements of subdivision (a). (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2016. Compensation for Services Rendered and Reimbursement of Expenses (a) APPLICATION FOR COMPENSATION OR REIMBURSEMENT. An entity seeking interim or final compensation for services, or reimbursement of necessary expenses, from the estate shall file an application setting forth a detailed statement of (1) the services rendered, time expended and expenses incurred, and (2) the amounts requested. An application for compensation shall include a statement as to what payments have theretofore been made or promised to the applicant for services rendered or to be rendered in any capacity whatsoever in connection with the case, the source of the compensation so paid or promised, whether any compensation previously received has been shared and whether an agreement or understanding exists between the applicant and any other entity for the sharing of compensation received or to be received for services rendered in or in connection with the case, and the particulars of any sharing of compensation or agreement or understanding therefor, except that details of any agreement by the applicant for the sharing of compensation as a member or regular associate of a firm of lawyers or accountants shall not be required. The requirements of this subdivision shall apply to an application for compensation for services rendered by an attorney or accountant even though the application is filed by a creditor or other entity. Unless the case is a chapter 9 municipality case, the applicant shall transmit to the United States trustee a copy of the application. (b) DISCLOSURE OF COMPENSATION PAID OR PROMISED TO ATTORNEY FOR DEBTOR. Every attorney for a debtor, whether or not the attorney applies for compensation, shall file and transmit to the United States trustee within 14 days after the order for relief, or at another time as the court may direct, the statement required by § 329 of the Code including whether the attorney has shared or agreed to share the compensation with any other entity. The statement shall include the particulars of any such sharing or Rule 2017 FEDERAL RULES OF BANKRUPTCY PROCEDURE 38 agreement to share by the attorney, but the details of any agreement for the sharing of the compensation with a member or regular associate of the attorney’s law firm shall not be required. A supplemental statement shall be filed and transmitted to the United States trustee within 14 days after any payment or agreement not previously disclosed. (c) DISCLOSURE OF COMPENSATION PAID OR PROMISED TO BANKRUPTCY PETITION PREPARER. Before a petition is filed, every bankruptcy petition preparer for a debtor shall deliver to the debtor, the declaration under penalty of perjury required by § 110(h)(2). The declaration shall disclose any fee, and the source of any fee, received from or on behalf of the debtor within 12 months of the filing of the case and all unpaid fees charged to the debtor. The declaration shall also describe the services performed and documents prepared or caused to be prepared by the bankruptcy petition preparer. The declaration shall be filed with the petition. The petition preparer shall file a supplemental statement within 14 days after any payment or agreement not previously disclosed. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 27, 2003, eff. Dec. 1, 2003; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2017. Examination of Debtor’s Transactions with Debtor’s Attorney According to the information provided, Rule 1004.2 in Chapter 15 Cases, who can file a motion for a determination that the debtor’s center of main interests is other than as stated in the petition for recognition commencing the Chapter 15 case, and when should this motion be filed?	Only use the information above to answer the question. Do not use any outside sources. If you cannot answer the question with the information provided say "I cannot answer without further research." The response should be written in paragraph form unless the answer would be more beneficial in markdown format. Please answer in a simple manner that is easy for the average person to understand. EVIDENCE: FEDERAL RULES OF BANKRUPTCY PROCEDURE Effective August 1, 1983, as amended to December 1, 2017 Rule 1001. Scope of Rules and Forms; Short Title The Bankruptcy Rules and Forms govern procedure in cases under title 11 of the United States Code. The rules shall be cited as the Federal Rules of Bankruptcy Procedure and the forms as the Official Bankruptcy Forms. These rules shall be construed, administered, and employed by the court and the parties to secure the just, speedy, and inexpensive determination of every case and proceeding. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 27, 2017, eff. Dec. 1, 2017.) PART I—COMMENCEMENT OF CASE; PROCEEDINGS RELATING TO PETITION AND ORDER FOR RELIEF Rule 1002. Commencement of Case (a) PETITION. A petition commencing a case under the Code shall be filed with the clerk. (b) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall forthwith transmit to the United States trustee a copy of the petition filed pursuant to subdivision (a) of this rule. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1003. Involuntary Petition (a) TRANSFEROR OR TRANSFEREE OF CLAIM. A transferor or transferee of a claim shall annex to the original and each copy of the petition a copy of all documents evidencing the transfer, whether transferred unconditionally, for security, or otherwise, and a signed statement that the claim was not transferred for the purpose of commencing the case and setting forth the consideration for and terms of the transfer. An entity that has transferred or acquired a claim for the purpose of commencing a case for liquidation under chapter 7 or for reorganization under chapter 11 shall not be a qualified petitioner. (b) JOINDER OF PETITIONERS AFTER FILING. If the answer to an involuntary petition filed by fewer than three creditors avers the existence of 12 or more creditors, the debtor shall file with the answer a list of all creditors with their addresses, a brief statement of the nature of their claims, and the amounts thereof. If it appears that there are 12 or more creditors as provided in § 303(b) of the Code, the court shall afford a reasonable opportunity for other creditors to join in the petition before a hearing is held thereon. (As amended Mar. 30, 1987, eff. Aug. 1, 1987.) Rule 1004. Involuntary Petition Against a Partnership After filing of an involuntary petition under § 303(b)(3) of the Code, (1) the petitioning partners or other petitioners shall promptly send to or serve on each general partner who is not a petitioner a copy of the petition; and (2) the clerk shall promptly issue a summons for service on each general partner who is not a petitioner. Rule 1010 applies to the form and service of the summons. (As amended Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 1004.1. Petition for an Infant or Incompetent Person If an infant or incompetent person has a representative, including a general guardian, committee, conservator, or similar fiduciary, the representative may file a voluntary petition on behalf of the infant or incompetent person. An infant or incompetent person who does not have a duly appointed representative may file a voluntary petition by next friend or guardian ad litem. The court shall appoint a guardian ad litem for an infant or incompetent person who is a debtor and is not otherwise represented or shall make any other order to protect the infant or incompetent debtor. (Added Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 1004.2. Petition in Chapter 15 Cases (a) DESIGNATING CENTER OF MAIN INTERESTS. A petition for recognition of a foreign proceeding under chapter 15 of the Code shall state the country where the debtor has its center of main interests. The petition shall also identify each country in which a foreign proceeding by, regarding, or against the debtor is pending. (b) CHALLENGING DESIGNATION. The United States trustee or a party in interest may file a motion for a determination that the debtor’s center of main interests is other than as stated in the petition for recognition commencing the chapter 15 case. Unless the court orders otherwise, the motion shall be filed no later than seven days before the date set for the hearing on the petition. The motion shall be transmitted to the United States trustee and served on the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor was a party as of the time the petition was filed, and such other entities as the court may direct. (Added Apr. 26, 2011, eff. Dec. 1, 2011.) Rule 1005. Caption of Petition The caption of a petition commencing a case under the Code shall contain the name of the court, the title of the case, and the docket number. The title of the case shall include the following information about the debtor: name, employer identification number, last four digits of the social-security number or individual debtor’s taxpayer-identification number, any other federal taxpayer-identification number, and all other names used within eight years before filing the petition. If the petition is not filed by 3 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 the debtor, it shall include all names used by the debtor which are known to the petitioners. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1006. Filing Fee (a) GENERAL REQUIREMENT. Every petition shall be accompanied by the filing fee except as provided in subdivisions (b) and (c) of this rule. For the purpose of this rule, ‘‘filing fee’’ means the filing fee prescribed by 28 U.S.C. § 1930(a)(1)–(a)(5) and any other fee prescribed by the Judicial Conference of the United States under 28 U.S.C. § 1930(b) that is payable to the clerk upon the commencement of a case under the Code. (b) PAYMENT OF FILING FEE IN INSTALLMENTS. (1) Application to Pay Filing Fee in Installments. A voluntary petition by an individual shall be accepted for filing, regardless of whether any portion of the filing fee is paid, if accompanied by the debtor’s signed application, prepared as prescribed by the appropriate Official Form, stating that the debtor is unable to pay the filing fee except in installments. (2) Action on Application. Prior to the meeting of creditors, the court may order the filing fee paid to the clerk or grant leave to pay in installments and fix the number, amount and dates of payment. The number of installments shall not exceed four, and the final installment shall be payable not later than 120 days after filing the petition. For cause shown, the court may extend the time of any installment, provided the last installment is paid not later than 180 days after filing the petition. (3) Postponement of Attorney’s Fees. All installments of the filing fee must be paid in full before the debtor or chapter 13 trustee may make further payments to an attorney or any other person who renders services to the debtor in connection with the case. (c) WAIVER OF FILING FEE. A voluntary chapter 7 petition filed by an individual shall be accepted for filing if accompanied by the debtor’s application requesting a waiver under 28 U.S.C. § 1930(f), prepared as prescribed by the appropriate Official Form. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 27, 2017, eff. Dec. 1, 2017.) Rule 1007. Lists, Schedules, Statements, and Other Documents; Time Limits (a) CORPORATE OWNERSHIP STATEMENT, LIST OF CREDITORS AND EQUITY SECURITY HOLDERS, AND OTHER LISTS. (1) Voluntary Case. In a voluntary case, the debtor shall file with the petition a list containing the name and address of each entity included or to be included on Schedules D, E/F, G, and H as prescribed by the Official Forms. If the debtor is a corporation, other than a governmental unit, the debtor shall file with the petition a corporate ownership statement containing the information described in Rule 7007.1. The debtor shall file a supplemental statement promptly upon any change in circumstances that renders the corporate ownership statement inaccurate. Rule 1007 FEDERAL RULES OF BANKRUPTCY PROCEDURE 4 (2) Involuntary Case. In an involuntary case, the debtor shall file, within seven days after entry of the order for relief, a list containing the name and address of each entity included or to be included on Schedules D, E/F, G, and H as prescribed by the Official Forms. (3) Equity Security Holders. In a chapter 11 reorganization case, unless the court orders otherwise, the debtor shall file within 14 days after entry of the order for relief a list of the debtor’s equity security holders of each class showing the number and kind of interests registered in the name of each holder, and the last known address or place of business of each holder. (4) Chapter 15 Case. In addition to the documents required under § 1515 of the Code, a foreign representative filing a petition for recognition under chapter 15 shall file with the petition: (A) a corporate ownership statement containing the information described in Rule 7007.1; and (B) unless the court orders otherwise, a list containing the names and addresses of all persons or bodies authorized to administer foreign proceedings of the debtor, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and all entities against whom provisional relief is being sought under § 1519 of the Code. (5) Extension of Time. Any extension of time for the filing of the lists required by this subdivision may be granted only on motion for cause shown and on notice to the United States trustee and to any trustee, committee elected under § 705 or appointed under § 1102 of the Code, or other party as the court may direct. (b) SCHEDULES, STATEMENTS, AND OTHER DOCUMENTS REQUIRED. (1) Except in a chapter 9 municipality case, the debtor, unless the court orders otherwise, shall file the following schedules, statements, and other documents, prepared as prescribed by the appropriate Official Forms, if any: (A) schedules of assets and liabilities; (B) a schedule of current income and expenditures; (C) a schedule of executory contracts and unexpired leases; (D) a statement of financial affairs; (E) copies of all payment advices or other evidence of payment, if any, received by the debtor from an employer within 60 days before the filing of the petition, with redaction of all but the last four digits of the debtor’s social-security number or individual taxpayer-identification number; and (F) a record of any interest that the debtor has in an account or program of the type specified in § 521(c) of the Code. (2) An individual debtor in a chapter 7 case shall file a statement of intention as required by § 521(a) of the Code, prepared as prescribed by the appropriate Official Form. A copy of the statement of intention shall be served on the trustee and the creditors named in the statement on or before the filing of the statement. 5 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 (3) Unless the United States trustee has determined that the credit counseling requirement of § 109(h) does not apply in the district, an individual debtor must file a statement of compliance with the credit counseling requirement, prepared as prescribed by the appropriate Official Form which must include one of the following: (A) an attached certificate and debt repayment plan, if any, required by § 521(b); (B) a statement that the debtor has received the credit counseling briefing required by § 109(h)(1) but does not have the certificate required by § 521(b); (C) a certification under § 109(h)(3); or (D) a request for a determination by the court under § 109(h)(4). (4) Unless § 707(b)(2)(D) applies, an individual debtor in a chapter 7 case shall file a statement of current monthly income prepared as prescribed by the appropriate Official Form, and, if the current monthly income exceeds the median family income for the applicable state and household size, the information, including calculations, required by § 707(b), prepared as prescribed by the appropriate Official Form. (5) An individual debtor in a chapter 11 case shall file a statement of current monthly income, prepared as prescribed by the appropriate Official Form. (6) A debtor in a chapter 13 case shall file a statement of current monthly income, prepared as prescribed by the appropriate Official Form, and, if the current monthly income exceeds the median family income for the applicable state and household size, a calculation of disposable income made in accordance with § 1325(b)(3), prepared as prescribed by the appropriate Official Form. (7) Unless an approved provider of an instructional course concerning personal financial management has notified the court that a debtor has completed the course after filing the petition: (A) An individual debtor in a chapter 7 or chapter 13 case shall file a statement of completion of the course, prepared as prescribed by the appropriate Official Form; and (B) An individual debtor in a chapter 11 case shall file the statement if § 1141(d)(3) applies. (8) If an individual debtor in a chapter 11, 12, or 13 case has claimed an exemption under § 522(b)(3)(A) in property of the kind described in § 522(p)(1) with a value in excess of the amount set out in § 522(q)(1), the debtor shall file a statement as to whether there is any proceeding pending in which the debtor may be found guilty of a felony of a kind described in § 522(q)(1)(A) or found liable for a debt of the kind described in § 522(q)(1)(B). (c) TIME LIMITS. In a voluntary case, the schedules, statements, and other documents required by subdivision (b)(1), (4), (5), and (6) shall be filed with the petition or within 14 days thereafter, except as otherwise provided in subdivisions (d), (e), (f), and (h) of this rule. In an involuntary case, the schedules, statements, and other Rule 1007 FEDERAL RULES OF BANKRUPTCY PROCEDURE 6 1So in original. Probably should be only one section symbol. documents required by subdivision (b)(1) shall be filed by the debtor within 14 days after the entry of the order for relief. In a voluntary case, the documents required by paragraphs (A), (C), and (D) of subdivision (b)(3) shall be filed with the petition. Unless the court orders otherwise, a debtor who has filed a statement under subdivision (b)(3)(B), shall file the documents required by subdivision (b)(3)(A) within 14 days of the order for relief. In a chapter 7 case, the debtor shall file the statement required by subdivision (b)(7) within 60 days after the first date set for the meeting of creditors under § 341 of the Code, and in a chapter 11 or 13 case no later than the date when the last payment was made by the debtor as required by the plan or the filing of a motion for a discharge under § 1141(d)(5)(B) or § 1328(b) of the Code. The court may, at any time and in its discretion, enlarge the time to file the statement required by subdivision (b)(7). The debtor shall file the statement required by subdivision (b)(8) no earlier than the date of the last payment made under the plan or the date of the filing of a motion for a discharge under §§ 1141(d)(5)(B),1 1228(b), or 1328(b) of the Code. Lists, schedules, statements, and other documents filed prior to the conversion of a case to another chapter shall be deemed filed in the converted case unless the court directs otherwise. Except as provided in § 1116(3), any extension of time to file schedules, statements, and other documents required under this rule may be granted only on motion for cause shown and on notice to the United States trustee, any committee elected under § 705 or appointed under § 1102 of the Code, trustee, examiner, or other party as the court may direct. Notice of an extension shall be given to the United States trustee and to any committee, trustee, or other party as the court may direct. (d) LIST OF 20 LARGEST CREDITORS IN CHAPTER 9 MUNICIPALITY CASE OR CHAPTER 11 REORGANIZATION CASE. In addition to the list required by subdivision (a) of this rule, a debtor in a chapter 9 municipality case or a debtor in a voluntary chapter 11 reorganization case shall file with the petition a list containing the name, address and claim of the creditors that hold the 20 largest unsecured claims, excluding insiders, as prescribed by the appropriate Official Form. In an involuntary chapter 11 reorganization case, such list shall be filed by the debtor within 2 days after entry of the order for relief under § 303(h) of the Code. (e) LIST IN CHAPTER 9 MUNICIPALITY CASES. The list required by subdivision (a) of this rule shall be filed by the debtor in a chapter 9 municipality case within such time as the court shall fix. If a proposed plan requires a revision of assessments so that the proportion of special assessments or special taxes to be assessed against some real property will be different from the proportion in effect at the date the petition is filed, the debtor shall also file a list showing the name and address of each known holder of title, legal or equitable, to real property adversely affected. On motion for cause shown, the court may modify the requirements of this subdivision and subdivision (a) of this rule. 7 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 (f) STATEMENT OF SOCIAL SECURITY NUMBER. An individual debtor shall submit a verified statement that sets out the debtor’s social security number, or states that the debtor does not have a social security number. In a voluntary case, the debtor shall submit the statement with the petition. In an involuntary case, the debtor shall submit the statement within 14 days after the entry of the order for relief. (g) PARTNERSHIP AND PARTNERS. The general partners of a debtor partnership shall prepare and file the list required under subdivision (a), schedules of the assets and liabilities, schedule of current income and expenditures, schedule of executory contracts and unexpired leases, and statement of financial affairs of the partnership. The court may order any general partner to file a statement of personal assets and liabilities within such time as the court may fix. (h) INTERESTS ACQUIRED OR ARISING AFTER PETITION. If, as provided by § 541(a)(5) of the Code, the debtor acquires or becomes entitled to acquire any interest in property, the debtor shall within 14 days after the information comes to the debtor’s knowledge or within such further time the court may allow, file a supplemental schedule in the chapter 7 liquidation case, chapter 11 reorganization case, chapter 12 family farmer’s debt adjustment case, or chapter 13 individual debt adjustment case. If any of the property required to be reported under this subdivision is claimed by the debtor as exempt, the debtor shall claim the exemptions in the supplemental schedule. The duty to file a supplemental schedule in accordance with this subdivision continues notwithstanding the closing of the case, except that the schedule need not be filed in a chapter 11, chapter 12, or chapter 13 case with respect to property acquired after entry of the order confirming a chapter 11 plan or discharging the debtor in a chapter 12 or chapter 13 case. (i) DISCLOSURE OF LIST OF SECURITY HOLDERS. After notice and hearing and for cause shown, the court may direct an entity other than the debtor or trustee to disclose any list of security holders of the debtor in its possession or under its control, indicating the name, address and security held by any of them. The entity possessing this list may be required either to produce the list or a true copy thereof, or permit inspection or copying, or otherwise disclose the information contained on the list. (j) IMPOUNDING OF LISTS. On motion of a party in interest and for cause shown the court may direct the impounding of the lists filed under this rule, and may refuse to permit inspection by any entity. The court may permit inspection or use of the lists, however, by any party in interest on terms prescribed by the court. (k) PREPARATION OF LIST, SCHEDULES, OR STATEMENTS ON DEFAULT OF DEBTOR. If a list, schedule, or statement, other than a statement of intention, is not prepared and filed as required by this rule, the court may order the trustee, a petitioning creditor, committee, or other party to prepare and file any of these papers within a time fixed by the court. The court may approve reimbursement of the cost incurred in complying with such an order as an administrative expense. (l) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall forthwith transmit to the United States trustee a copy of every list, schedule, and statement filed pursuant to subdivision (a)(1), (a)(2), (b), (d), or (h) of this rule. (m) INFANTS AND INCOMPETENT PERSONS. If the debtor knows that a person on the list of creditors or schedules is an infant or incompetent person, the debtor also shall include the name, address, and legal relationship of any person upon whom process would be served in an adversary proceeding against the infant or incompetent person in accordance with Rule 7004(b)(2). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 23, 2001, eff. Dec. 1, 2001; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 25, 2005, eff. Dec. 1, 2005; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 23, 2012, eff. Dec. 1, 2012: Apr. 16, 2013, eff. Dec. 1, 2013; Apr. 29, 2015, eff. Dec. 1, 2015.) Rule 1008. Verification of Petitions and Accompanying Papers All petitions, lists, schedules, statements and amendments thereto shall be verified or contain an unsworn declaration as provided in 28 U.S.C. § 1746. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1009. Amendments of Voluntary Petitions, Lists, Schedules and Statements (a) GENERAL RIGHT TO AMEND. A voluntary petition, list, schedule, or statement may be amended by the debtor as a matter of course at any time before the case is closed. The debtor shall give notice of the amendment to the trustee and to any entity affected thereby. On motion of a party in interest, after notice and a hearing, the court may order any voluntary petition, list, schedule, or statement to be amended and the clerk shall give notice of the amendment to entities designated by the court. (b) STATEMENT OF INTENTION. The statement of intention may be amended by the debtor at any time before the expiration of the period provided in § 521(a) of the Code. The debtor shall give notice of the amendment to the trustee and to any entity affected thereby. (c) STATEMENT OF SOCIAL SECURITY NUMBER. If a debtor becomes aware that the statement of social security number submitted under Rule 1007(f) is incorrect, the debtor shall promptly submit an amended verified statement setting forth the correct social security number. The debtor shall give notice of the amendment to all of the entities required to be included on the list filed under Rule 1007(a)(1) or (a)(2). (d) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall promptly transmit to the United States trustee a copy of every amendment filed or submitted under subdivision (a), (b), or (c) of this rule. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 12, 2006, eff. Dec. 1, 2006; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1010. Service of Involuntary Petition and Summons (a) SERVICE OF INVOLUNTARY PETITION AND SUMMONS. On the filing of an involuntary petition, the clerk shall forthwith issue a summons for service. When an involuntary petition is filed, service shall be made on the debtor. The summons shall be served with a copy of the petition in the manner provided for service of a summons and complaint by Rule 7004(a) or (b). If service cannot be so made, the court may order that the summons and petition be served by mailing copies to the party’s last known address, and by at least one publication in a manner and form directed by the court. The summons and petition may be served on the party anywhere. Rule 7004(e) and Rule 4(l) F.R.Civ.P. apply when service is made or attempted under this rule. (b) CORPORATE OWNERSHIP STATEMENT. Each petitioner that is a corporation shall file with the involuntary petition a corporate ownership statement containing the information described in Rule 7007.1. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1011. Responsive Pleading or Motion in Involuntary Cases (a) WHO MAY CONTEST PETITION. The debtor named in an involuntary petition may contest the petition. In the case of a petition against a partnership under Rule 1004, a nonpetitioning general partner, or a person who is alleged to be a general partner but denies the allegation, may contest the petition. (b) DEFENSES AND OBJECTIONS; WHEN PRESENTED. Defenses and objections to the petition shall be presented in the manner prescribed by Rule 12 F.R.Civ.P. and shall be filed and served within 21 days after service of the summons, except that if service is made by publication on a party or partner not residing or found within the state in which the court sits, the court shall prescribe the time for filing and serving the response. (c) EFFECT OF MOTION. Service of a motion under Rule 12(b) F.R.Civ.P. shall extend the time for filing and serving a responsive pleading as permitted by Rule 12(a) F.R.Civ.P. (d) CLAIMS AGAINST PETITIONERS. A claim against a petitioning creditor may not be asserted in the answer except for the purpose of defeating the petition. (e) OTHER PLEADINGS. No other pleadings shall be permitted, except that the court may order a reply to an answer and prescribe the time for filing and service. (f) CORPORATE OWNERSHIP STATEMENT. If the entity responding to the involuntary petition is a corporation, the entity shall file with its first appearance, pleading, motion, response, or other request addressed to the court a corporate ownership statement containing the information described in Rule 7007.1. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 26, 2004, eff. Dec. 1, 2004; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1012. Responsive Pleading in Cross-Border Cases (a) WHO MAY CONTEST PETITION. The debtor or any party in interest may contest a petition for recognition of a foreign proceeding. (b) OBJECTIONS AND RESPONSES; WHEN PRESENTED. Objections and other responses to the petition shall be presented no later Rule 1013 FEDERAL RULES OF BANKRUPTCY PROCEDURE 10 than seven days before the date set for the hearing on the petition, unless the court prescribes some other time or manner for responses. (c) CORPORATE OWNERSHIP STATEMENT. If the entity responding to the petition is a corporation, then the entity shall file a corporate ownership statement containing the information described in Rule 7007.1 with its first appearance, pleading, motion, response, or other request addressed to the court. (Added Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1013. Hearing and Disposition of a Petition in an Involuntary Case (a) CONTESTED PETITION. The court shall determine the issues of a contested petition at the earliest practicable time and forthwith enter an order for relief, dismiss the petition, or enter any other appropriate order. (b) DEFAULT. If no pleading or other defense to a petition is filed within the time provided by Rule 1011, the court, on the next day, or as soon thereafter as practicable, shall enter an order for the relief requested in the petition. [(c) ORDER FOR RELIEF] (Abrogated Apr. 22, 1993, eff. Aug. 1, 1993) (As amended Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993.) Rule 1014. Dismissal and Change of Venue (a) DISMISSAL AND TRANSFER OF CASES. (1) Cases Filed in Proper District. If a petition is filed in the proper district, the court, on the timely motion of a party in interest or on its own motion, and after hearing on notice to the petitioners, the United States trustee, and other entities as directed by the court, may transfer the case to any other district if the court determines that the transfer is in the interest of justice or for the convenience of the parties. (2) Cases Filed in Improper District. If a petition is filed in an improper district, the court, on the timely motion of a party in interest or on its own motion, and after hearing on notice to the petitioners, the United States trustee, and other entities as directed by the court, may dismiss the case or transfer it to any other district if the court determines that transfer is in the interest of justice or for the convenience of the parties. (b) PROCEDURE WHEN PETITIONS INVOLVING THE SAME DEBTOR OR RELATED DEBTORS ARE FILED IN DIFFERENT COURTS. If petitions commencing cases under the Code or seeking recognition under chapter 15 are filed in different districts by, regarding, or against (1) the same debtor, (2) a partnership and one or more of its general partners, (3) two or more general partners, or (4) a debtor and an affiliate, the court in the district in which the first-filed petition is pending may determine, in the interest of justice or for the convenience of the parties, the district or districts in which any of the cases should proceed. The court may so determine on motion and after a hearing, with notice to the following entities in the affected cases: the United States trustee, entities entitled to notice under Rule 2002(a), and other entities as the court directs. 11 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1017 The court may order the parties to the later-filed cases not to proceed further until it makes the determination. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 30, 2007, eff. Dec. 1, 2007; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 25, 2014, eff. Dec. 1, 2014.) Rule 1015. Consolidation or Joint Administration of Cases Pending in Same Court (a) CASES INVOLVING SAME DEBTOR. If two or more petitions by, regarding, or against the same debtor are pending in the same court, the court may order consolidation of the cases. (b) CASES INVOLVING TWO OR MORE RELATED DEBTORS. If a joint petition or two or more petitions are pending in the same court by or against (1) spouses, or (2) a partnership and one or more of its general partners, or (3) two or more general partners, or (4) a debtor and an affiliate, the court may order a joint administration of the estates. Prior to entering an order the court shall give consideration to protecting creditors of different estates against potential conflicts of interest. An order directing joint administration of individual cases of spouses shall, if one spouse has elected the exemptions under § 522(b)(2) of the Code and the other has elected the exemptions under § 522(b)(3), fix a reasonable time within which either may amend the election so that both shall have elected the same exemptions. The order shall notify the debtors that unless they elect the same exemptions within the time fixed by the court, they will be deemed to have elected the exemptions provided by § 522(b)(2). (c) EXPEDITING AND PROTECTIVE ORDERS. When an order for consolidation or joint administration of a joint case or two or more cases is entered pursuant to this rule, while protecting the rights of the parties under the Code, the court may enter orders as may tend to avoid unnecessary costs and delay. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 27, 2017, eff. Dec. 1, 2017.) Rule 1016. Death or Incompetency of Debtor Death or incompetency of the debtor shall not abate a liquidation case under chapter 7 of the Code. In such event the estate shall be administered and the case concluded in the same manner, so far as possible, as though the death or incompetency had not occurred. If a reorganization, family farmer’s debt adjustment, or individual’s debt adjustment case is pending under chapter 11, chapter 12, or chapter 13, the case may be dismissed; or if further administration is possible and in the best interest of the parties, the case may proceed and be concluded in the same manner, so far as possible, as though the death or incompetency had not occurred. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1017. Dismissal or Conversion of Case; Suspension (a) VOLUNTARY DISMISSAL; DISMISSAL FOR WANT OF PROSECUTION OR OTHER CAUSE. Except as provided in §§ 707(a)(3), 707(b), 1208(b), and 1307(b) of the Code, and in Rule 1017(b), (c), and (e), a case Rule 1017 FEDERAL RULES OF BANKRUPTCY PROCEDURE 12 shall not be dismissed on motion of the petitioner, for want of prosecution or other cause, or by consent of the parties, before a hearing on notice as provided in Rule 2002. For the purpose of the notice, the debtor shall file a list of creditors with their addresses within the time fixed by the court unless the list was previously filed. If the debtor fails to file the list, the court may order the debtor or another entity to prepare and file it. (b) DISMISSAL FOR FAILURE TO PAY FILING FEE. (1) If any installment of the filing fee has not been paid, the court may, after a hearing on notice to the debtor and the trustee, dismiss the case. (2) If the case is dismissed or closed without full payment of the filing fee, the installments collected shall be distributed in the same manner and proportions as if the filing fee had been paid in full. (c) DISMISSAL OF VOLUNTARY CHAPTER 7 OR CHAPTER 13 CASE FOR FAILURE TO TIMELY FILE LIST OF CREDITORS, SCHEDULES, AND STATEMENT OF FINANCIAL AFFAIRS. The court may dismiss a voluntary chapter 7 or chapter 13 case under § 707(a)(3) or § 1307(c)(9) after a hearing on notice served by the United States trustee on the debtor, the trustee, and any other entities as the court directs. (d) SUSPENSION. The court shall not dismiss a case or suspend proceedings under § 305 before a hearing on notice as provided in Rule 2002(a). (e) DISMISSAL OF AN INDIVIDUAL DEBTOR’S CHAPTER 7 CASE, OR CONVERSION TO A CASE UNDER CHAPTER 11 OR 13, FOR ABUSE. The court may dismiss or, with the debtor’s consent, convert an individual debtor’s case for abuse under § 707(b) only on motion and after a hearing on notice to the debtor, the trustee, the United States trustee, and any other entity as the court directs. (1) Except as otherwise provided in § 704(b)(2), a motion to dismiss a case for abuse under § 707(b) or (c) may be filed only within 60 days after the first date set for the meeting of creditors under § 341(a), unless, on request filed before the time has expired, the court for cause extends the time for filing the motion to dismiss. The party filing the motion shall set forth in the motion all matters to be considered at the hearing. In addition, a motion to dismiss under § 707(b)(1) and (3) shall state with particularity the circumstances alleged to constitute abuse. (2) If the hearing is set on the court’s own motion, notice of the hearing shall be served on the debtor no later than 60 days after the first date set for the meeting of creditors under § 341(a). The notice shall set forth all matters to be considered by the court at the hearing. (f) PROCEDURE FOR DISMISSAL, CONVERSION, OR SUSPENSION. (1) Rule 9014 governs a proceeding to dismiss or suspend a case, or to convert a case to another chapter, except under §§ 706(a), 1112(a), 1208(a) or (b), or 1307(a) or (b). (2) Conversion or dismissal under §§ 706(a), 1112(a), 1208(b), or 1307(b) shall be on motion filed and served as required by Rule 9013. (3) A chapter 12 or chapter 13 case shall be converted without court order when the debtor files a notice of conversion under 13 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1019 §§ 1208(a) or 1307(a). The filing date of the notice becomes the date of the conversion order for the purposes of applying § 348(c) and Rule 1019. The clerk shall promptly transmit a copy of the notice to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 17, 2000, eff. Dec. 1, 2000; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1018. Contested Involuntary Petitions; Contested Petitions Commencing Chapter 15 Cases; Proceedings to Vacate Order for Relief; Applicability of Rules in Part VII Governing Adversary Proceedings Unless the court otherwise directs and except as otherwise prescribed in Part I of these rules, the following rules in Part VII apply to all proceedings contesting an involuntary petition or a chapter 15 petition for recognition, and to all proceedings to vacate an order for relief: Rules 7005, 7008–7010, 7015, 7016, 7024–7026, 7028–7037, 7052, 7054, 7056, and 7062. The court may direct that other rules in Part VII shall also apply. For the purposes of this rule a reference in the Part VII rules to adversary proceedings shall be read as a reference to proceedings contesting an involuntary petition or a chapter 15 petition for recognition, or proceedings to vacate an order for relief. Reference in the Federal Rules of Civil Procedure to the complaint shall be read as a reference to the petition. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 28, 2010, eff. Dec. 1, 2010.) Rule 1019. Conversion of a Chapter 11 Reorganization Case, Chapter 12 Family Farmer’s Debt Adjustment Case, or Chapter 13 Individual’s Debt Adjustment Case to a Chapter 7 Liquidation Case When a chapter 11, chapter 12, or chapter 13 case has been converted or reconverted to a chapter 7 case: (1) Filing of Lists, Inventories, Schedules, Statements. (A) Lists, inventories, schedules, and statements of financial affairs theretofore filed shall be deemed to be filed in the chapter 7 case, unless the court directs otherwise. If they have not been previously filed, the debtor shall comply with Rule 1007 as if an order for relief had been entered on an involuntary petition on the date of the entry of the order directing that the case continue under chapter 7. (B) If a statement of intention is required, it shall be filed within 30 days after entry of the order of conversion or before the first date set for the meeting of creditors, whichever is earlier. The court may grant an extension of time for cause only on written motion filed, or oral request made during a hearing, before the time has expired. Notice of an extension shall be given to the United States trustee and to any committee, trustee, or other party as the court may direct. (2) New Filing Periods. (A) A new time period for filing a motion under § 707(b) or (c), a claim, a complaint objecting to discharge, or a Rule 1019 FEDERAL RULES OF BANKRUPTCY PROCEDURE 14 1So in original. Probably should be ‘‘Rule’’. complaint to obtain a determination of dischargeability of any debt shall commence under Rules 1 1017, 3002, 4004, or 4007, but a new time period shall not commence if a chapter 7 case had been converted to a chapter 11, 12, or 13 case and thereafter reconverted to a chapter 7 case and the time for filing a motion under § 707(b) or (c), a claim, a complaint objecting to discharge, or a complaint to obtain a determination of the dischargeability of any debt, or any extension thereof, expired in the original chapter 7 case. (B) A new time period for filing an objection to a claim of exemptions shall commence under Rule 4003(b) after conversion of a case to chapter 7 unless: (i) the case was converted to chapter 7 more than one year after the entry of the first order confirming a plan under chapter 11, 12, or 13; or (ii) the case was previously pending in chapter 7 and the time to object to a claimed exemption had expired in the original chapter 7 case. (3) Claims Filed Before Conversion. All claims actually filed by a creditor before conversion of the case are deemed filed in the chapter 7 case. (4) Turnover of Records and Property. After qualification of, or assumption of duties by the chapter 7 trustee, any debtor in possession or trustee previously acting in the chapter 11, 12, or 13 case shall, forthwith, unless otherwise ordered, turn over to the chapter 7 trustee all records and property of the estate in the possession or control of the debtor in possession or trustee. (5) Filing Final Report and Schedule of Postpetition Debts. (A) Conversion of Chapter 11 or Chapter 12 Case. Unless the court directs otherwise, if a chapter 11 or chapter 12 case is converted to chapter 7, the debtor in possession or, if the debtor is not a debtor in possession, the trustee serving at the time of conversion, shall: (i) not later than 14 days after conversion of the case, file a schedule of unpaid debts incurred after the filing of the petition and before conversion of the case, including the name and address of each holder of a claim; and (ii) not later than 30 days after conversion of the case, file and transmit to the United States trustee a final report and account; (B) Conversion of Chapter 13 Case. Unless the court directs otherwise, if a chapter 13 case is converted to chapter 7, (i) the debtor, not later than 14 days after conversion of the case, shall file a schedule of unpaid debts incurred after the filing of the petition and before conversion of the case, including the name and address of each holder of a claim; and (ii) the trustee, not later than 30 days after conversion of the case, shall file and transmit to the United States trustee a final report and account; 15 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1020 (C) Conversion After Confirmation of a Plan. Unless the court orders otherwise, if a chapter 11, chapter 12, or chapter 13 case is converted to chapter 7 after confirmation of a plan, the debtor shall file: (i) a schedule of property not listed in the final report and account acquired after the filing of the petition but before conversion, except if the case is converted from chapter 13 to chapter 7 and § 348(f)(2) does not apply; (ii) a schedule of unpaid debts not listed in the final report and account incurred after confirmation but before the conversion; and (iii) a schedule of executory contracts and unexpired leases entered into or assumed after the filing of the petition but before conversion. (D) Transmission to United States Trustee. The clerk shall forthwith transmit to the United States trustee a copy of every schedule filed pursuant to Rule 1019(5). (6) Postpetition Claims; Preconversion Administrative Expenses; Notice. A request for payment of an administrative expense incurred before conversion of the case is timely filed under § 503(a) of the Code if it is filed before conversion or a time fixed by the court. If the request is filed by a governmental unit, it is timely if it is filed before conversion or within the later of a time fixed by the court or 180 days after the date of the conversion. A claim of a kind specified in § 348(d) may be filed in accordance with Rules 3001(a)–(d) and 3002. Upon the filing of the schedule of unpaid debts incurred after commencement of the case and before conversion, the clerk, or some other person as the court may direct, shall give notice to those entities listed on the schedule of the time for filing a request for payment of an administrative expense and, unless a notice of insufficient assets to pay a dividend is mailed in accordance with Rule 2002(e), the time for filing a claim of a kind specified in § 348(d). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2010, eff. Dec. 1, 2010.) Rule 1020. Small Business Chapter 11 Reorganization Case (a) SMALL BUSINESS DEBTOR DESIGNATION. In a voluntary chapter 11 case, the debtor shall state in the petition whether the debtor is a small business debtor. In an involuntary chapter 11 case, the debtor shall file within 14 days after entry of the order for relief a statement as to whether the debtor is a small business debtor. Except as provided in subdivision (c), the status of the case as a small business case shall be in accordance with the debtor’s statement under this subdivision, unless and until the court enters an order finding that the debtor’s statement is incorrect. (b) OBJECTING TO DESIGNATION. Except as provided in subdivision (c), the United States trustee or a party in interest may file an objection to the debtor’s statement under subdivision (a) no later than 30 days after the conclusion of the meeting of creditors held Rule 1021 FEDERAL RULES OF BANKRUPTCY PROCEDURE 16 under § 341(a) of the Code, or within 30 days after any amendment to the statement, whichever is later. (c) APPOINTMENT OF COMMITTEE OF UNSECURED CREDITORS. If a committee of unsecured creditors has been appointed under § 1102(a)(1), the case shall proceed as a small business case only if, and from the time when, the court enters an order determining that the committee has not been sufficiently active and representative to provide effective oversight of the debtor and that the debtor satisfies all the other requirements for being a small business. A request for a determination under this subdivision may be filed by the United States trustee or a party in interest only within a reasonable time after the failure of the committee to be sufficiently active and representative. The debtor may file a request for a determination at any time as to whether the committee has been sufficiently active and representative. (d) PROCEDURE FOR OBJECTION OR DETERMINATION. Any objection or request for a determination under this rule shall be governed by Rule 9014 and served on: the debtor; the debtor’s attorney; the United States trustee; the trustee; any committee appointed under § 1102 or its authorized agent, or, if no committee of unsecured creditors has been appointed under § 1102, the creditors included on the list filed under Rule 1007(d); and any other entity as the court directs. (Added Apr. 11, 1997, eff. Dec. 1, 1997; amended Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 1021. Health Care Business Case (a) HEALTH CARE BUSINESS DESIGNATION. Unless the court orders otherwise, if a petition in a case under chapter 7, chapter 9, or chapter 11 states that the debtor is a health care business, the case shall proceed as a case in which the debtor is a health care business. (b) MOTION. The United States trustee or a party in interest may file a motion to determine whether the debtor is a health care business. The motion shall be transmitted to the United States trustee and served on: the debtor; the trustee; any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, the creditors included on the list filed under Rule 1007(d); and any other entity as the court directs. The motion shall be governed by Rule 9014. (Added Apr. 23, 2008, eff. Dec. 1, 2008.) PART II—OFFICERS AND ADMINISTRATION; NOTICES; MEETINGS; EXAMINATIONS; ELECTIONS; ATTORNEYS AND ACCOUNTANTS Rule 2001. Appointment of Interim Trustee Before Order for Relief in a Chapter 7 Liquidation Case (a) APPOINTMENT. At any time following the commencement of an involuntary liquidation case and before an order for relief, the court on written motion of a party in interest may order the appointment of an interim trustee under § 303(g) of the Code. The 17 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 motion shall set forth the necessity for the appointment and may be granted only after hearing on notice to the debtor, the petitioning creditors, the United States trustee, and other parties in interest as the court may designate. (b) BOND OF MOVANT. An interim trustee may not be appointed under this rule unless the movant furnishes a bond in an amount approved by the court, conditioned to indemnify the debtor for costs, attorney’s fee, expenses, and damages allowable under § 303(i) of the Code. (c) ORDER OF APPOINTMENT. The order directing the appointment of an interim trustee shall state the reason the appointment is necessary and shall specify the trustee’s duties. (d) TURNOVER AND REPORT. Following qualification of the trustee selected under § 702 of the Code, the interim trustee, unless otherwise ordered, shall (1) forthwith deliver to the trustee all the records and property of the estate in possession or subject to control of the interim trustee and, (2) within 30 days thereafter file a final report and account. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2002. Notices to Creditors, Equity Security Holders, Administrators in Foreign Proceedings, Persons Against Whom Provisional Relief is Sought in Ancillary and Other Cross-Border Cases, United States, and United States Trustee (a) TWENTY-ONE-DAY NOTICES TO PARTIES IN INTEREST. Except as provided in subdivisions (h), (i), (l), (p), and (q) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, the trustee, all creditors and indenture trustees at least 21 days’ notice by mail of: (1) the meeting of creditors under § 341 or § 1104(b) of the Code, which notice, unless the court orders otherwise, shall include the debtor’s employer identification number, social security number, and any other federal taxpayer identification number; (2) a proposed use, sale, or lease of property of the estate other than in the ordinary course of business, unless the court for cause shown shortens the time or directs another method of giving notice; (3) the hearing on approval of a compromise or settlement of a controversy other than approval of an agreement pursuant to Rule 4001(d), unless the court for cause shown directs that notice not be sent; (4) in a chapter 7 liquidation, a chapter 11 reorganization case, or a chapter 12 family farmer debt adjustment case, the hearing on the dismissal of the case or the conversion of the case to another chapter, unless the hearing is under § 707(a)(3) or § 707(b) or is on dismissal of the case for failure to pay the filing fee; (5) the time fixed to accept or reject a proposed modification of a plan; (6) a hearing on any entity’s request for compensation or reimbursement of expenses if the request exceeds $1,000; (7) the time fixed for filing proofs of claims pursuant to Rule 3003(c); Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 18 (8) the time fixed for filing objections and the hearing to consider confirmation of a chapter 12 plan; and (9) the time fixed for filing objections to confirmation of a chapter 13 plan. (b) TWENTY-EIGHT-DAY NOTICES TO PARTIES IN INTEREST. Except as provided in subdivision (l) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, the trustee, all creditors and indenture trustees not less than 28 days’ notice by mail of the time fixed (1) for filing objections and the hearing to consider approval of a disclosure statement or, under § 1125(f), to make a final determination whether the plan provides adequate information so that a separate disclosure statement is not necessary; (2) for filing objections and the hearing to consider confirmation of a chapter 9 or chapter 11 plan; and (3) for the hearing to consider confirmation of a chapter 13 plan. (c) CONTENT OF NOTICE. (1) Proposed Use, Sale, or Lease of Property. Subject to Rule 6004, the notice of a proposed use, sale, or lease of property required by subdivision (a)(2) of this rule shall include the time and place of any public sale, the terms and conditions of any private sale and the time fixed for filing objections. The notice of a proposed use, sale, or lease of property, including real estate, is sufficient if it generally describes the property. The notice of a proposed sale or lease of personally identifiable information under § 363(b)(1) of the Code shall state whether the sale is consistent with any policy prohibiting the transfer of the information. (2) Notice of Hearing on Compensation. The notice of a hearing on an application for compensation or reimbursement of expenses required by subdivision (a)(6) of this rule shall identify the applicant and the amounts requested. (3) Notice of Hearing on Confirmation When Plan Provides for an Injunction. If a plan provides for an injunction against conduct not otherwise enjoined under the Code, the notice required under Rule 2002(b)(2) shall: (A) include in conspicuous language (bold, italic, or underlined text) a statement that the plan proposes an injunction; (B) describe briefly the nature of the injunction; and (C) identify the entities that would be subject to the injunction. (d) NOTICE TO EQUITY SECURITY HOLDERS. In a chapter 11 reorganization case, unless otherwise ordered by the court, the clerk, or some other person as the court may direct, shall in the manner and form directed by the court give notice to all equity security holders of (1) the order for relief; (2) any meeting of equity security holders held pursuant to § 341 of the Code; (3) the hearing on the proposed sale of all or substantially all of the debtor’s assets; (4) the hearing on the dismissal or conversion of a case to another chapter; (5) the time fixed for filing objections to and the hearing to consider approval of a disclosure statement; (6) the time fixed for filing objections to and the hearing to consider confirmation of a plan; and (7) the time fixed to accept or reject a proposed modification of a plan. 19 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 (e) NOTICE OF NO DIVIDEND. In a chapter 7 liquidation case, if it appears from the schedules that there are no assets from which a dividend can be paid, the notice of the meeting of creditors may include a statement to that effect; that it is unnecessary to file claims; and that if sufficient assets become available for the payment of a dividend, further notice will be given for the filing of claims. (f) OTHER NOTICES. Except as provided in subdivision (l) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, all creditors, and indenture trustees notice by mail of: (1) the order for relief; (2) the dismissal or the conversion of the case to another chapter, or the suspension of proceedings under § 305; (3) the time allowed for filing claims pursuant to Rule 3002; (4) the time fixed for filing a complaint objecting to the debtor’s discharge pursuant to § 727 of the Code as provided in Rule 4004; (5) the time fixed for filing a complaint to determine the dischargeability of a debt pursuant to § 523 of the Code as provided in Rule 4007; (6) the waiver, denial, or revocation of a discharge as provided in Rule 4006; (7) entry of an order confirming a chapter 9, 11, or 12 plan; (8) a summary of the trustee’s final report in a chapter 7 case if the net proceeds realized exceed $1,500; (9) a notice under Rule 5008 regarding the presumption of abuse; (10) a statement under § 704(b)(1) as to whether the debtor’s case would be presumed to be an abuse under § 707(b); and (11) the time to request a delay in the entry of the discharge under §§ 1141(d)(5)(C), 1228(f), and 1328(h). Notice of the time fixed for accepting or rejecting a plan pursuant to Rule 3017(c) shall be given in accordance with Rule 3017(d). (g) ADDRESSING NOTICES. (1) Notices required to be mailed under Rule 2002 to a creditor, indenture trustee, or equity security holder shall be addressed as such entity or an authorized agent has directed in its last request filed in the particular case. For the purposes of this subdivision— (A) a proof of claim filed by a creditor or indenture trustee that designates a mailing address constitutes a filed request to mail notices to that address, unless a notice of no dividend has been given under Rule 2002(e) and a later notice of possible dividend under Rule 3002(c)(5) has not been given; and (B) a proof of interest filed by an equity security holder that designates a mailing address constitutes a filed request to mail notices to that address. (2) Except as provided in § 342(f) of the Code, if a creditor or indenture trustee has not filed a request designating a mailing address under Rule 2002(g)(1) or Rule 5003(e), the notices shall be mailed to the address shown on the list of creditors or schedule of liabilities, whichever is filed later. If an equity security holder has not filed a request designating a mailing address under Rule 2002(g)(1) or Rule 5003(e), the notices shall be Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 20 mailed to the address shown on the list of equity security holders. (3) If a list or schedule filed under Rule 1007 includes the name and address of a legal representative of an infant or incompetent person, and a person other than that representative files a request or proof of claim designating a name and mailing address that differs from the name and address of the representative included in the list or schedule, unless the court orders otherwise, notices under Rule 2002 shall be mailed to the representative included in the list or schedules and to the name and address designated in the request or proof of claim. (4) Notwithstanding Rule 2002(g)(1)–(3), an entity and a notice provider may agree that when the notice provider is directed by the court to give a notice, the notice provider shall give the notice to the entity in the manner agreed to and at the address or addresses the entity supplies to the notice provider. That address is conclusively presumed to be a proper address for the notice. The notice provider’s failure to use the supplied address does not invalidate any notice that is otherwise effective under applicable law. (5) A creditor may treat a notice as not having been brought to the creditor’s attention under § 342(g)(1) only if, prior to issuance of the notice, the creditor has filed a statement that designates the name and address of the person or organizational subdivision of the creditor responsible for receiving notices under the Code, and that describes the procedures established by the creditor to cause such notices to be delivered to the designated person or subdivision. (h) NOTICES TO CREDITORS WHOSE CLAIMS ARE FILED. In a chapter 7 case, after 90 days following the first date set for the meeting of creditors under § 341 of the Code, the court may direct that all notices required by subdivision (a) of this rule be mailed only to the debtor, the trustee, all indenture trustees, creditors that hold claims for which proofs of claim have been filed, and creditors, if any, that are still permitted to file claims by reason of an extension granted pursuant to Rule 3002(c)(1) or (c)(2). In a case where notice of insufficient assets to pay a dividend has been given to creditors pursuant to subdivision (e) of this rule, after 90 days following the mailing of a notice of the time for filing claims pursuant to Rule 3002(c)(5), the court may direct that notices be mailed only to the entities specified in the preceding sentence. (i) NOTICES TO COMMITTEES. Copies of all notices required to be mailed pursuant to this rule shall be mailed to the committees elected under § 705 or appointed under § 1102 of the Code or to their authorized agents. Notwithstanding the foregoing subdivisions, the court may order that notices required by subdivision (a)(2), (3) and (6) of this rule be transmitted to the United States trustee and be mailed only to the committees elected under § 705 or appointed under § 1102 of the Code or to their authorized agents and to the creditors and equity security holders who serve on the trustee or debtor in possession and file a request that all notices be mailed to them. A committee appointed under § 1114 shall receive copies of all notices required by subdivisions (a)(1), (a)(5), (b), (f)(2), and (f)(7), and such other notices as the court may direct. 21 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 1So in original. Period probably should not appear. (j) NOTICES TO THE UNITED STATES. Copies of notices required to be mailed to all creditors under this rule shall be mailed (1) in a chapter 11 reorganization case, to the Securities and Exchange Commission at any place the Commission designates, if the Commission has filed either a notice of appearance in the case or a written request to receive notices; (2) in a commodity broker case, to the Commodity Futures Trading Commission at Washington, D.C.; (3) in a chapter 11 case, to the Internal Revenue Service at its address set out in the register maintained under Rule 5003(e) for the district in which the case is pending; (4) if the papers in the case disclose a debt to the United States other than for taxes, to the United States attorney for the district in which the case is pending and to the department, agency, or instrumentality of the United States through which the debtor became indebted; or (5) if the filed papers disclose a stock interest of the United States, to the Secretary of the Treasury at Washington, D.C. (k) NOTICES TO UNITED STATES TRUSTEE. Unless the case is a chapter 9 municipality case or unless the United States trustee requests otherwise, the clerk, or some other person as the court may direct, shall transmit to the United States trustee notice of the matters described in subdivisions (a)(2), (a)(3), (a)(4), (a)(8), (b), (f)(1), (f)(2), (f)(4), (f)(6), (f)(7), (f)(8), and (q) of this rule and notice of hearings on all applications for compensation or reimbursement of expenses. Notices to the United States trustee shall be transmitted within the time prescribed in subdivision (a) or (b) of this rule. The United States trustee shall also receive notice of any other matter if such notice is requested by the United States trustee or ordered by the court. Nothing in these rules requires the clerk or any other person to transmit to the United States trustee any notice, schedule, report, application or other document in a case under the Securities Investor Protection Act, 15 U.S.C. § 78aaa et. 1 seq. (l) NOTICE BY PUBLICATION. The court may order notice by publication if it finds that notice by mail is impracticable or that it is desirable to supplement the notice. (m) ORDERS DESIGNATING MATTER OF NOTICES. The court may from time to time enter orders designating the matters in respect to which, the entity to whom, and the form and manner in which notices shall be sent except as otherwise provided by these rules. (n) CAPTION. The caption of every notice given under this rule shall comply with Rule 1005. The caption of every notice required to be given by the debtor to a creditor shall include the information required to be in the notice by § 342(c) of the Code. (o) NOTICE OF ORDER FOR RELIEF IN CONSUMER CASE. In a voluntary case commenced by an individual debtor whose debts are primarily consumer debts, the clerk or some other person as the court may direct shall give the trustee and all creditors notice by mail of the order for relief within 21 days from the date thereof. (p) NOTICE TO A CREDITOR WITH A FOREIGN ADDRESS. (1) If, at the request of the United States trustee or a party in interest, or on its own initiative, the court finds that a notice mailed within the time prescribed by these rules would Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 22 not be sufficient to give a creditor with a foreign address to which notices under these rules are mailed reasonable notice under the circumstances, the court may order that the notice be supplemented with notice by other means or that the time prescribed for the notice by mail be enlarged. (2) Unless the court for cause orders otherwise, a creditor with a foreign address to which notices under this rule are mailed shall be given at least 30 days’ notice of the time fixed for filing a proof of claim under Rule 3002(c) or Rule 3003(c). (3) Unless the court for cause orders otherwise, the mailing address of a creditor with a foreign address shall be determined under Rule 2002(g). (q) NOTICE OF PETITION FOR RECOGNITION OF FOREIGN PROCEEDING AND OF COURT’S INTENTION TO COMMUNICATE WITH FOREIGN COURTS AND FOREIGN REPRESENTATIVES. (1) Notice of Petition for Recognition. After the filing of a petition for recognition of a foreign proceeding, the court shall promptly schedule and hold a hearing on the petition. The clerk, or some other person as the court may direct, shall forthwith give the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and such other entities as the court may direct, at least 21 days’ notice by mail of the hearing. The notice shall state whether the petition seeks recognition as a foreign main proceeding or foreign nonmain proceeding and shall include the petition and any other document the court may require. If the court consolidates the hearing on the petition with the hearing on a request for provisional relief, the court may set a shorter notice period, with notice to the entities listed in this subdivision. (2) Notice of Court’s Intention to Communicate with Foreign Courts and Foreign Representatives. The clerk, or some other person as the court may direct, shall give the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and such other entities as the court may direct, notice by mail of the court’s intention to communicate with a foreign court or foreign representative. (As amended Pub. L. 98–91, § 2(a), Aug. 30, 1983, 97 Stat. 607; Pub. L. 98–353, title III, § 321, July 10, 1984, 98 Stat. 357; Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 17, 2000, eff. Dec. 1, 2000; Apr. 23, 2001, eff. Dec. 1, 2001; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 26, 2004, eff. Dec. 1, 2004; Apr. 25, 2005, eff. Dec. 1, 2005; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2016, eff. Dec. 1, 2016; Apr. 27, 2017, eff. Dec. 1, 2017.) 23 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2003 Rule 2003. Meeting of Creditors or Equity Security Holders (a) DATE AND PLACE. Except as otherwise provided in § 341(e) of the Code, in a chapter 7 liquidation or a chapter 11 reorganization case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 40 days after the order for relief. In a chapter 12 family farmer debt adjustment case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 35 days after the order for relief. In a chapter 13 individual’s debt adjustment case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 50 days after the order for relief. If there is an appeal from or a motion to vacate the order for relief, or if there is a motion to dismiss the case, the United States trustee may set a later date for the meeting. The meeting may be held at a regular place for holding court or at any other place designated by the United States trustee within the district convenient for the parties in interest. If the United States trustee designates a place for the meeting which is not regularly staffed by the United States trustee or an assistant who may preside at the meeting, the meeting may be held not more than 60 days after the order for relief. (b) ORDER OF MEETING. (1) Meeting of Creditors. The United States trustee shall preside at the meeting of creditors. The business of the meeting shall include the examination of the debtor under oath and, in a chapter 7 liquidation case, may include the election of a creditors’ committee and, if the case is not under subchapter V of chapter 7, the election of a trustee. The presiding officer shall have the authority to administer oaths. (2) Meeting of Equity Security Holders. If the United States trustee convenes a meeting of equity security holders pursuant to § 341(b) of the Code, the United States trustee shall fix a date for the meeting and shall preside. (3) Right To Vote. In a chapter 7 liquidation case, a creditor is entitled to vote at a meeting if, at or before the meeting, the creditor has filed a proof of claim or a writing setting forth facts evidencing a right to vote pursuant to § 702(a) of the Code unless objection is made to the claim or the proof of claim is insufficient on its face. A creditor of a partnership may file a proof of claim or writing evidencing a right to vote for the trustee for the estate of the general partner notwithstanding that a trustee for the estate of the partnership has previously qualified. In the event of an objection to the amount or allowability of a claim for the purpose of voting, unless the court orders otherwise, the United States trustee shall tabulate the votes for each alternative presented by the dispute and, if resolution of such dispute is necessary to determine the result of the election, the tabulations for each alternative shall be reported to the court. (c) RECORD OF MEETING. Any examination under oath at the meeting of creditors held pursuant to § 341(a) of the Code shall be recorded verbatim by the United States trustee using electronic sound recording equipment or other means of recording, and such record shall be preserved by the United States trustee and available for public access until two years after the conclusion of the Rule 2004 FEDERAL RULES OF BANKRUPTCY PROCEDURE 24 meeting of creditors. Upon request of any entity, the United States trustee shall certify and provide a copy or transcript of such recording at the entity’s expense. (d) REPORT OF ELECTION AND RESOLUTION OF DISPUTES IN A CHAPTER 7 CASE. (1) Report of Undisputed Election. In a chapter 7 case, if the election of a trustee or a member of a creditors’ committee is not disputed, the United States trustee shall promptly file a report of the election, including the name and address of the person or entity elected and a statement that the election is undisputed. (2) Disputed Election. If the election is disputed, the United States trustee shall promptly file a report stating that the election is disputed, informing the court of the nature of the dispute, and listing the name and address of any candidate elected under any alternative presented by the dispute. No later than the date on which the report is filed, the United States trustee shall mail a copy of the report to any party in interest that has made a request to receive a copy of the report. Pending disposition by the court of a disputed election for trustee, the interim trustee shall continue in office. Unless a motion for the resolution of the dispute is filed no later than 14 days after the United States trustee files a report of a disputed election for trustee, the interim trustee shall serve as trustee in the case. (e) ADJOURNMENT. The meeting may be adjourned from time to time by announcement at the meeting of the adjourned date and time. The presiding official shall promptly file a statement specifying the date and time to which the meeting is adjourned. (f) SPECIAL MEETINGS. The United States trustee may call a special meeting of creditors on request of a party in interest or on the United States trustee’s own initiative. (g) FINAL MEETING. If the United States trustee calls a final meeting of creditors in a case in which the net proceeds realized exceed $1,500, the clerk shall mail a summary of the trustee’s final account to the creditors with a notice of the meeting, together with a statement of the amount of the claims allowed. The trustee shall attend the final meeting and shall, if requested, report on the administration of the estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 26, 1999, eff. Dec. 1, 1999; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 26, 2011, eff. Dec. 1, 2011.) Rule 2004. Examination (a) EXAMINATION ON MOTION. On motion of any party in interest, the court may order the examination of any entity. (b) SCOPE OF EXAMINATION. The examination of an entity under this rule or of the debtor under § 343 of the Code may relate only to the acts, conduct, or property or to the liabilities and financial condition of the debtor, or to any matter which may affect the administration of the debtor’s estate, or to the debtor’s right to a discharge. In a family farmer’s debt adjustment case under chapter 12, an individual’s debt adjustment case under chapter 13, or 25 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2005 a reorganization case under chapter 11 of the Code, other than for the reorganization of a railroad, the examination may also relate to the operation of any business and the desirability of its continuance, the source of any money or property acquired or to be acquired by the debtor for purposes of consummating a plan and the consideration given or offered therefor, and any other matter relevant to the case or to the formulation of a plan. (c) COMPELLING ATTENDANCE AND PRODUCTION OF DOCUMENTS. The attendance of an entity for examination and for the production of documents, whether the examination is to be conducted within or without the district in which the case is pending, may be compelled as provided in Rule 9016 for the attendance of a witness at a hearing or trial. As an officer of the court, an attorney may issue and sign a subpoena on behalf of the court for the district in which the examination is to be held if the attorney is admitted to practice in that court or in the court in which the case is pending. (d) TIME AND PLACE OF EXAMINATION OF DEBTOR. The court may for cause shown and on terms as it may impose order the debtor to be examined under this rule at any time or place it designates, whether within or without the district wherein the case is pending. (e) MILEAGE. An entity other than a debtor shall not be required to attend as a witness unless lawful mileage and witness fee for one day’s attendance shall be first tendered. If the debtor resides more than 100 miles from the place of examination when required to appear for an examination under this rule, the mileage allowed by law to a witness shall be tendered for any distance more than 100 miles from the debtor’s residence at the date of the filing of the first petition commencing a case under the Code or the residence at the time the debtor is required to appear for the examination, whichever is the lesser. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 2005. Apprehension and Removal of Debtor to Compel Attendance for Examination (a) ORDER TO COMPEL ATTENDANCE FOR EXAMINATION. On motion of any party in interest supported by an affidavit alleging (1) that the examination of the debtor is necessary for the proper administration of the estate and that there is reasonable cause to believe that the debtor is about to leave or has left the debtor’s residence or principal place of business to avoid examination, or (2) that the debtor has evaded service of a subpoena or of an order to attend for examination, or (3) that the debtor has willfully disobeyed a subpoena or order to attend for examination, duly served, the court may issue to the marshal, or some other officer authorized by law, an order directing the officer to bring the debtor before the court without unnecessary delay. If, after hearing, the court finds the allegations to be true, the court shall thereupon cause the debtor to be examined forthwith. If necessary, the court shall fix conditions for further examination and for the debtor’s obedience to all orders made in reference thereto. (b) REMOVAL. Whenever any order to bring the debtor before the court is issued under this rule and the debtor is found in a district Rule 2006 FEDERAL RULES OF BANKRUPTCY PROCEDURE 26 other than that of the court issuing the order, the debtor may be taken into custody under the order and removed in accordance with the following rules: (1) If the debtor is taken into custody under the order at a place less than 100 miles from the place of issue of the order, the debtor shall be brought forthwith before the court that issued the order. (2) If the debtor is taken into custody under the order at a place 100 miles or more from the place of issue of the order, the debtor shall be brought without unnecessary delay before the nearest available United States magistrate judge, bankruptcy judge, or district judge. If, after hearing, the magistrate judge, bankruptcy judge, or district judge finds that an order has issued under this rule and that the person in custody is the debtor, or if the person in custody waives a hearing, the magistrate judge, bankruptcy judge, or district judge shall order removal, and the person in custody shall be released on conditions ensuring prompt appearance before the court that issued the order to compel the attendance. (c) CONDITIONS OF RELEASE. In determining what conditions will reasonably assure attendance or obedience under subdivision (a) of this rule or appearance under subdivision (b) of this rule, the court shall be governed by the provisions and policies of title 18, U.S.C., § 3146(a) and (b). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 22, 1993, eff. Aug. 1, 1993.) Rule 2006. Solicitation and Voting of Proxies in Chapter 7 Liquidation Cases (a) APPLICABILITY. This rule applies only in a liquidation case pending under chapter 7 of the Code. (b) DEFINITIONS. (1) Proxy. A proxy is a written power of attorney authorizing any entity to vote the claim or otherwise act as the owner’s attorney in fact in connection with the administration of the estate. (2) Solicitation of Proxy. The solicitation of a proxy is any communication, other than one from an attorney to a regular client who owns a claim or from an attorney to the owner of a claim who has requested the attorney to represent the owner, by which a creditor is asked, directly or indirectly, to give a proxy after or in contemplation of the filing of a petition by or against the debtor. (c) AUTHORIZED SOLICITATION. (1) A proxy may be solicited only by (A) a creditor owning an allowable unsecured claim against the estate on the date of the filing of the petition; (B) a committee elected pursuant to § 705 of the Code; (C) a committee of creditors selected by a majority in number and amount of claims of creditors (i) whose claims are not contingent or unliquidated, (ii) who are not disqualified from voting under § 702(a) of the Code and (iii) who were present or represented at a meeting of which all creditors having claims of over $500 or the 100 creditors having the largest claims had at least seven days’ notice in writing 27 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2006 and of which meeting written minutes were kept and are available reporting the names of the creditors present or represented and voting and the amounts of their claims; or (D) a bona fide trade or credit association, but such association may solicit only creditors who were its members or subscribers in good standing and had allowable unsecured claims on the date of the filing of the petition. (2) A proxy may be solicited only in writing. (d) SOLICITATION NOT AUTHORIZED. This rule does not permit solicitation (1) in any interest other than that of general creditors; (2) by or on behalf of any custodian; (3) by the interim trustee or by or on behalf of any entity not qualified to vote under § 702(a) of the Code; (4) by or on behalf of an attorney at law; or (5) by or on behalf of a transferee of a claim for collection only. (e) DATA REQUIRED FROM HOLDERS OF MULTIPLE PROXIES. At any time before the voting commences at any meeting of creditors pursuant to § 341(a) of the Code, or at any other time as the court may direct, a holder of two or more proxies shall file and transmit to the United States trustee a verified list of the proxies to be voted and a verified statement of the pertinent facts and circumstances in connection with the execution and delivery of each proxy, including: (1) a copy of the solicitation; (2) identification of the solicitor, the forwarder, if the forwarder is neither the solicitor nor the owner of the claim, and the proxyholder, including their connections with the debtor and with each other. If the solicitor, forwarder, or proxyholder is an association, there shall also be included a statement that the creditors whose claims have been solicited and the creditors whose claims are to be voted were members or subscribers in good standing and had allowable unsecured claims on the date of the filing of the petition. If the solicitor, forwarder, or proxyholder is a committee of creditors, the statement shall also set forth the date and place the committee was organized, that the committee was organized in accordance with clause (B) or (C) of paragraph (c)(1) of this rule, the members of the committee, the amounts of their claims, when the claims were acquired, the amounts paid therefor, and the extent to which the claims of the committee members are secured or entitled to priority; (3) a statement that no consideration has been paid or promised by the proxyholder for the proxy; (4) a statement as to whether there is any agreement and, if so, the particulars thereof, between the proxyholder and any other entity for the payment of any consideration in connection with voting the proxy, or for the sharing of compensation with any entity, other than a member or regular associate of the proxyholder’s law firm, which may be allowed the trustee or any entity for services rendered in the case, or for the employment of any person as attorney, accountant, appraiser, auctioneer, or other employee for the estate; (5) if the proxy was solicited by an entity other than the proxyholder, or forwarded to the holder by an entity who is neither a solicitor of the proxy nor the owner of the claim, a statement signed and verified by the solicitor or forwarder that no consideration has been paid or promised for the proxy, and whether there is any agreement, and, if so, the particulars thereof, between the solicitor or forwarder and any other entity for the payment of any consideration in connection with voting the proxy, or for sharing compensation with any entity other than a member or regular associate of the solicitor’s or forwarder’s law firm which may be allowed the trustee or any entity for services rendered in the case, or for the employment of any person as attorney, accountant, appraiser, auctioneer, or other employee for the estate; (6) if the solicitor, forwarder, or proxyholder is a committee, a statement signed and verified by each member as to the amount and source of any consideration paid or to be paid to such member in connection with the case other than by way of dividend on the member’s claim. (f) ENFORCEMENT OF RESTRICTIONS ON SOLICITATION. On motion of any party in interest or on its own initiative, the court may determine whether there has been a failure to comply with the provisions of this rule or any other impropriety in connection with the solicitation or voting of a proxy. After notice and a hearing the court may reject any proxy for cause, vacate any order entered in consequence of the voting of any proxy which should have been rejected, or take any other appropriate action. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2007. Review of Appointment of Creditors’ Committee Organized Before Commencement of the Case (a) MOTION TO REVIEW APPOINTMENT. If a committee appointed by the United States trustee pursuant to § 1102(a) of the Code consists of the members of a committee organized by creditors before the commencement of a chapter 9 or chapter 11 case, on motion of a party in interest and after a hearing on notice to the United States trustee and other entities as the court may direct, the court may determine whether the appointment of the committee satisfies the requirements of § 1102(b)(1) of the Code. (b) SELECTION OF MEMBERS OF COMMITTEE. The court may find that a committee organized by unsecured creditors before the commencement of a chapter 9 or chapter 11 case was fairly chosen if: (1) it was selected by a majority in number and amount of claims of unsecured creditors who may vote under § 702(a) of the Code and were present in person or represented at a meeting of which all creditors having unsecured claims of over $1,000 or the 100 unsecured creditors having the largest claims had at least seven days’ notice in writing, and of which meeting written minutes reporting the names of the creditors present or represented and voting and the amounts of their claims were kept and are available for inspection; (2) all proxies voted at the meeting for the elected committee were solicited pursuant to Rule 2006 and the lists and statements required by subdivision (e) thereof have been transmitted to the United States trustee; and (3) the organization of the committee was in all other respects fair and proper. 29 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2007.1 (c) FAILURE TO COMPLY WITH REQUIREMENTS FOR APPOINTMENT. After a hearing on notice pursuant to subdivision (a) of this rule, the court shall direct the United States trustee to vacate the appointment of the committee and may order other appropriate action if the court finds that such appointment failed to satisfy the requirements of § 1102(b)(1) of the Code. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2007.1. Appointment of Trustee or Examiner in a Chapter 11 Reorganization Case (a) ORDER TO APPOINT TRUSTEE OR EXAMINER. In a chapter 11 reorganization case, a motion for an order to appoint a trustee or an examiner under § 1104(a) or § 1104(c) of the Code shall be made in accordance with Rule 9014. (b) ELECTION OF TRUSTEE. (1) Request for an Election. A request to convene a meeting of creditors for the purpose of electing a trustee in a chapter 11 reorganization case shall be filed and transmitted to the United States trustee in accordance with Rule 5005 within the time prescribed by § 1104(b) of the Code. Pending court approval of the person elected, any person appointed by the United States trustee under § 1104(d) and approved in accordance with subdivision (c) of this rule shall serve as trustee. (2) Manner of Election and Notice. An election of a trustee under § 1104(b) of the Code shall be conducted in the manner provided in Rules 2003(b)(3) and 2006. Notice of the meeting of creditors convened under § 1104(b) shall be given as provided in Rule 2002. The United States trustee shall preside at the meeting. A proxy for the purpose of voting in the election may be solicited only by a committee of creditors appointed under § 1102 of the Code or by any other party entitled to solicit a proxy pursuant to Rule 2006. (3) Report of Election and Resolution of Disputes. (A) Report of Undisputed Election. If no dispute arises out of the election, the United States trustee shall promptly file a report certifying the election, including the name and address of the person elected and a statement that the election is undisputed. The report shall be accompanied by a verified statement of the person elected setting forth that person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (B) Dispute Arising Out of an Election. If a dispute arises out of an election, the United States trustee shall promptly file a report stating that the election is disputed, informing the court of the nature of the dispute, and listing the name and address of any candidate elected under any alternative presented by the dispute. The report shall be accompanied by a verified statement by each candidate elected under each alternative presented by the dispute, setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any Rule 2007.2 FEDERAL RULES OF BANKRUPTCY PROCEDURE 30 person employed in the office of the United States trustee. Not later than the date on which the report of the disputed election is filed, the United States trustee shall mail a copy of the report and each verified statement to any party in interest that has made a request to convene a meeting under § 1104(b) or to receive a copy of the report, and to any committee appointed under § 1102 of the Code. (c) APPROVAL OF APPOINTMENT. An order approving the appointment of a trustee or an examiner under § 1104(d) of the Code shall be made on application of the United States trustee. The application shall state the name of the person appointed and, to the best of the applicant’s knowledge, all the person’s connections with the debtor, creditors, any other parties in interest, their respective attorneys and accountants, the United States trustee, or persons employed in the office of the United States trustee. The application shall state the names of the parties in interest with whom the United States trustee consulted regarding the appointment. The application shall be accompanied by a verified statement of the person appointed setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (Added Apr. 30, 1991, eff. Aug. 1, 1991; amended Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 2007.2. Appointment of Patient Care Ombudsman in a Health Care Business Case (a) ORDER TO APPOINT PATIENT CARE OMBUDSMAN. In a chapter 7, chapter 9, or chapter 11 case in which the debtor is a health care business, the court shall order the appointment of a patient care ombudsman under § 333 of the Code, unless the court, on motion of the United States trustee or a party in interest filed no later than 21 days after the commencement of the case or within another time fixed by the court, finds that the appointment of a patient care ombudsman is not necessary under the specific circumstances of the case for the protection of patients. (b) MOTION FOR ORDER TO APPOINT OMBUDSMAN. If the court has found that the appointment of an ombudsman is not necessary, or has terminated the appointment, the court, on motion of the United States trustee or a party in interest, may order the appointment at a later time if it finds that the appointment has become necessary to protect patients. (c) NOTICE OF APPOINTMENT. If a patient care ombudsman is appointed under § 333, the United States trustee shall promptly file a notice of the appointment, including the name and address of the person appointed. Unless the person appointed is a State Long-Term Care Ombudsman, the notice shall be accompanied by a verified statement of the person appointed setting forth the person’s connections with the debtor, creditors, patients, any other party in interest, their respective attorneys and accountants, the United States trustee, and any person employed in the office of the United States trustee. (d) TERMINATION OF APPOINTMENT. On motion of the United States trustee or a party in interest, the court may terminate the 31 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2009 appointment of a patient care ombudsman if the court finds that the appointment is not necessary to protect patients. (e) MOTION. A motion under this rule shall be governed by Rule 9014. The motion shall be transmitted to the United States trustee and served on: the debtor; the trustee; any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, on the creditors included on the list filed under Rule 1007(d); and such other entities as the court may direct. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2008. Notice to Trustee of Selection The United States trustee shall immediately notify the person selected as trustee how to qualify and, if applicable, the amount of the trustee’s bond. A trustee that has filed a blanket bond pursuant to Rule 2010 and has been selected as trustee in a chapter 7, chapter 12, or chapter 13 case that does not notify the court and the United States trustee in writing of rejection of the office within seven days after receipt of notice of selection shall be deemed to have accepted the office. Any other person selected as trustee shall notify the court and the United States trustee in writing of acceptance of the office within seven days after receipt of notice of selection or shall be deemed to have rejected the office. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2009. Trustees for Estates When Joint Administration Ordered (a) ELECTION OF SINGLE TRUSTEE FOR ESTATES BEING JOINTLY ADMINISTERED. If the court orders a joint administration of two or more estates under Rule 1015(b), creditors may elect a single trustee for the estates being jointly administered, unless the case is under subchapter V of chapter 7 of the Code. (b) RIGHT OF CREDITORS TO ELECT SEPARATE TRUSTEE. Notwithstanding entry of an order for joint administration under Rule 1015(b), the creditors of any debtor may elect a separate trustee for the estate of the debtor as provided in § 702 of the Code, unless the case is under subchapter V of chapter 7. (c) APPOINTMENT OF TRUSTEES FOR ESTATES BEING JOINTLY ADMINISTERED. (1) Chapter 7 Liquidation Cases. Except in a case governed by subchapter V of chapter 7, the United States trustee may appoint one or more interim trustees for estates being jointly administered in chapter 7 cases. (2) Chapter 11 Reorganization Cases. If the appointment of a trustee is ordered, the United States trustee may appoint one or more trustees for estates being jointly administered in chapter 11 cases. (3) Chapter 12 Family Farmer’s Debt Adjustment Cases. The United States trustee may appoint one or more trustees for estates being jointly administered in chapter 12 cases. Rule 2010 FEDERAL RULES OF BANKRUPTCY PROCEDURE 32 (4) Chapter 13 Individual’s Debt Adjustment Cases. The United States trustee may appoint one or more trustees for estates being jointly administered in chapter 13 cases. (d) POTENTIAL CONFLICTS OF INTEREST. On a showing that creditors or equity security holders of the different estates will be prejudiced by conflicts of interest of a common trustee who has been elected or appointed, the court shall order the selection of separate trustees for estates being jointly administered. (e) SEPARATE ACCOUNTS. The trustee or trustees of estates being jointly administered shall keep separate accounts of the property and distribution of each estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 27, 2003, eff. Dec. 1, 2003.) Rule 2010. Qualification by Trustee; Proceeding on Bond (a) BLANKET BOND. The United States trustee may authorize a blanket bond in favor of the United States conditioned on the faithful performance of official duties by the trustee or trustees to cover (1) a person who qualifies as trustee in a number of cases, and (2) a number of trustees each of whom qualifies in a different case. (b) PROCEEDING ON BOND. A proceeding on the trustee’s bond may be brought by any party in interest in the name of the United States for the use of the entity injured by the breach of the condition. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2011. Evidence of Debtor in Possession or Qualification of Trustee (a) Whenever evidence is required that a debtor is a debtor in possession or that a trustee has qualified, the clerk may so certify and the certificate shall constitute conclusive evidence of that fact. (b) If a person elected or appointed as trustee does not qualify within the time prescribed by § 322(a) of the Code, the clerk shall so notify the court and the United States trustee. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2012. Substitution of Trustee or Successor Trustee; Accounting (a) TRUSTEE. If a trustee is appointed in a chapter 11 case or the debtor is removed as debtor in possession in a chapter 12 case, the trustee is substituted automatically for the debtor in possession as a party in any pending action, proceeding, or matter. (b) SUCCESSOR TRUSTEE. When a trustee dies, resigns, is removed, or otherwise ceases to hold office during the pendency of a case under the Code (1) the successor is automatically substituted as a party in any pending action, proceeding, or matter; and (2) the successor trustee shall prepare, file, and transmit to the United States trustee an accounting of the prior administration of the estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) 33 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2014 Rule 2013. Public Record of Compensation Awarded to Trustees, Examiners, and Professionals (a) RECORD TO BE KEPT. The clerk shall maintain a public record listing fees awarded by the court (1) to trustees and attorneys, accountants, appraisers, auctioneers and other professionals employed by trustees, and (2) to examiners. The record shall include the name and docket number of the case, the name of the individual or firm receiving the fee and the amount of the fee awarded. The record shall be maintained chronologically and shall be kept current and open to examination by the public without charge. ‘‘Trustees,’’ as used in this rule, does not include debtors in possession. (b) SUMMARY OF RECORD. At the close of each annual period, the clerk shall prepare a summary of the public record by individual or firm name, to reflect total fees awarded during the preceding year. The summary shall be open to examination by the public without charge. The clerk shall transmit a copy of the summary to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2014. Employment of Professional Persons (a) APPLICATION FOR AND ORDER OF EMPLOYMENT. An order approving the employment of attorneys, accountants, appraisers, auctioneers, agents, or other professionals pursuant to § 327, § 1103, or § 1114 of the Code shall be made only on application of the trustee or committee. The application shall be filed and, unless the case is a chapter 9 municipality case, a copy of the application shall be transmitted by the applicant to the United States trustee. The application shall state the specific facts showing the necessity for the employment, the name of the person to be employed, the reasons for the selection, the professional services to be rendered, any proposed arrangement for compensation, and, to the best of the applicant’s knowledge, all of the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. The application shall be accompanied by a verified statement of the person to be employed setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (b) SERVICES RENDERED BY MEMBER OR ASSOCIATE OF FIRM OF ATTORNEYS OR ACCOUNTANTS. If, under the Code and this rule, a law partnership or corporation is employed as an attorney, or an accounting partnership or corporation is employed as an accountant, or if a named attorney or accountant is employed, any partner, member, or regular associate of the partnership, corporation, or individual may act as attorney or accountant so employed, without further order of the court. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2015 FEDERAL RULES OF BANKRUPTCY PROCEDURE 34 Rule 2015. Duty to Keep Records, Make Reports, and Give Notice of Case or Change of Status (a) TRUSTEE OR DEBTOR IN POSSESSION. A trustee or debtor in possession shall: (1) in a chapter 7 liquidation case and, if the court directs, in a chapter 11 reorganization case file and transmit to the United States trustee a complete inventory of the property of the debtor within 30 days after qualifying as a trustee or debtor in possession, unless such an inventory has already been filed; (2) keep a record of receipts and the disposition of money and property received; (3) file the reports and summaries required by § 704(a)(8) of the Code, which shall include a statement, if payments are made to employees, of the amounts of deductions for all taxes required to be withheld or paid for and in behalf of employees and the place where these amounts are deposited; (4) as soon as possible after the commencement of the case, give notice of the case to every entity known to be holding money or property subject to withdrawal or order of the debtor, including every bank, savings or building and loan association, public utility company, and landlord with whom the debtor has a deposit, and to every insurance company which has issued a policy having a cash surrender value payable to the debtor, except that notice need not be given to any entity who has knowledge or has previously been notified of the case; (5) in a chapter 11 reorganization case, on or before the last day of the month after each calendar quarter during which there is a duty to pay fees under 28 U.S.C. § 1930(a)(6), file and transmit to the United States trustee a statement of any disbursements made during that quarter and of any fees payable under 28 U.S.C. § 1930(a)(6) for that quarter; and (6) in a chapter 11 small business case, unless the court, for cause, sets another reporting interval, file and transmit to the United States trustee for each calendar month after the order for relief, on the appropriate Official Form, the report required by § 308. If the order for relief is within the first 15 days of a calendar month, a report shall be filed for the portion of the month that follows the order for relief. If the order for relief is after the 15th day of a calendar month, the period for the remainder of the month shall be included in the report for the next calendar month. Each report shall be filed no later than 21 days after the last day of the calendar month following the month covered by the report. The obligation to file reports under this subparagraph terminates on the effective date of the plan, or conversion or dismissal of the case. (b) CHAPTER 12 TRUSTEE AND DEBTOR IN POSSESSION. In a chapter 12 family farmer’s debt adjustment case, the debtor in possession shall perform the duties prescribed in clauses (2)–(4) of subdivision (a) of this rule and, if the court directs, shall file and transmit to the United States trustee a complete inventory of the property of the debtor within the time fixed by the court. If the debtor is removed as debtor in possession, the trustee shall perform the duties of the debtor in possession prescribed in this paragraph. 35 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2015.1 (c) CHAPTER 13 TRUSTEE AND DEBTOR. (1) Business Cases. In a chapter 13 individual’s debt adjustment case, when the debtor is engaged in business, the debtor shall perform the duties prescribed by clauses (2)–(4) of subdivision (a) of this rule and, if the court directs, shall file and transmit to the United States trustee a complete inventory of the property of the debtor within the time fixed by the court. (2) Nonbusiness Cases. In a chapter 13 individual’s debt adjustment case, when the debtor is not engaged in business, the trustee shall perform the duties prescribed by clause (2) of subdivision (a) of this rule. (d) FOREIGN REPRESENTATIVE. In a case in which the court has granted recognition of a foreign proceeding under chapter 15, the foreign representative shall file any notice required under § 1518 of the Code within 14 days after the date when the representative becomes aware of the subsequent information. (e) TRANSMISSION OF REPORTS. In a chapter 11 case the court may direct that copies or summaries of annual reports and copies or summaries of other reports shall be mailed to the creditors, equity security holders, and indenture trustees. The court may also direct the publication of summaries of any such reports. A copy of every report or summary mailed or published pursuant to this subdivision shall be transmitted to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 29, 2002, eff. Dec. 1, 2002; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 23, 2012, eff. Dec. 1, 2012.) Rule 2015.1. Patient Care Ombudsman (a) REPORTS. A patient care ombudsman, at least 14 days before making a report under § 333(b)(2) of the Code, shall give notice that the report will be made to the court, unless the court orders otherwise. The notice shall be transmitted to the United States trustee, posted conspicuously at the health care facility that is the subject of the report, and served on: the debtor; the trustee; all patients; and any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, on the creditors included on the list filed under Rule 1007(d); and such other entities as the court may direct. The notice shall state the date and time when the report will be made, the manner in which the report will be made, and, if the report is in writing, the name, address, telephone number, email address, and website, if any, of the person from whom a copy of the report may be obtained at the debtor’s expense. (b) AUTHORIZATION TO REVIEW CONFIDENTIAL PATIENT RECORDS. A motion by a patient care ombudsman under § 333(c) to review confidential patient records shall be governed by Rule 9014, served on the patient and any family member or other contact person whose name and address have been given to the trustee or the debtor for the purpose of providing information regarding the patient’s health care, and transmitted to the United States trustee subject Rule 2015.2 FEDERAL RULES OF BANKRUPTCY PROCEDURE 36 to applicable nonbankruptcy law relating to patient privacy. Unless the court orders otherwise, a hearing on the motion may not be commenced earlier than 14 days after service of the motion. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2015.2. Transfer of Patient in Health Care Business Case Unless the court orders otherwise, if the debtor is a health care business, the trustee may not transfer a patient to another health care business under § 704(a)(12) of the Code unless the trustee gives at least 14 days’ notice of the transfer to the patient care ombudsman, if any, the patient, and any family member or other contact person whose name and address has been given to the trustee or the debtor for the purpose of providing information regarding the patient’s health care. The notice is subject to applicable nonbankruptcy law relating to patient privacy. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2015.3. Reports of Financial Information on Entities in Which a Chapter 11 Estate Holds a Controlling or Substantial Interest (a) REPORTING REQUIREMENT. In a chapter 11 case, the trustee or debtor in possession shall file periodic financial reports of the value, operations, and profitability of each entity that is not a publicly traded corporation or a debtor in a case under title 11, and in which the estate holds a substantial or controlling interest. The reports shall be prepared as prescribed by the appropriate Official Form, and shall be based upon the most recent information reasonably available to the trustee or debtor in possession. (b) TIME FOR FILING; SERVICE. The first report required by this rule shall be filed no later than seven days before the first date set for the meeting of creditors under § 341 of the Code. Subsequent reports shall be filed no less frequently than every six months thereafter, until the effective date of a plan or the case is dismissed or converted. Copies of the report shall be served on the United States trustee, any committee appointed under § 1102 of the Code, and any other party in interest that has filed a request therefor. (c) PRESUMPTION OF SUBSTANTIAL OR CONTROLLING INTEREST; JUDICIAL DETERMINATION. For purposes of this rule, an entity of which the estate controls or owns at least a 20 percent interest, shall be presumed to be an entity in which the estate has a substantial or controlling interest. An entity in which the estate controls or owns less than a 20 percent interest shall be presumed not to be an entity in which the estate has a substantial or controlling interest. Upon motion, the entity, any holder of an interest therein, the United States trustee, or any other party in interest may seek to rebut either presumption, and the court shall, after notice and a hearing, determine whether the estate’s interest in the entity is substantial or controlling. (d) MODIFICATION OF REPORTING REQUIREMENT. The court may, after notice and a hearing, vary the reporting requirement established by subdivision (a) of this rule for cause, including that the 37 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2016 trustee or debtor in possession is not able, after a good faith effort, to comply with those reporting requirements, or that the information required by subdivision (a) is publicly available. (e) NOTICE AND PROTECTIVE ORDERS. No later than 14 days before filing the first report required by this rule, the trustee or debtor in possession shall send notice to the entity in which the estate has a substantial or controlling interest, and to all holders— known to the trustee or debtor in possession—of an interest in that entity, that the trustee or debtor in possession expects to file and serve financial information relating to the entity in accordance with this rule. The entity in which the estate has a substantial or controlling interest, or a person holding an interest in that entity, may request protection of the information under § 107 of the Code. (f) EFFECT OF REQUEST. Unless the court orders otherwise, the pendency of a request under subdivisions (c), (d), or (e) of this rule shall not alter or stay the requirements of subdivision (a). (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2016. Compensation for Services Rendered and Reimbursement of Expenses (a) APPLICATION FOR COMPENSATION OR REIMBURSEMENT. An entity seeking interim or final compensation for services, or reimbursement of necessary expenses, from the estate shall file an application setting forth a detailed statement of (1) the services rendered, time expended and expenses incurred, and (2) the amounts requested. An application for compensation shall include a statement as to what payments have theretofore been made or promised to the applicant for services rendered or to be rendered in any capacity whatsoever in connection with the case, the source of the compensation so paid or promised, whether any compensation previously received has been shared and whether an agreement or understanding exists between the applicant and any other entity for the sharing of compensation received or to be received for services rendered in or in connection with the case, and the particulars of any sharing of compensation or agreement or understanding therefor, except that details of any agreement by the applicant for the sharing of compensation as a member or regular associate of a firm of lawyers or accountants shall not be required. The requirements of this subdivision shall apply to an application for compensation for services rendered by an attorney or accountant even though the application is filed by a creditor or other entity. Unless the case is a chapter 9 municipality case, the applicant shall transmit to the United States trustee a copy of the application. (b) DISCLOSURE OF COMPENSATION PAID OR PROMISED TO ATTORNEY FOR DEBTOR. Every attorney for a debtor, whether or not the attorney applies for compensation, shall file and transmit to the United States trustee within 14 days after the order for relief, or at another time as the court may direct, the statement required by § 329 of the Code including whether the attorney has shared or agreed to share the compensation with any other entity. The statement shall include the particulars of any such sharing or Rule 2017 FEDERAL RULES OF BANKRUPTCY PROCEDURE 38 agreement to share by the attorney, but the details of any agreement for the sharing of the compensation with a member or regular associate of the attorney’s law firm shall not be required. A supplemental statement shall be filed and transmitted to the United States trustee within 14 days after any payment or agreement not previously disclosed. (c) DISCLOSURE OF COMPENSATION PAID OR PROMISED TO BANKRUPTCY PETITION PREPARER. Before a petition is filed, every bankruptcy petition preparer for a debtor shall deliver to the debtor, the declaration under penalty of perjury required by § 110(h)(2). The declaration shall disclose any fee, and the source of any fee, received from or on behalf of the debtor within 12 months of the filing of the case and all unpaid fees charged to the debtor. The declaration shall also describe the services performed and documents prepared or caused to be prepared by the bankruptcy petition preparer. The declaration shall be filed with the petition. The petition preparer shall file a supplemental statement within 14 days after any payment or agreement not previously disclosed. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 27, 2003, eff. Dec. 1, 2003; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2017. Examination of Debtor’s Transactions with Debtor’s Attorney USER: According to the information provided, Rule 1004.2 in Chapter 15 Cases, who can file a motion for a determination that the debtor’s center of main interests is other than as stated in the petition for recognition commencing the Chapter 15 case, and when should this motion be filed? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	65	48	19,865	null	335
<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document]	I would like a policy analysis based on this article. I will need you to focus more on the EV parts so make sure to be more detailed on those.	The Canadian government is imposing a 100 per cent tariff on imports of Chinese-made electric vehicles (EVs), aluminum and steel. The announcement, made by Department of Finance Canada during the Liberal cabinet retreat in Halifax on Monday, follows a 30-day federal consultation period that began in July. The move reflects the government’s growing concerns over China’s trade practices in the EV sector. It aims to address issues related to unfair competition, labour and environmental standards and national security over data. “Canadian workers and critical sectors, including steel and aluminum…are facing an intentional, state-directed policy of overcapacity, undermining Canada’s ability to compete in domestic and global markets,” says Chrystia Freeland, deputy prime minister and minister of finance, in a statement. “That is why our government is moving forward with decisive action to level the playing field, protect Canadian workers, and match measures taken by key trading partners.” The tariffs will take effect on October 1. The EV-related tarrif will apply to a range of vehicles, including electric and certain hybrid passenger vehicles, trucks, buses and delivery vans. The new surtax will be added on top of the existing 6.1 per cent Most-Favoured Nation import tariff already in place for EVs produced in China. In addition to the tariffs on EVs, Canada is imposing a 25 per cent tariff on Chinese steel and aluminum. The government is also taking steps to limit the eligibility of Chinese-made EVs for federal incentives, such as the Incentives for Zero-Emission Vehicles, Medium- and Heavy-Duty Zero-Emission Vehicles, and the Zero-Emission Vehicle Infrastructure Program. Chinese-made cars in Canada The automakers likely to face the most immediate impact from the new EV tariff are Tesla and Polestar, both of which currently sell Chinese-made EVs in Canada. According to federal lobbyist registry documents, Tesla updated its lobbying goals in August (just days before the government’s announcement) to include efforts to “engage with government and provide guidance with regard to policy responses to China’s automotive trade practices, in an effort to protect Canada’s automotive sector, ensure electric vehicle affordability for Canadian consumers, and the achievement of Canada’s greenhouse gas reduction objectives.” (Latest data released by Transport Canada show that Tesla is leading in iZEV rebate claims, with 4,826 in May and a total of 20,293 claims in 2024, so far.) Another automaker that may face negative effects from the sanctions is China’s largest EV manufacturer, BYD. Earlier this month, lobbyist documents revealed BYD’s plans to enter the Canadian electric passenger vehicle market. The new tariffs will potentially complicate the company’s expansion plans here due to increased costs associated with importing Chinese-made vehicles. Elsewhere, BYD’s market strategy has already been influenced by tariffs. In May, the Biden Administration imposed a 100 per cent tariff on Chinese-made EVs, as well as tariffs on advanced batteries, solar cells, steel and aluminum. BYD’s Executive Vice President and CEO of BYD Americas, Stella Li, has previously stated that the company had no plans to enter the U.S. market because of political complications. Europe’s stance on Chinese-made EVs is similar to both Canada and U.S. Last week, the European Commission announced new tariff rates as part of an ongoing investigation into Chinese electric car subsidies. These tariffs, ranging from nine per cent to 36.3 per cent, are slightly lower than the initially proposed range of 17.4 per cent to 38.1 per cent in June. Mixed reactions The announcement of the new tariffs was positively welcomed by Canada’s auto industry and labour unions. “Given the highly integrated nature of the automotive industry across North America, alignment with the U.S. on the approach to China is fundamental to its continued success,” said Brian Kingston, president & CEO of the Canadian Vehicle Manufacturers’ Association, in a press statement. “With an upcoming review of the Canada-United States-Mexico Agreement in 2026 there is simply too much at stake for the automotive industry and the broader economy if Canada is misaligned.” Unifor, the largest private-sector union in Canada, also supports the tariffs, stressing the need to protect Canadian workers and build a forward-looking auto industry that provides “good union jobs” and “economic benefits.” “Canada can and must protect auto and manufacturing jobs here in this country, which thousands of workers rely on for their livelihoods,” said Unifor National president, Lana Payne. “There is no justification to trade away high-paying, high-skilled jobs for cheap high-carbon intensive vehicles built under deplorable working conditions. However, not all groups are in favour of tariffs. Clean Energy Canada raised concerns that the decision could lead to fewer affordable electric vehicles for Canadians, reduced competition and increased climate pollution. “Strong EV demand depends on building and offering EVs that Canadians want — and can afford. If Canadian EV sales drop as a result of the new measures, this might be used as a justification for cancelling, delaying, or downgrading EV ambitions and, ironically, further delaying the domestic production they’re meant to protect.” Clean Energy Canada suggests the federal government complement its trade measures with an EV affordability package, including extending the iZEV program until 2028, lowering the price cap on rebates to $50,000 to compel automakers to drop their EV prices below the cap and introducing rebates for used EVs. More consultations coming The federal government says it will review the tariffs on Chinese-made EVs, aluminum and steel within a year of implementation, with the possibility of extending the policy or introducing additional measures, if necessary. The Canadian government is also concerned that China’s non-market practices are jeopardizing other key sectors within Canada’s EV supply chain, including batteries, semiconductors, solar products and critical minerals. In 2023, China’s battery production alone was enough to meet global demand, according to BloombergNEF. The International Energy Agency reports that China dominates the processing of critical minerals and handles over half of the world’s lithium, cobalt, graphite and rare earth elements. Barclays projects that China’s semiconductor manufacturing capacity could more than double within five to seven years, potentially leading to market oversupply by 2026. In response to these developments, the Government of Canada is launching a second 30-day consultation focused on the vital sectors of batteries, semiconductors, solar products and critical minerals.	<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> I would like a policy analysis based on this article. I will need you to focus more on the EV parts so make sure to be more detailed on those. <TEXT> The Canadian government is imposing a 100 per cent tariff on imports of Chinese-made electric vehicles (EVs), aluminum and steel. The announcement, made by Department of Finance Canada during the Liberal cabinet retreat in Halifax on Monday, follows a 30-day federal consultation period that began in July. The move reflects the government’s growing concerns over China’s trade practices in the EV sector. It aims to address issues related to unfair competition, labour and environmental standards and national security over data. “Canadian workers and critical sectors, including steel and aluminum…are facing an intentional, state-directed policy of overcapacity, undermining Canada’s ability to compete in domestic and global markets,” says Chrystia Freeland, deputy prime minister and minister of finance, in a statement. “That is why our government is moving forward with decisive action to level the playing field, protect Canadian workers, and match measures taken by key trading partners.” The tariffs will take effect on October 1. The EV-related tarrif will apply to a range of vehicles, including electric and certain hybrid passenger vehicles, trucks, buses and delivery vans. The new surtax will be added on top of the existing 6.1 per cent Most-Favoured Nation import tariff already in place for EVs produced in China. In addition to the tariffs on EVs, Canada is imposing a 25 per cent tariff on Chinese steel and aluminum. The government is also taking steps to limit the eligibility of Chinese-made EVs for federal incentives, such as the Incentives for Zero-Emission Vehicles, Medium- and Heavy-Duty Zero-Emission Vehicles, and the Zero-Emission Vehicle Infrastructure Program. Chinese-made cars in Canada The automakers likely to face the most immediate impact from the new EV tariff are Tesla and Polestar, both of which currently sell Chinese-made EVs in Canada. According to federal lobbyist registry documents, Tesla updated its lobbying goals in August (just days before the government’s announcement) to include efforts to “engage with government and provide guidance with regard to policy responses to China’s automotive trade practices, in an effort to protect Canada’s automotive sector, ensure electric vehicle affordability for Canadian consumers, and the achievement of Canada’s greenhouse gas reduction objectives.” (Latest data released by Transport Canada show that Tesla is leading in iZEV rebate claims, with 4,826 in May and a total of 20,293 claims in 2024, so far.) Another automaker that may face negative effects from the sanctions is China’s largest EV manufacturer, BYD. Earlier this month, lobbyist documents revealed BYD’s plans to enter the Canadian electric passenger vehicle market. The new tariffs will potentially complicate the company’s expansion plans here due to increased costs associated with importing Chinese-made vehicles. Elsewhere, BYD’s market strategy has already been influenced by tariffs. In May, the Biden Administration imposed a 100 per cent tariff on Chinese-made EVs, as well as tariffs on advanced batteries, solar cells, steel and aluminum. BYD’s Executive Vice President and CEO of BYD Americas, Stella Li, has previously stated that the company had no plans to enter the U.S. market because of political complications. Europe’s stance on Chinese-made EVs is similar to both Canada and U.S. Last week, the European Commission announced new tariff rates as part of an ongoing investigation into Chinese electric car subsidies. These tariffs, ranging from nine per cent to 36.3 per cent, are slightly lower than the initially proposed range of 17.4 per cent to 38.1 per cent in June. Mixed reactions The announcement of the new tariffs was positively welcomed by Canada’s auto industry and labour unions. “Given the highly integrated nature of the automotive industry across North America, alignment with the U.S. on the approach to China is fundamental to its continued success,” said Brian Kingston, president & CEO of the Canadian Vehicle Manufacturers’ Association, in a press statement. “With an upcoming review of the Canada-United States-Mexico Agreement in 2026 there is simply too much at stake for the automotive industry and the broader economy if Canada is misaligned.” Unifor, the largest private-sector union in Canada, also supports the tariffs, stressing the need to protect Canadian workers and build a forward-looking auto industry that provides “good union jobs” and “economic benefits.” “Canada can and must protect auto and manufacturing jobs here in this country, which thousands of workers rely on for their livelihoods,” said Unifor National president, Lana Payne. “There is no justification to trade away high-paying, high-skilled jobs for cheap high-carbon intensive vehicles built under deplorable working conditions. However, not all groups are in favour of tariffs. Clean Energy Canada raised concerns that the decision could lead to fewer affordable electric vehicles for Canadians, reduced competition and increased climate pollution. “Strong EV demand depends on building and offering EVs that Canadians want — and can afford. If Canadian EV sales drop as a result of the new measures, this might be used as a justification for cancelling, delaying, or downgrading EV ambitions and, ironically, further delaying the domestic production they’re meant to protect.” Clean Energy Canada suggests the federal government complement its trade measures with an EV affordability package, including extending the iZEV program until 2028, lowering the price cap on rebates to $50,000 to compel automakers to drop their EV prices below the cap and introducing rebates for used EVs. More consultations coming The federal government says it will review the tariffs on Chinese-made EVs, aluminum and steel within a year of implementation, with the possibility of extending the policy or introducing additional measures, if necessary. The Canadian government is also concerned that China’s non-market practices are jeopardizing other key sectors within Canada’s EV supply chain, including batteries, semiconductors, solar products and critical minerals. In 2023, China’s battery production alone was enough to meet global demand, according to BloombergNEF. The International Energy Agency reports that China dominates the processing of critical minerals and handles over half of the world’s lithium, cobalt, graphite and rare earth elements. Barclays projects that China’s semiconductor manufacturing capacity could more than double within five to seven years, potentially leading to market oversupply by 2026. In response to these developments, the Government of Canada is launching a second 30-day consultation focused on the vital sectors of batteries, semiconductors, solar products and critical minerals. https://electricautonomy.ca/policy-regulations/2024-08-27/canada-imposes-tariffs-on-chinese-made-evs-aluminum-steel/	<TASK DESCRIPTION> Only use the provided text to answer the question, no outside sources. <QUESTION> [user request] <TEXT> [context document] EVIDENCE: The Canadian government is imposing a 100 per cent tariff on imports of Chinese-made electric vehicles (EVs), aluminum and steel. The announcement, made by Department of Finance Canada during the Liberal cabinet retreat in Halifax on Monday, follows a 30-day federal consultation period that began in July. The move reflects the government’s growing concerns over China’s trade practices in the EV sector. It aims to address issues related to unfair competition, labour and environmental standards and national security over data. “Canadian workers and critical sectors, including steel and aluminum…are facing an intentional, state-directed policy of overcapacity, undermining Canada’s ability to compete in domestic and global markets,” says Chrystia Freeland, deputy prime minister and minister of finance, in a statement. “That is why our government is moving forward with decisive action to level the playing field, protect Canadian workers, and match measures taken by key trading partners.” The tariffs will take effect on October 1. The EV-related tarrif will apply to a range of vehicles, including electric and certain hybrid passenger vehicles, trucks, buses and delivery vans. The new surtax will be added on top of the existing 6.1 per cent Most-Favoured Nation import tariff already in place for EVs produced in China. In addition to the tariffs on EVs, Canada is imposing a 25 per cent tariff on Chinese steel and aluminum. The government is also taking steps to limit the eligibility of Chinese-made EVs for federal incentives, such as the Incentives for Zero-Emission Vehicles, Medium- and Heavy-Duty Zero-Emission Vehicles, and the Zero-Emission Vehicle Infrastructure Program. Chinese-made cars in Canada The automakers likely to face the most immediate impact from the new EV tariff are Tesla and Polestar, both of which currently sell Chinese-made EVs in Canada. According to federal lobbyist registry documents, Tesla updated its lobbying goals in August (just days before the government’s announcement) to include efforts to “engage with government and provide guidance with regard to policy responses to China’s automotive trade practices, in an effort to protect Canada’s automotive sector, ensure electric vehicle affordability for Canadian consumers, and the achievement of Canada’s greenhouse gas reduction objectives.” (Latest data released by Transport Canada show that Tesla is leading in iZEV rebate claims, with 4,826 in May and a total of 20,293 claims in 2024, so far.) Another automaker that may face negative effects from the sanctions is China’s largest EV manufacturer, BYD. Earlier this month, lobbyist documents revealed BYD’s plans to enter the Canadian electric passenger vehicle market. The new tariffs will potentially complicate the company’s expansion plans here due to increased costs associated with importing Chinese-made vehicles. Elsewhere, BYD’s market strategy has already been influenced by tariffs. In May, the Biden Administration imposed a 100 per cent tariff on Chinese-made EVs, as well as tariffs on advanced batteries, solar cells, steel and aluminum. BYD’s Executive Vice President and CEO of BYD Americas, Stella Li, has previously stated that the company had no plans to enter the U.S. market because of political complications. Europe’s stance on Chinese-made EVs is similar to both Canada and U.S. Last week, the European Commission announced new tariff rates as part of an ongoing investigation into Chinese electric car subsidies. These tariffs, ranging from nine per cent to 36.3 per cent, are slightly lower than the initially proposed range of 17.4 per cent to 38.1 per cent in June. Mixed reactions The announcement of the new tariffs was positively welcomed by Canada’s auto industry and labour unions. “Given the highly integrated nature of the automotive industry across North America, alignment with the U.S. on the approach to China is fundamental to its continued success,” said Brian Kingston, president & CEO of the Canadian Vehicle Manufacturers’ Association, in a press statement. “With an upcoming review of the Canada-United States-Mexico Agreement in 2026 there is simply too much at stake for the automotive industry and the broader economy if Canada is misaligned.” Unifor, the largest private-sector union in Canada, also supports the tariffs, stressing the need to protect Canadian workers and build a forward-looking auto industry that provides “good union jobs” and “economic benefits.” “Canada can and must protect auto and manufacturing jobs here in this country, which thousands of workers rely on for their livelihoods,” said Unifor National president, Lana Payne. “There is no justification to trade away high-paying, high-skilled jobs for cheap high-carbon intensive vehicles built under deplorable working conditions. However, not all groups are in favour of tariffs. Clean Energy Canada raised concerns that the decision could lead to fewer affordable electric vehicles for Canadians, reduced competition and increased climate pollution. “Strong EV demand depends on building and offering EVs that Canadians want — and can afford. If Canadian EV sales drop as a result of the new measures, this might be used as a justification for cancelling, delaying, or downgrading EV ambitions and, ironically, further delaying the domestic production they’re meant to protect.” Clean Energy Canada suggests the federal government complement its trade measures with an EV affordability package, including extending the iZEV program until 2028, lowering the price cap on rebates to $50,000 to compel automakers to drop their EV prices below the cap and introducing rebates for used EVs. More consultations coming The federal government says it will review the tariffs on Chinese-made EVs, aluminum and steel within a year of implementation, with the possibility of extending the policy or introducing additional measures, if necessary. The Canadian government is also concerned that China’s non-market practices are jeopardizing other key sectors within Canada’s EV supply chain, including batteries, semiconductors, solar products and critical minerals. In 2023, China’s battery production alone was enough to meet global demand, according to BloombergNEF. The International Energy Agency reports that China dominates the processing of critical minerals and handles over half of the world’s lithium, cobalt, graphite and rare earth elements. Barclays projects that China’s semiconductor manufacturing capacity could more than double within five to seven years, potentially leading to market oversupply by 2026. In response to these developments, the Government of Canada is launching a second 30-day consultation focused on the vital sectors of batteries, semiconductors, solar products and critical minerals. USER: I would like a policy analysis based on this article. I will need you to focus more on the EV parts so make sure to be more detailed on those. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	20	30	1,018	null	458
Limit your response to a maximum of 100 words. You may only respond to the prompt using information provided in the context block. If possible, use figures or percentages in your arguments. Don't use the word "medicine".	Why is access to information important when dealing with health products?	15. The need for good governance is increasingly recognized as a major hurdle on the road to achieving universal health coverage. Weak governance complicates access to health products by fuelling inefficiencies, distorting competition and leaving the system vulnerable to undue influence, corruption, waste, fraud and abuse. Given the large role of health products in the provision of health care and the proportion of health spending they represent (as high as 60% for medicines in some countries),2 improving governance will help prevent the waste of public resources needed to sustain health systems and provide quality and affordable care. 16. There is a pressing need to improve access to timely, robust and relevant information concerning health products. Unbiased information that is free of any conflict of interest is vital for the sound selection, incorporation, prescription and use of health products. Transparency of this information is central to accountability, strengthens confidence in public institutions and improves the efficiency of the system. Activities in the road map address the transparency of clinical trials enabling support for clinical trial registries and address price transparency through the Market Information for Access to Vaccines (MI4A platform),3 for example. 17. The relationship between government and the private sector, such as pharmaceutical companies and medical device companies, requires particular attention. A question of growing importance is how to support governments to work effectively with the private sector and develop public policy while avoiding the risks of undue influence and maximizing benefits. WHO supports improving practices in both the public and private sectors to ensure that national policies reflect the central role of access to health products in achieving universal health coverage and in contributing to improved accountability.	system instruction: Limit your response to a maximum of 100 words. You may only respond to the prompt using information provided in the context block. If possible, use figures or percentages in your arguments. Don't use the word "medicine". question: Why is access to information important when dealing with health products? context block: [15. The need for good governance is increasingly recognized as a major hurdle on the road to achieving universal health coverage. Weak governance complicates access to health products by fuelling inefficiencies, distorting competition and leaving the system vulnerable to undue influence, corruption, waste, fraud and abuse. Given the large role of health products in the provision of health care and the proportion of health spending they represent (as high as 60% for medicines in some countries),2 improving governance will help prevent the waste of public resources needed to sustain health systems and provide quality and affordable care. 16. There is a pressing need to improve access to timely, robust and relevant information concerning health products. Unbiased information that is free of any conflict of interest is vital for the sound selection, incorporation, prescription and use of health products. Transparency of this information is central to accountability, strengthens confidence in public institutions and improves the efficiency of the system. Activities in the road map address the transparency of clinical trials enabling support for clinical trial registries and address price transparency through the Market Information for Access to Vaccines (MI4A platform),3 for example. 17. The relationship between government and the private sector, such as pharmaceutical companies and medical device companies, requires particular attention. A question of growing importance is how to support governments to work effectively with the private sector and develop public policy while avoiding the risks of undue influence and maximizing benefits. WHO supports improving practices in both the public and private sectors to ensure that national policies reflect the central role of access to health products in achieving universal health coverage and in contributing to improved accountability.]	Limit your response to a maximum of 100 words. You may only respond to the prompt using information provided in the context block. If possible, use figures or percentages in your arguments. Don't use the word "medicine". EVIDENCE: 15. The need for good governance is increasingly recognized as a major hurdle on the road to achieving universal health coverage. Weak governance complicates access to health products by fuelling inefficiencies, distorting competition and leaving the system vulnerable to undue influence, corruption, waste, fraud and abuse. Given the large role of health products in the provision of health care and the proportion of health spending they represent (as high as 60% for medicines in some countries),2 improving governance will help prevent the waste of public resources needed to sustain health systems and provide quality and affordable care. 16. There is a pressing need to improve access to timely, robust and relevant information concerning health products. Unbiased information that is free of any conflict of interest is vital for the sound selection, incorporation, prescription and use of health products. Transparency of this information is central to accountability, strengthens confidence in public institutions and improves the efficiency of the system. Activities in the road map address the transparency of clinical trials enabling support for clinical trial registries and address price transparency through the Market Information for Access to Vaccines (MI4A platform),3 for example. 17. The relationship between government and the private sector, such as pharmaceutical companies and medical device companies, requires particular attention. A question of growing importance is how to support governments to work effectively with the private sector and develop public policy while avoiding the risks of undue influence and maximizing benefits. WHO supports improving practices in both the public and private sectors to ensure that national policies reflect the central role of access to health products in achieving universal health coverage and in contributing to improved accountability. USER: Why is access to information important when dealing with health products? Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	37	11	278	null	223
You must only respond using information that is found in the provided context block. You must not use any other outside sources when forming an answer to the user's question. You may use markdown to format an answer.	Summarise how the laws are likely to impact these two groups.	Speech Rights of Adults Much of the material targeted by age verification laws is protected speech when accessed by adults. With respect to pornography, sexual content that depicts adults but is not legally obscene is protected speech with respect to adults even if it might qualify as speech “harmful to minors.” With respect to social media, the Supreme Court has recognized that social media enables individuals to “engage in a wide array of protected First Amendment activity.” A law may burden adult speech even if it specifically targets material accessed by minors. The Supreme Court’s decision in Reno struck down the Communications Decency Act (CDA) primarily on the basis that the law would impermissibly burden adult speech. The reasons for believing the CDA would burden adult speech may apply to contemporary age verification laws. The Reno court determined that the CDA’s ban on transmitting indecent material to minors would burden adult speech “in the absence of a viable age verification process,” because distributors of material would fear liability for transmitting material to minors. The Court also observed that a website operator’s decision to adopt age verification may block adults from lawful content if the adults lack material required for verification, such as a credit card. Lower courts have suggested that age verification may further burden adult speech by deterring adult users who are not willing to provide identifying information to access potentially embarrassing content. In a different context, the Supreme Court held that a requirement that cable television operators block sexual programming unless a viewer requests access to the programming in writing would “restrict viewing by [cable] subscribers who fear for their reputations” should their request be made public. Speech Rights of Minors Minors, like adults, possess free speech rights under the First Amendment. The Supreme Court has repeatedly held that, except in “relatively narrow and well-defined circumstances,” government has no more power to restrict speech for minors than it does for adults. Laws that target social media websites may fall outside these “narrow” circumstances. The Supreme Court has struck down other laws that attempted to restrict the dissemination of protected speech to minors, including laws involving violent video games and movies with nudity. Social media allows minors to access a broad array of protected speech, meaning a law restricting minors’ access to social media may have a greater impact on minors’ speech rights than narrower laws the Supreme Court has previously struck down. Pornography age verification laws may also impact minors’ access to constitutionally protected material. State laws that seek to mandate age verification for pornography often apply to “material harmful to minors,” a term that tracks the language used by the Supreme Court in Ginsberg v. New York and Miller v. California. Although the Supreme Court has upheld restrictions on physical distribution of material harmful to minors, federal appellate courts have raised issues with such restrictions as they might apply on the internet. For example, the Third Circuit held in multiple decisions that COPA’s definition of “material that is harmful to minors” was unconstitutionally vague and overbroad. The Miller definition of obscenity depends on whether “the average person, applying contemporary community standards” would find that the material in question “appeals to the prurient interest.” Definitions of material “harmful to minors” incorporate this language and specify that the question is whether someone “applying contemporary community standards” would find the material “appeals to the prurient interest” of minors. In cases that involve physical distribution of offensive material, the relevant “community standards” are those of the material’s recipient. The Third Circuit observed that applying a “contemporary community standards” requirement to internet communications, which are typically available worldwide, would subject all material on the internet to the standards of “the most puritanical communities.” The Supreme Court has not decided how to apply “contemporary community standards” to internet communications, beyond concluding that the use of “contemporary community standards” alone did not render COPA unconstitutional. Some Justices have expressed support for a nationwide Congressional Research Service 4 “community standard,” while other Justices have suggested that the standards should depend on where material is received, as is the case with laws that do not involve the internet.	System instruction: You must only respond using information that is found in the provided context block. You must not use any other outside sources when forming an answer to the user's question. You may use markdown to format an answer. question: Summarise how the laws are likely to impact these two groups. context: Speech Rights of Adults Much of the material targeted by age verification laws is protected speech when accessed by adults. With respect to pornography, sexual content that depicts adults but is not legally obscene is protected speech with respect to adults even if it might qualify as speech “harmful to minors.” With respect to social media, the Supreme Court has recognized that social media enables individuals to “engage in a wide array of protected First Amendment activity.” A law may burden adult speech even if it specifically targets material accessed by minors. The Supreme Court’s decision in Reno struck down the Communications Decency Act (CDA) primarily on the basis that the law would impermissibly burden adult speech. The reasons for believing the CDA would burden adult speech may apply to contemporary age verification laws. The Reno court determined that the CDA’s ban on transmitting indecent material to minors would burden adult speech “in the absence of a viable age verification process,” because distributors of material would fear liability for transmitting material to minors. The Court also observed that a website operator’s decision to adopt age verification may block adults from lawful content if the adults lack material required for verification, such as a credit card. Lower courts have suggested that age verification may further burden adult speech by deterring adult users who are not willing to provide identifying information to access potentially embarrassing content. In a different context, the Supreme Court held that a requirement that cable television operators block sexual programming unless a viewer requests access to the programming in writing would “restrict viewing by [cable] subscribers who fear for their reputations” should their request be made public. Speech Rights of Minors Minors, like adults, possess free speech rights under the First Amendment. The Supreme Court has repeatedly held that, except in “relatively narrow and well-defined circumstances,” government has no more power to restrict speech for minors than it does for adults. Laws that target social media websites may fall outside these “narrow” circumstances. The Supreme Court has struck down other laws that attempted to restrict the dissemination of protected speech to minors, including laws involving violent video games and movies with nudity. Social media allows minors to access a broad array of protected speech, meaning a law restricting minors’ access to social media may have a greater impact on minors’ speech rights than narrower laws the Supreme Court has previously struck down. Pornography age verification laws may also impact minors’ access to constitutionally protected material. State laws that seek to mandate age verification for pornography often apply to “material harmful to minors,” a term that tracks the language used by the Supreme Court in Ginsberg v. New York and Miller v. California. Although the Supreme Court has upheld restrictions on physical distribution of material harmful to minors, federal appellate courts have raised issues with such restrictions as they might apply on the internet. For example, the Third Circuit held in multiple decisions that COPA’s definition of “material that is harmful to minors” was unconstitutionally vague and overbroad. The Miller definition of obscenity depends on whether “the average person, applying contemporary community standards” would find that the material in question “appeals to the prurient interest.” Definitions of material “harmful to minors” incorporate this language and specify that the question is whether someone “applying contemporary community standards” would find the material “appeals to the prurient interest” of minors. In cases that involve physical distribution of offensive material, the relevant “community standards” are those of the material’s recipient. The Third Circuit observed that applying a “contemporary community standards” requirement to internet communications, which are typically available worldwide, would subject all material on the internet to the standards of “the most puritanical communities.” The Supreme Court has not decided how to apply “contemporary community standards” to internet communications, beyond concluding that the use of “contemporary community standards” alone did not render COPA unconstitutional. Some Justices have expressed support for a nationwide Congressional Research Service 4 “community standard,” while other Justices have suggested that the standards should depend on where material is received, as is the case with laws that do not involve the internet.	You must only respond using information that is found in the provided context block. You must not use any other outside sources when forming an answer to the user's question. You may use markdown to format an answer. EVIDENCE: Speech Rights of Adults Much of the material targeted by age verification laws is protected speech when accessed by adults. With respect to pornography, sexual content that depicts adults but is not legally obscene is protected speech with respect to adults even if it might qualify as speech “harmful to minors.” With respect to social media, the Supreme Court has recognized that social media enables individuals to “engage in a wide array of protected First Amendment activity.” A law may burden adult speech even if it specifically targets material accessed by minors. The Supreme Court’s decision in Reno struck down the Communications Decency Act (CDA) primarily on the basis that the law would impermissibly burden adult speech. The reasons for believing the CDA would burden adult speech may apply to contemporary age verification laws. The Reno court determined that the CDA’s ban on transmitting indecent material to minors would burden adult speech “in the absence of a viable age verification process,” because distributors of material would fear liability for transmitting material to minors. The Court also observed that a website operator’s decision to adopt age verification may block adults from lawful content if the adults lack material required for verification, such as a credit card. Lower courts have suggested that age verification may further burden adult speech by deterring adult users who are not willing to provide identifying information to access potentially embarrassing content. In a different context, the Supreme Court held that a requirement that cable television operators block sexual programming unless a viewer requests access to the programming in writing would “restrict viewing by [cable] subscribers who fear for their reputations” should their request be made public. Speech Rights of Minors Minors, like adults, possess free speech rights under the First Amendment. The Supreme Court has repeatedly held that, except in “relatively narrow and well-defined circumstances,” government has no more power to restrict speech for minors than it does for adults. Laws that target social media websites may fall outside these “narrow” circumstances. The Supreme Court has struck down other laws that attempted to restrict the dissemination of protected speech to minors, including laws involving violent video games and movies with nudity. Social media allows minors to access a broad array of protected speech, meaning a law restricting minors’ access to social media may have a greater impact on minors’ speech rights than narrower laws the Supreme Court has previously struck down. Pornography age verification laws may also impact minors’ access to constitutionally protected material. State laws that seek to mandate age verification for pornography often apply to “material harmful to minors,” a term that tracks the language used by the Supreme Court in Ginsberg v. New York and Miller v. California. Although the Supreme Court has upheld restrictions on physical distribution of material harmful to minors, federal appellate courts have raised issues with such restrictions as they might apply on the internet. For example, the Third Circuit held in multiple decisions that COPA’s definition of “material that is harmful to minors” was unconstitutionally vague and overbroad. The Miller definition of obscenity depends on whether “the average person, applying contemporary community standards” would find that the material in question “appeals to the prurient interest.” Definitions of material “harmful to minors” incorporate this language and specify that the question is whether someone “applying contemporary community standards” would find the material “appeals to the prurient interest” of minors. In cases that involve physical distribution of offensive material, the relevant “community standards” are those of the material’s recipient. The Third Circuit observed that applying a “contemporary community standards” requirement to internet communications, which are typically available worldwide, would subject all material on the internet to the standards of “the most puritanical communities.” The Supreme Court has not decided how to apply “contemporary community standards” to internet communications, beyond concluding that the use of “contemporary community standards” alone did not render COPA unconstitutional. Some Justices have expressed support for a nationwide Congressional Research Service 4 “community standard,” while other Justices have suggested that the standards should depend on where material is received, as is the case with laws that do not involve the internet. USER: Summarise how the laws are likely to impact these two groups. Assistant: Answer only using the evidence. If unknown, say you cannot answer. Cite sources.	false	38	11	692	null	797

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